PE case Flashcards
What are the risk factors for PE
What can cause it
DVT, currently or previously Immobilisation Malignancy Coagulopathy Oral contraceptives
Venous thrombus Tumour Fat Amniotic fluid Air Injected material
What are the signs and symptoms for PE
Pleuritic chest pain
-sharp, localized, worse on inspiration
What are the differentials for acute pleuritic pain
What are the differentials for slow onset pleuritic pain
Acute
- PT
- PE
Slow onset
- Pneumonia
- Cancer
What investigations would you order
What could you find
ECG (acute pulmonary HTN)
- sinus tachycardia
- RBBB
- R ventricular strain (T wave inversion in V1-4)
- Right axis deviation
- Dominant R wave in V1 (RV dilation)
- R atrial enlargement
- S1Q3T3
- tachyarrythmias
- non specific ST changes
CXR
- normal, rule out PT
- can find other features
How would you interpret the results of the Wells score
How would you manage from here on
Less than 4
- PE unlikely, D dimer
- if still likely, offer CTPA and interim DOAC (apixaban, rivaroxaban)
More than 4
- PE likely
- Offer CTPA and interim anticoagulation
Fibrinolytic for PE (alteplase)
What are the 2 complications of PE
Hypoxia
-VQ mismatch
RV failure
-pulmonary circulation normally has a large reserve => but if it all fills up, puts pressure on RV => CV collapse, cardiac arrest
What are the questions that you would ask in the Wells score
How would you score each of the 7 questions
Signs and symptoms of DVT = 3 Alternative diagnosis unlikely = 3 Tachycardia (100+) = 1.5 Immobilized for 3+ days/surgery in past month = 1.5 Past DVT/PE = 1.5 Haemoptysis = 1 Malignancy in the last 6 months = 1
How would you manage post discharge
Provoked VTE => 3months on DOAC
Unprovoked VTE => 6months on DOAC