Pulmonary Embolism by Kinder - SRS Flashcards
What is the definition of a pulmonary embolism?
obstruction of a pulmonary artery by material that has traveled to the lungs from elsewhere in the body through the blood stream.
List as many sources of pulmonary emboli as you can
- venous thromboembolism
- fat
- amniotic fluid
- air
- tumor cells
- talc in venous drug users
- medical devices
Venous thromboembolism is the third most common cause of cardiovascular death after MI and stroke. What percent of these patients present with no risk factors and are classified as unprovoked attacks?
1/2
What are the risk factors for VTE?
- Advanced age
- history of previous VTE
- Obesity
- active cancer
- Surgery
- pregnancy
- immobilization
- estrogen therapy
What are the components of virchow’s triad?
Stasis
Vascular damage
hypercoagulability
What are some examples of hypercoaguble states?
- Factor V Leiden
- Prothrombin 20120 gene mutation
- Antithrombin deficiency
- protein C deficiency
- protein S deficiency
Where do most PE come from?
Lower extremity DVT
Where do DVT typically begin?
Where do they grow to?
Start in calf veins and grow proximally to the popliteal vein and then more proximal to where they have increased likliehood of embolization.
What are upper extremity DVT typically associated with? What are the odds of these embolizing?
Indwelling catheters.
Low odds of embolization
What are the symptomsof VTE?
- dyspnea
- tachypnea
- hypoxemia
- pleuritic chest pain
- cough
- hemoptysis
- leg pain
- leg swelling
- palpitations
- anxiety
- lightheadedness
- syncope
What are the signs of VTE?
- split S2 with loud pulmonic component
- right ventricular heave
What tests are useful for Pulmonary Embolism?
D-dimer
CT pulmonary angiography
VQ scan
Pulmonary angiography
Venous compression ultrasound of lower extremities
EKG
Echocardiogram
What are the sensitivity and specifitity of the venous compression ultrasound of LE for DVT?
Sensitivity and specificity of 95%
What are the possible EKG findings in a PE case?
S1, Q3, T3 pattern
RBBB
What are the echo findings you might see in PE?
right ventricular dysfunction, dilation, hypokinesis
