Pulmonary Embolism

Question 1

Pulmonary Embolism

Answer 1

Thrombus forms in the venous system of the deep veins in legs (usually) and travels to the pulmonary arteries.

Question 2

What causes a thrombus?

Answer 2

Blood clots because it is stagnant - then thrombus forms which can occlude an artery/vein.
If a thrombus breaks, that is called an embolus. This can travel in the body - to brain (to cause a stroke) or lungs

Question 3

Aetiology

Answer 3

Main thing is that embolus is formed usually when the person is not moving their legs - most common site is thrombus in the legs. The venous circulation is not encouraged.
Recent major trauma
Recent surgery - sedentarism
Cancer
Significant cardiopulmonary disease e.g. MI
Pregnancy- foetus pressing on major abdominal veins

Question 4

Symptoms

Answer 4

Pleuritic chest pain
Cough
Haemoptysis
Dyspnoea
Syncope or cardiac arrest (in massive PE)

Question 5

Clinical signs

Answer 5

Pyrexia
Pleural rub
Dullness percussion at base (pleural effusion)
Tachycardia
Tachypnoea
Hypoxia

Question 6

Investigations

Answer 6

Wells score - symptoms, signs of VTE, previous VTE
Revised Geneva Score - based on risk factors, symptoms, signs
FBC - such as troponin which is an indicator of myocardial infarction - myocytes dying
CXR, CT
ECG
D-dimer
CT Pulmonary Angiogram (CTPA)
V/Q scan
Echocardiography- strain on the right ventricle. If there is, more at risk of death

Question 7

What is a D-dimer?

Answer 7

Product of coagulation

If negative then it means there has been no clotting

Question 8

Treatment

Answer 8

Oxygen - if necessary
Low molecular weight heparin e.g. dalteparin
Warfarin- anticoagulant
Direct Oral Anticoagulants (DOAC)- rivaroxaban, apixaban
Thrombolysis
Pulmonary Embolectomy- operation