Pulmonary circulation disorders: PE and PHT Flashcards
What is PE ?
It is the oclussion of the pulmonary arterial blood flow due to thrombosis of the pulmonary artery branches. The most common thrombus are blood clots and rarely an embolus formed by tumor segments, air or fat can cause PE.
What is the most common source of PE ?
DVT
What are the risk factors for PE ?
- Immobilization (Classically prolonged flight >8hrs)
- Malignancy
- Surgery within 3 months
- Obesity
- OCP / Hormone replacement therapy
- Thrombophilia (genetic risk factor)
- Central venous lines
- Anti-phospholipid syndrome
- Inflammatory bowel disease
What are the symptoms of PE ?
- Abrupt onset of dyspnea, lateral > central pleuritic chest pain.
- Hemoptysis
- Pre-Syncope or syncope.
What are the symptoms of DVT ?
It is always unilateral
-Lower limb swelling
– Lower limb pain
– Red or darkened skin over the area
– Warm skin around the affected area
What are the signs of PE ?
- Tachypnoea
- Tachycardia
- Hypotension
- Loud 2nd pulmonary heart sound.
What are the ddx of PE ?
- Pneumothorax
- Pneumonia
- Acute coronary syndrome
- Musculoskeletal pain
- Cardiac arrythmia
- Acute pulmonary oedema
- Acute exacerbation of COPD
- Pericarditis
What is the method to make a definitive Dx of PE ?
A CTPA involves injection of intravenous contrast to look for flow voids in the pulmonary arterial tree.
What is the bedside Dx test for DVT ?
Doppler US.
What is the utility of Wells score in PE ?
- Low risk < 2 points
- Intermediate risk: 2 to 6 points
- High risk > 6 points.
- Less than 4 indicates PE unlikely and greater than 4 indicates PE likely.
What is the approach to a patient with < 4 on wells score ?
First step: Check D-Dimer
If D-dimer is < 500 ng/ml, PE ruled out.
If it is greater than > 500 ng/ml CTPA to rule out or rule in PE.
What is the approach to a patient with > 4 on wells score ?
CTPA to rule out or rule in PE.
What is mcconnell sign on ECO in acute PE ?
McConnell’s sign is defined as right ventricular free wall akinesis with sparing of the apex. Typically this looks as if the apex of the RV is a trampoline bouncing up and down while the rest of the RV remains still. This finding is not sensitive, but in a small study was specific for an acute PE.
What are the reliable ECG findings in pulmonary embolism ?
- Sinus tachycardia
- Right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). This pattern is associated with high pulmonary artery pressures (34%).
- Non-specific ST segment and T wave changes, including ST elevation and depression (50%)
What is the management of unstable PE ?
PE causing persistent hypotension (<90/60mmHg)should be treated with immediate systemic thrombolysis using Alteplase.
Thrombectomy can be done by an interventional cardiologist.
