Pulmonary embolism (PE) Flashcards
What is a PE?
When a blood clot (thrombus) forms in the pulmonary arteries
1) What is the usual cause of a PE?
2) Name another cause of a PE
1) DVT
2) RV thrombus following an MI, septic emboli from right sided infective endocarditis, fat, air or amniotic fluid emboli
Name 2 risk factors for developing a PE
- Immobility
- Recent surgery
- Long haul flights
- Pregnancy
- Hormone therapy with oestrogen
- Malignancy
- Polycythaemia
- Systemic lupus erythematosus
- Thrombophilia
- Previous PE
1) Name 2 symptoms of a PE
2) Name 2 signs of a PE
1) Acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, syncope, any symptoms of a DVT
2) Pyrexia, cyanosis, tachypnoea, tachycardia, hypotension, raised JVP, pleural rub, pleural effusion, any signs of a DVT
What is often seen in an ABG of a patient with a PE?
1) Respiratory alkalosis
1) If a Wells score predicts likely DVT/PE, what investigation should be done next?
2) If a Wells score predicts unlikely DVT/PE, what investigation should be done next?
3) What are the 2 main options for a definitive diagnosis of PE?
4) Which of these is 1st line, and when would the 2nd line option be used?
1) CT pulmonary angiogram
2) D dimer test
3) CT pulmonary angiogram and a ventilation-perfusion scan
4) 1st line = CTPA, VQ scan used if patient has renal impairment or allergy to contrast
1) What is a CT pulmonary angiogram?
2) What is a ventilation-perfusion scan?
3) Name a scenario when ventilation-perfusion scan be used ahead of a CT pulmonary angiogram?
4) In a PE, will there be a deficit in ventilation or perfusion?
5) If PE is suspected but CTPA is negative, what test is done next?
1) Chest CT scan with an intravenous contrast that highlights the pulmonary arteries to demonstrate any blood clots
2) Using radioactive isotopes and a gamma camera to compare the ventilation with the perfusion of the lungs.
3) Patients with renal impairment, contrast allergy or at risk from radiation where a CTPA is unsuitable.
4) Perfusion
5) Proximal leg vein doppler US
What is the initial management of a PE?
LMWH
1) What are the 2 options for long term management?
2) In which 2 scenarios would these drugs not be used, and what drugs would be used?
1) DOACs and warfarin
2) Pregnancy, antiphospholipid syndrome - LMWH
1) What is the treatment if there’s a massive PE?
2) Name one of these drugs
1) Thrombolysis with thrombolytics/fibrinolytics
2) Streptokinase, alteplase or tenecteplase
If someone has a ‘provoked PE’, how long should they be managed for?
3 months
1) What is commonly seen on ECG of PE?
2) What is the ‘textbook’ answer for ECG changes in PE (but not actually seen often)
1) Sinus tachycardia
2) S1, Q3, T3
If someone may be having a PE, how do you know whether to do a D dimer or CTPA first?
CTPA 1st if Wells score > 4, D dimer if < 4
