General: PE

Question 1

Outline the pathophysiology of PE.

Answer 1

Blockage of the pulmonary artery by a substance that travelled in the bloodstream = thrombus from DVT

Abnormal blood flow = usually due to recent immobility, such as a long-distance flight or being bed-bound in hospital

Abnormal blood components = can be caused by multiple factors, such as smoking, sepsis, malignancy, or even inherited blood disorders (e.g. Factor V Leiden)

Abnormal vessel wall = can be from atheroma formation, inflammatory response, or direct trauma

Question 2

Outline the aetiology of PE.

Answer 2

DVT

R-sided mural thrombus (post-MI)

Atrial fibrillation (AF)

Neoplastic cells

Fat cells (tibial fracture)

Question 3

What are the signs and symptoms of PE?

Answer 3

Dyspnoea

Pleuritic chest pain

Cough

Haemoptysis

Tachycardia

Tachypnoea

Pyrexia

Pleural rub

Signs of DVT

Question 4

What are the risk factors of PE?

Answer 4

Increasing age

Previous VTE

Smoking

Pregnancy

Recent surgery = Especially abdominal, pelvic, hip, or knee

Prolonged immobility for >3 days

HRT

Oral Contraceptive Pill

Active malignancy

Obesity

Thrombophilia disorder.

Question 5

How would you investigate PE?

Answer 5

Wells score

• Score < 4 = PE clinically unlikely, requires a further D-dimer test to exclude
• Score > 4 = PE clinically likely and a PE diagnosis should be confirmed with a CT Pulmonary Angiography (CTPA) scan (or V/Q scan in those with poor renal function)
• ECG = rule out MI

Question 6

How would you manage PE?

Answer 6

Direct oral anticoagulants (DOACs) = apixaban, rivaroxaban

Vit K antagonist = warfarin (LMWH to cover until INR sufficiently therapeutic

LMWH = recommended in pts with cancer-associated VTE

Question 7

What are the complications of PE?

Answer 7

Death