Pulmonary Embolism

Question 1

Name some risk factors for PE/DVT

Answer 1

Pregnancy

Prolonged immobilisation

Previous VTE

Contraceptive pill

Long haul flights

Cancer

HF

Obesity

Surgery > 30mins

Hormone replacement therapy

Thrombophilia

Smoking

Question 2

Name some signs and symptoms of PE

Answer 2

Dyspnoea

Pleuritic chest pain

Cough

Substernal chest pain

Fever

Haemoptysis

Syncope

Unilateral leg pain

Tachycardia

Low BP

Raised JVP

Pleural rub in cases of pulmonary infarction

Question 3

What are the main differential diagnoses with PE

Answer 3

Pneumothorax

Pneumonia

Pleurisy

Musculoskeletal chest pain

MI

Pericarditis

Question 4

What investigations can be done for PE

Answer 4

Blood gases - look for hypoxaemia/hypocapnia

CXR - commonly find nothing

ECG

D-dimer - used for exclusion. Normal D-dimer rules out PE

Well’s criteria for PE

Imaging - CTPA

Question 5

What is the common ECG finding in patients with PE

Answer 5

Right ventricular strain:

• T-wave inversion in right precordial leads (V1-4 and inferior leads: II, III, aVF)

Classical finding is S_IQ_IIIT_III:

• Large S wave in V1
• Pathological Q wave in V3
• Inverted T wave in V3

Ccommon finding is tachycardia

Question 6

What is the Well’s criteria for PE

Answer 6

Well’s criteria is a set of criteria that is used for diagnostic probability of a patient having a PE

If score >4 then PE likely and imaging required

If score 0-4 then undergo blood tests for D-dimer - if +ve then further imaging required, if -ve then no further investigations required

Question 7

What is the treatment of PE

Answer 7

Oxygen

Heparinisation

Haemodynamic support

Respiratory support

Exogenous fibrinolytics

Percutaneous catheter directed thrombectomy

Surgical pulmonary embolectomy

Question 8

How does heparin work

Answer 8

Stops thromus propagation in pulmonary arteries and at embolic source

Allows fibrinolytic system to lyse thrombus

Decreases frequency of further thrombus

Does not dissolve clots, stops it getting bigger

Question 9

Following heparinisation, what should be given/done to patients to prevent another PE/DVT

Answer 9

Either:

• Give oral anticoagulant. If patient has identifiable risk factor then anticoagulant for 3mths, if no identifiable risk factor or cancer then give indefinitely
• Patients who cannot be anticoagulated, put an IVC filter in to prevent clots travelling up from leg