pulmonary vascular disease: pulmonary embolism

Question 1

What is pulmonary embolism

Answer 1

Thrombus forms in veins of legs-can move to pulmonary arteries.
Low pressure valve system in the legs so clots more likely to form

Question 2

Causes of PE

Answer 2

production of procoagulants:

• surgery/ trauma
• pregnancy
• Thrombophilia-abnormal factor 5 clotting factor
• cancer
• cardiovascular disease

Question 3

Signs PE

Answer 3

1-mild: pleural rub, pyrexia-dullness when percussion on APEX of lungs
2-many small emboli: hypotension + tachypnoea + tachycardia
3-massive emboli: tachycardia, hypoxia, hypotension, tachypnoea

Question 4

Symptoms PE

Answer 4

• pleuritic chest pain + cough + haemoptysis- caused by infarction or pleurisy
• Isolated acute dyspnoea- bleeding into tissues
• cardiac arrest

Question 5

How to define PE

Answer 5

• pulmonary CT angiogram
• Wells score- based of venous thromboembolism +signs + symptoms
• Revised Geneva score- based on risk factors +signs + symptoms

Question 6

investigations for PE

Answer 6

LIMITED:
Blood count
ECG 
Chest X-ray
USEFUL: 
-bronchoscopy
-D-dimer: measure of coagulant breakdown 
-V/Q scan 
-Echocardiogram
PREVENTATIVE:
-mammogram  and CT of abdomen- see whether related to cancer 
- thrombophilia test

Question 7

Treatment

Answer 7

• O2
• low molecular weight- heparin
• warfarin
• direct oral anti-coagulants
• thrombolysis
• pulmonary embolectomy