Pulmonary Vascular Disease Flashcards
define pulmonary embolism (PE)
development of a thrombus (blood clot) within the pulmonary arterial vasculature, that typically develops from and underlying DVT and embolises
risk factors of PE
immobility recent surgery long haul flights/travel pregnancy hormone therapy with oestrogen malignancy
clinical features of PE
sudden-onset dyspnoea
pleuritic chest pain
cough with/without haemoptysis
signs of PE
tachycardia tachypnoea hypoxia raised respiratory rate low grade pyrexia
signs of massive PE
hypotension
cyanosis
right heart strain - JVP, parasternal heave and loud P2
important sign to look for in PE
a unilateral, swollen tender/painful calf
potential signs of PE on an ECG
normal or sinus tachycardia
if massive:
- P pulmonale
- right axis deviation
- right bundle branch block
what score system is used to assess patient risk of PE?
Wells Score - assess risk factors and clinical signs present and deems patient ‘likely’ or ‘unlikely’
blood investigations in PE
ABG - can be normal or show Type I respiratory failure and/or respiratory alkalosis
FBC, CRP, U+E and clotting function
additional blood investigation in PE
D-dimer - used if patient deemed unlikely (Wells Score <4) to have PE but still suspicious
investigations in PE
CT pulmonary angiogram (CTPA)
contraindications of CTPA use and alternative imaging methods
use V/Q scan or lower limb duplex if patient has:
- renal impairment
- pregnancy
- contrast allergy
when is bedside echocardiogram used in PE
if patient thought to have a massive PE in order to assess for thrombolysis suitability
management of massive PE
if patient haemodynamically unstable or right heart strain present, perform thrombolysis (IV or direct)
examples of thrombolytic agents
streptokinase, alteplase and tenecteplase
