Pulmonary Embolism Flashcards
discuss PE
silent peril
embolism that forms elsewhere usually LE - DVT
travels to lung/heart
discuss DVT
thrombus formation in LE venous system - deep and superficial
what is VTE
venothromboembolism
DVT proceeding to PE
what is more common PE or DVT
DVT occurs 3 times more than PE
not all DVT will becone PE - 1/3 only
what causes VTE more, PE or DVT ?
PE more likely causes VTE than DVT alone
PE would cause more PEs
discuss post-phlebitic syndrome
late adverse effect of DVT - wks, mo to yrs
inflammation to venous valves of legs = regurgitation and edema
~ 2 hrs prolonged standing
- ankle and calf swelling
- skin ulcer
epidemiology of DVT
15% mortality rate
diff to detect and happens instantly
death rate inc c age
M=F
african-american
50% idiopathic
discuss pulmonary infarction
pleuritic chest pain - unremitting or wax/wane
- clot lodges in PA
hemoptysis - clot lodges in R&L PA
lodges in peripheral pulmo arterial tree
tissue infarc - 3-7 d p obstruction
fever
leukocytosis
elevated ESR
infarc evidence
discuss pulmonary infarction syndrome
caused by tiny peripheral PE
plueritic chest pain - lancinating and non responsive to meds
low grade fever
pleural rub
scant hemoptysis
leukocytosis
5 most common co-morbidities in PE
HTN
surgery within 3 mo
immob within 30 d
cancer
obesity
discuss PE with air travel
~ 20-30k above sea level - inc chance of DVT
dapat mag move, stretch and ankle pump q 2 hrs
discuss virchow’s triad
circulatory stasis - prolonged immob inc risk for thrombosis
endothelial injury - injury or inflammation to BV triggers clotting
hypercoagulable state - obese, DM, HTN higher risk for clot
cant perform clot if 1 of 3 is not present - need all 3
2 types of PE
inherited or primary - unusual
acquired or secondary- from conditions or lifestyle
major acquired risk factors for VTE
inc age
arterial disease
obesity
smoking
COPD
personal or family hx
recent surgery, trauma or immob
acute infection
air travel
cancer
hormone pills
pacemaker, catheters, defib leads
discuss inherited VTE
factor V leiden - protein C resistance
prothrombin gene mutation 20210
antithrombin III deficiency
protein C and S deficiency
discuss protein C and S
maintains blood in fluid form
discuss acquired VTE
antiphospholipid antibody syndrome - APAS
- like lupus
- miscarriage mothers
hyperhomocysteinemia - for homosustain
- high level inc chance of clots
discuss effect of PE in ventricular function
obstruction in PA causes inc RV afterload = R sided HF
R sided HF can lead to L sided HF
exp inc pulmonary vasucular resistance in PE
obstruction inc pressure
neurohormonal agents - baroreceptors detect = constrict
exp impaired gas exchange in PE
inc alveolar dead space - hypoxemia
exp alveolar hypervent in PE
reflex stim - sense low O2
urges to breathe faster
exp in airway resistance in PE
bronchoconstriction
exp dec pulmonary compliance in PE
lung edema
lung hemmorhage
loss of surfactant
usual clinical manifestations of small PE
dyspena - MC symptom
tachypnea - MC sign
pleuritic chest pain
usual clinical manifestations of massive PE
severe dyspnea
syncope
cyanosis
no chest pain
can die immed
signs PT should watch out for in PE
tachypnea
tachycardia
low grade fever
discuss clincial decision rule
> 4 - high prob
≤ 4 - non high prob
components of management in PE
anticoagulants - heparin and -aban
fibrinolysis - mga -ase
embolectomy - high risk pero mamatay na din naman
VC filter - prevent clot from going to heart/lung
primary and secondary prevention
predictors of inc mortality
sys BP less or equal to 100
older than 70 yo
more than 100 bpm
CHF
chronic lung disease
cancer
