Pulmonary embolism & Deep Vein thrombosis

Question 1

what is a pulmonary embolism?

Answer 1

= the result of obstruction of a pulmonary artery by a thrombus

Question 2

symptoms of pulmonary embolism?

Answer 2

• shortness of breath
• chest pain, especially upon breathing in
• coughing up blood
  = they appear suddenly

Question 3

what are the signs of a pulmonary embolism?

Answer 3

1) central cyanosis
2) tachypnoea
3) tachycardia
4) low BP
5) crackles
6) rub

Question 4

what are risk factors for a PE?

Answer 4

• very similar to those of a deep vein thrombosis;
  1) overnight / obese
  2) inactive or immobile for long periods of time e.g. travelling or after surgery
  3) smoking cigarettes
  4) being pregnant or having given birth in previous 6 weeks

Question 5

what would a chest X-ray of a pulmonary embolism show?

Answer 5

a chest X-ray would be normal

Question 6

what are tests that allow you to diagnose a PE?

Answer 6

1) VQ scan
= to measure the ventilation-perfusion match

2) CT pulmonary angiography
3) blood tests
4) venous ultrasound and echocardiography

Question 7

what are you looking for in a blood test?

Answer 7

1) raised levels of D-dimer
2) high levels of Troponin T
3) high levels of brain natriuretic peptide

Question 8

what is D-dimer?

Answer 8

= it is a degradation product of fibrin, the end product of coagulation cascade & principal component of blood clots

Question 9

what result in a ventilation perfusion scan would should the presence of a pulmonary embolism?

Answer 9

• mismatched perfusion & ventilation.

Question 10

Why is a CT pulmonary angiography useful for determining whether a patent has a PE?

Answer 10

because it shows the lung tissue as well as the blood vessels.

Question 11

how would you treat a pulmonary embolism?

Answer 11

• oxygen therapy
• analgesia for pleuritic chest pain
• fluid for hypotension
• anti-coagulants to speed clot resolution & prevent further emboli
• treated for 5-7 days with subcutaneous injections of LMWH
• long term oral anticoagulants with warfarin at the same time

Question 12

what does a DVT present with?

Answer 12

• swollen, hot, red & tender leg
• usually proximal
• may be whole leg or just the calf depending on site

Question 13

what investigations could be done for a DVT?

Answer 13

1) Ultra-sound Doppler leg scan
2) CT scan of ileo-femoral veins
3) IVC & pelvis