PE Flashcards
What is a PE
Blockage of the pulmonary arteries in the lung, typically arising from DVT or other VTE, or can be thrombogenic in the lungs themselves
What are the risk factors for PE (CT Sil Vous Plait)
- C: Cancer, COPD, Cardiac failure
- T: Trauma, Time (age), Travel (long haul flight)
- S: Stasis/Surgery
- V: Varicose veins, Virchow’s triad
- P: Pill (OCP), Pregnancy, Polycythemia, Previous VTE
How can PE cause stroke
If there is ASD or PFO, thrombus from the right side of the heart e.g. VTE can travel into left side and therefore embolise to the brain
How does PE present
- Pleuritic chest pain
- SOB
- Haemoptysis
- Tachycardia
- Tachypnoea
- Chest will typically be clear however clinically may hear crackles
What does ECG show in PE
- Sinus tachycardia = most common finding
- S1Q3T3 = sensitive but rare finding
What does CXR show in PE
- Typically doesn’t show anything
- May see Westermark sign (shadowing due to occlusion of artery)
- May see Hampton Hump (wedge shaped opacification)
What do we use to assess likelihood of PE
2-level Well’s Score:
- Previous VTE (1.5)
- Evidence of DVT (3)
- Stasis (1.5)
- Cancer (1)
- Opinion is PE (3)
- Racing heart > 100 bpm (1.5)
- Exsanguination (haemoptysis) (1)
> 4 = PE likely
≤ 4 = PE unlikely
Wells > 4
Immediate CTPA with interim anticoagulation
Wells ≤ 4
D-Dimer - give interim anticoagulation if cannot be done within 4 hours
Wells > 4 CTPA positive
PE diagnosed - anticoagulate
Wells > 4 CTPA negative
Consider proximal leg USS if DVT suspected
Wells ≤ 4 D dimer positive
CTPA with interim anticoagulation
Wells ≤ 4 D dimer negative
Consider alternative diagnosis
PE management in stable patients
- DOACs - 3 months if provoked (RFs present), 6 months if unprovoked (no RFs)
- 2nd line = LMWH
- Consider IVC filter if recurrent
PE management with haemodynamic instability
Thrombolysis e.g. IV Alteplase
