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Cancer > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

Define Pulmonary Embolism?

A

Occlusion of pulmonary vessels, most commonly by a thrombus that has travelled to the pulmonary vascular system from another site

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2
Q

What is the aetiology of Pulmonary Embolism?

A

Thrombus
95% arise from DVT in the lower limbs
Rarely arises in the right atrium (in AF patients)

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3
Q

What are some other causes of embolus?

A 
Amniotic Fluid 
Air 
Fat 
Tumour 
Mycotic
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4
Q

What are the risk factors for PE?

A 
Surgical patients 
Immobility 
Obesity 
OCP
Heart Failure 
Malignancy
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5
Q

What is the epidemiology of Pulmonary Embolism?

A 
Relatively common (especially in hospitalised patients)
Occur in 10-20% of patients with confirmed proximal DVT
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6
Q

What does the presenting symptoms of Pulmonary Embolism depend on?

A

Site and Size of the embolus

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7
Q

What are the presenting symptoms of a small Pulmonary Embolism?

A

May be asymptomatic

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8
Q

What are the presenting symptoms of a moderate Pulmonary Embolism?

A

Sudden-onset SOB
Cough
Haemoptysis
Pleuritic Chest Pain

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9
Q

What are the presenting symptoms of a large (or proximal) Pulmonary Embolism?

A 
Same as moderate and:
Severe central pleuritic chest pain
Shock
Collapse 
Acute Right Heart Failure
Sudden Death
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10
Q

What are the presenting symptoms of Multiple Small Recurrent Pulmonary Embolisms?

A

Symptoms of pulmonary hypertension

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11
Q

How can the severity of a Pulmonary Embolism be assessed?

A

Based on associated signs

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12
Q

What are the signs of a small Pulmonary Embolism on physical examination?

A

Often no clinical signs

There may be some tachycardia and tachypnoea

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13
Q

What are the signs of a moderate Pulmonary Embolism on physical examination?

A

Tachypnoea
Tachycardia
Pleural rub
Low O2 saturation (despite O2 supplementation)

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14
Q

What are the signs of a massive Pulmonary Embolism on physical examinaton?

A

Shock
Cyanosis
Signs of right heart strain

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15
Q

What are the signs of right heart strain?

A

Raised JVP
Left parasternal heave
Accentuated S2 heart sound

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16
Q

What are the signs of Multiple Recurrent Pulmonary Embolism on physical examination?

A

Signs of pulmonary hypertension

Signs of RH failure

17
Q

How do you determine the best investigation for Pulmonary Embolism?

A

Well’s Score

18
Q

How is the Well’s Score used?

A 
Low Probability (Wells 4 or less) - Use D-Dimer
High Probability (Wells > 4) - required imaging (CTPA)
19
Q

What bloods would you do for a Pulmonary Embolism?

A

ABG

Thrombophilia screen

20
Q

What might you see on an ECG in Pulmonary Embolism?

A

May be normal
May show tachycardia, right axis deviation or RBBB
May show S1Q3T3 pattern

21
Q

Why do we do a CXR for Pulmonary Embolism?

A

Often normal but helps exclude other diagnoses

22
Q

How do we use Spiral CT Pulmonary Angiogram in Pulmonary Embolism?

A

First Line Investigation
Poor sensitivity for small emboli
Very sensitive for medium to large emboli

23
Q

How do we use Ventilation-Perfusion (VQ) scan in Pulmonary Embolism?

A

Identifies areas of ventilation and perfusion mismatch which would indicate an area of infarcted lung

24
Q

Why do we not use Pulmonary Angiogram for Pulmonary Embolism?

A

Invasive

Rarely necessary

25
Q

Why do we use Doppler US of Lower Limb in Pulmonary Embolism?

A

Allows assessment of venous thromboembolism

26
Q

What might you see on Echocardiography on Pulmonary Embolism?

A

May show right heart strain

27
Q

What is the primary prevention of Pulmonary Embolism?

A

Compression Stockings
Heparin prophylaxis for those at risk
Good mobilisation and adequate hydration

28
Q

What do we do if a patient with Pulmonary Embolism is haemodynamically stable?

A 
O2 
Anticoagulation with heparin or LMWH
Switch over to oral warfarin for at least 3 months 
Maintain INR 2-3
Analgesia
29
Q

What do we do if a patient with Pulmonary Embolism is haemodynamically unstable (massive PE)?

A

Resuscitate
O2
IV fluids
Thrombolysis with tPA may be considered if cardiac arrest is imminent

30
Q

What is the surgical and radiological management of Pulmonary Embolism?

A

Embolectomy
IVC filters - sometimes used for recurrent PEs despite adequate anticoagulation or when anticoagulation is contraindicated

31
Q

What are the possible complications of Pulmonary Embolism?

A

Death
Pulmonary Infarction
Pulmonary Hypertension
Right Heart Failure

32
Q

What is the prognosis for patients with Pulmonary Embolism?

A

30% mortality in those left untreated
8% mortality with treatment
Increased risk of future thromboembolic disease

Cancer (27 decks)

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