pulmonary embolism

Question 1

PE etiology?

Answer 1

most commonly- DVT

others:
fat, air, amniotic fluid emboli

Question 2

risk factors?

Answer 2

venous stasis: immobility, HF, obesity
hypercoagulability state: pregnancy, OCP, smoking, coagulation disorders
endothelial injury: trauma, surgery, recent fx, previous DVT

Question 3

clinical features?

Answer 3

due to infarction and inflammation: SOB, pleuritic chest pain, hemoptysis

due to low O2: tachypnea, tachycardia

if saddle thrombus: raised JVP, syncope, shock, or death

Question 4

diagnosis?

Answer 4

-D-dimer (high sensitivity but nonspecific)
-CT angiography with contrast is gold standard diagnostic test
-chest xray showing wedge shaped infarct (hampton hump) with pleural effusion is pathognomonic for PE
-ECG will show tachycardia and S1Q3T3 (deep S in L1, Q wave in L3, inverted T wave in L3)

Question 5

management?

Answer 5

hemodynamically stable: thrombolytic therapy continued for 3-6 months. if high risk of bleeding then use IVC filter

hemodynamically unstable: thrombolytic therapy if contraindicated do embolectomy

types of thrombolytic therapy: LMWH/ fondaparinux for first 5-10 days. DOAC/warfarin used up to 3 months