Pulmonary embolism Flashcards

1
Q

What is the definition of a PE?

A

A portion of a blood clot that has lodged into a pulmonary vein
MEDICAL EMERGENCY

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2
Q

How common is a PE?

A

Incidence of VTW is from 1-1.5/1000 person years

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3
Q

What is the pathology of a PE?

A
  • Usually arise from thrombi in the iliofemoral veins (DVT)
  • Rarely PE results from clot formation in the right heart
  • Clot obstructions the right ventricular outflow tract
  • = sudden ↑ in pulmonary vascular resistance
  • Causes acute right heart failure
  • Lung tissue is ventilated but not perfused
  • Risk of developing clots is based on Virchow’s triangle
  • ↑ coagulability
  • ↓ mobility
  • Blood vessel abnormality
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4
Q

What are the risk factors/aetiology of a PE?

A
  • Pregnancy
  • Recent surgery/hospitalisation
  • Varicose veins
  • Malignancy
  • Previous VTE
  • Hypertension
  • Congenital heart disease
  • Congestive heart failure
  • OCT/HRT
  • Haematological disorders
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5
Q

What are the signs/symptoms of a PE?

A
  • Small/medium PE’s
  • Breathlessness
  • Pleuritic chest pain
  • Haemoptysis
  • Tachyponoeic
  • Pleural rub
  • Exudative pleural effusion – occasionally bloodstained
  • Massive PE
  • Severe central chest pain
  • Sudden shock – pale, sweaty, tachypnoea, tachycardia
  • Syncope
  • Death
  • Central cyanosis
  • ↑ JVP
  • Right ventricular heave
  • Accentuation of the 2nd heart sound
  • Gallop rhythm (abnormal rhythm, 3 or 4 beats) – acute right hearted failure
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6
Q

What investigations would be conducted for a suspected PE?

A
  • Geneva score – predicts likelihood of PE
  • CXR
  • ↓ vascular markings
  • ↑ hemidiaphragm
  • Wedge shaped opacity adjacent to the pleural edge
  • Pleural effusion sometimes
  • ECG
  • Sinus tachycardia
  • New onset AF
  • Tall peaked T waves in Lead II
  • Right axis deviation
  • Right bundle branch block
  • Blood gases
  • D- dimer
  • CTPA
  • V/Q scan
  • Echocardiogram
  • Doppler
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7
Q

What are the surgical treatments for a PE?

A
  • Surgical embolectomy

* Insertion of vena caval filter – used to prevent further emboli

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8
Q

What are the pharmacological treatments for a PE?

A
  • High flow O2
  • Thrombolysis e.g. LMWH
  • Analgesia e.g. morphine
  • Warfarin/LMWH – prevent further PE’s
  • IV fluids
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