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Pulmonary > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What is the underlying cause of PE?

A

deep vein thrombosis

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2
Q

What two factors influence the morbidity and mortality of PE the most?

A

embolism size

cardiopulmonary status

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3
Q

Describe the main pathophysiology behind a pulmonary embolism.

A

increased pulmonary vascular resistance

right ventricle pressure and volume overload

decreased RV function and right coronary perfusion, RV wall ischemia

RV dilatation shifts the interventricular septum and decreases LV preload

decreased cardiac output and hypotension

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4
Q

What are some of the other pathophysiologic manifestations of PE outside of the main pathway.

A

hypoxemia and increased Aa O2 gradient caused by VQ mismatching from ventilation in poorly perfused capillaries and increased airway resistance

increased PVR and pulmonary hypertension due to vascular obstruction and vasoconstriction from vasoactive mediators

alveolar hyperventilation due to irritant receptor reflex stimulation and decreased O2 delivery

increased airway resitance due to bronchiolar constriction

decreased pulmonary compliance due to loss of surfactant, lung edema, or lung hemorrhage

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5
Q

Virchow’s Triad

A

risk factors for pulmonary embolism

1) hypercoagulable
2) stasis
3) trauma

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6
Q

factors that can contribute to a hypercoagulable state

A

factor V mutation

prothrombin mutation

decreased antithrombine III, protein C, or protein S

cancer

antiphospholipid syndrome

hyperhomocysteinemia

hormonal Rx (BCP)

heparin-induced thrombocytopenia

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7
Q

factors that contribute to stasis

A

travel

immobility

pregnancy

morbid obesity

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8
Q

factors that suggest a genetic predisposition to PE

A

Family history of PE, DVT, or sudden death

Unrecognized PE/DVT risk factors in a patient with new DVT or PE

Recurrent PE/DVT

Young age

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9
Q

What are some of the common symptoms of PE?

A

chest pain

dyspnea

cough

hemoptysis

syncope

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10
Q

common signs of PE

A

RR > 16/min

loud P2

pulse > 100/min

T > 37.8 C

phlebitis / DVT

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11
Q

clinical syndromes commonly found with PE

A

pleuritic chest pain +/- hemoptysis

unexplained dyspnea

shock / loss of consciousness

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12
Q

ECG findings in PE

A

normal

sinus tachycardia

atrial arrhythmia

RV strain - RBBB, P pulmonale, S1Q3T3

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13
Q

S1Q3T3

A

a prominent finding in ECGs of some PE patients

includes a prominent S wave in lead 1, a prominent Q wave in lead 3, and inverted T waves in lead 3

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14
Q

common chest x-ray findings in PE

A

normal

small pleural effusions

atelectais/infiltrate

Westermark’s Sign

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15
Q

Wstermark’s sign

A

a prominent pulmonary artery with distal oligemia

specifictiy is 90%

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16
Q

What do arterial blood gases typically reveal in patients with PE

A

acute respiratory alkalosis and hypoxemia

increased AaO2 gradient due to V/Q mismatching

17
Q

Wells Clinical Prediction Score

A

= 4 PE unlikely

> 4 PE likely

scoring system:

  • DVT signs/ symptoms - 3
  • HR > 100/min - 1.5
  • Hemoptysis - 1
  • Cancer - 1
  • PE >/= aternative Dx - 3
  • immobilization - 1.5
  • previous DVT/PE - 1.5
18
Q

D-Dimer test

A

D-dimers are elevated as a result of an activated fibrinolytic system

a low serum D-Dimer (<500ug/L by ELISA) has a negative predictive value of 97% in patients with low clinical suspicion

19
Q

When is the D-Dimer test not useful?

A

when the patient has/had

cancer

recent surgery

liver disease

high clinical suspicion (Wells Score > 4)

20
Q

ventilation perfusion scan

A

looks for VQ mismatch

less than 2% of patients with PE will have a normal VQ (%14)

21
Q

diagnostic test for PE

A

D-Dimer

VQ scan

chest CT angiogra

Duplex ultrasound

22
Q

management of PE/DVT

A

supportive therapy

anticoagulation

thrombolysis

23
Q

supportive management for pulmonary embolism

A

pulmonary hypertension and hypotension - treat with fluids and rarely vasopressors

VQ mismatching - treat with supplemental O2, bronchodilators, and rarely mechanical ventilation

24
Q

DVT/PD prophylaxis

A

moderate risk - heparin twice daily - LMWH, fondparinux, or pneumatic calf compression if needed

high risk - 10-14d LMWH, fondaparinux, apixiban, dabigatran, low-dose unfractionated heparin, warfarin, aspirin, or intermitten calf compression

25
Q

advantages of thrombolysis for acute PE over heparin

A

Pulmonary (37 decks)

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