Pulmonary Embolism

Question 1

What is the collective term for PE and DVT?

Answer 1

Venous thromboembolism (VTE)

Question 2

What are the risk factors for VTE?

Answer 2

• Active cancer
• Recent surgery
• Immobility
• Pregnancy
• Long haul flights
• Hormone therapy with oestrogen
• Haematological disorders, e.g. polycythaemia, thrombophilia

Question 3

What are the different types of VTE prophylaxis?

Answer 3

• Chemical, e.g. LMWH (such as enoxaparin or dalteparin)

- Mechanical, e.g. compression stockings

Question 4

Describe the clinical features of PE

Answer 4

• Dyspnoea
• Hypoxia
• Haemoptysis
• Pleuritic chest pain
• There may also be signs/symptoms of DVT

Question 5

Which scoring tool is used to predict the risk of a patient presenting with symptoms actually having a DVT or PE?

How are the results of the scoring tool interpreted?

Answer 5

• Wells score
• If score suggests DVT/PE likely, perform CTPA
• If score suggests DVT/PE unlikely, perform D-dimer and if positive then perform CTPA

Question 6

Describe the ECG findings associated with PE

Answer 6

• Sinus tachycardia (most common)
• Right ventricular strain pattern (T wave inversion in V1-V4 +/- the inferior leads)
• “S1Q3T3” pattern

Question 7

1) Describe the initial management of PE

2) How is this different for massive PE?

Answer 7

1) Treatment dose DOAC

2) Thrombolysis

Question 8

Following a PE, what are the options available for long term anticoagulation?

How long should anticoagulation be continued?

Answer 8

Options:

• Warfarin
• DOAC
• LMWH (first line in pregnancy or cancer)

How long treatment is continued:

• 3 months if there is an obvious reversible cause (then review)
• > 3 months if the cause is unclear, there is recurrent VTE or the cause is irreversible (this is often 6 months in practice)
• 6 months in active cancer (then review)