Pulmonary Embolism Flashcards
What is a pulmonary embolism (PE)?
Detached intravascular mass carried by blood to the lungs
How does a large PE present?
CVS schock
Low BP
Central cyanosis
Sudden death
How does a medium PE present?
Pleuritic pain
Haemotypsis
Breathlessness
How does a small (recurrent) PE present?
Progressive dyspnoea
Pulmonary hypertension
Right-sided Heart failure
What are risk factors for PE?
Thrombophilia Contraceptive pill Pregnancy Pelvic obstruction Trauma Surgery Immobility Malignancy Pulmonary hypertension or vasculitis Obesity
What makes up Virchow’s Triad?
Hypercoagulability. Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction
What are clinical features of PE?
Severe chest pain Breathlessness Haemoptysis Leg pain/swelling Cyanosis Fever Low BP Crackles Pleural Rub Tachycardia
What investigations can be performed?
D-dimer CTPA ECG Ultrasound V/Q scan
What does the D-dimer usually show?
Usually raised
What does the ECG usually show?
Acute right strain heart pattern
How do you treat PE?
Anticoagulation
What do you see on CXR?
Often normal
Wedge-shaped infarct
What does the V/Q scan usually show?
Perfusion defect before infarction
V/Q match defect after infarction
Which anticoagulation therapy can you give?
Low molecular weight heparin or Oral thrombin inhibitor (Dabigatran) or Factor X inhibitor (Rivaroxaban)
Oral warfarin
Thrombi-embolectomy (rarely)
Thrombolysis (tissue plasminogen activator - Tenecteplase) - only if life-threatening
How does warfarin act?
Antagonises vitamin K dependent prothrombin
