- A blockage of the pulmonary artery, often caused by thrombo-embolism of a DVT.
- Causes obstructed bloodflow through lungs and causes back up of blood. This puts pressure on the R-heart and this produces the symptoms of PE (RHF picture) – eventually leading to cor pulmonale over time.
- 15% of all DVTs become PEs
- Dyspnoea and course crackles
- Chest pain on inspiration
- Heart palpitations
- Pleural rub
- Tachypnoea / tachycardia
- L-parasternal heave
- Low grade fever
- Raised JVP
- Sudden death
- Clinical suspicion findings
- CT pulmonary angiography (CTPA)
- Elevated D-dimer (not overly reliable – reports fibrin degradation – not specific)
- CXR / USS
- ECG – may show a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III (“S1Q3T3) as well as a sinus tachycardia
- Cancer (prothrombotic state)
- Extended bed rest (post-op) / immobilised legs (plaster cast)
- Long haul flights (economy syndrome)
- Genetic thrombophilia (FH of VTE)
- Acquired thrombophilia
- HRT / OCP and oestrogen containing meds
- Mechanical valve/stents/joint replacments
- Blockage of main pulmonary artery leading to a poor pulmonary blood supply = VPI
Hereditary? Infective? How does it spread?
Treatment and management (conservative/medical/surgical)
- Treatment is typically with anticoagulant medication, including heparin and warfarin. Severe cases may require thrombolysis with drugs (…plase) such as tissue plasminogen activator (tPA) / streptokinase, or may require surgical intervention via pulmonary thrombectomy / embolectomy.
Untreated PE mortality is 26%