Pulmonary Venous Embolism

Question 1

What is PE?

Answer 1

a common, serious, and potentially fatal complication of thrombus formation within the deep venous circulation

Question 2

PE is the ______ leading cause of death amount hospitalized patients

Answer 2

3rd

Question 3

Less than ______% of patients with fatal emboli have received specific treatment for the condition.

Answer 3

10%

Question 4

What is a common embolus?

Answer 4

Thrombus, but many substances can embolize

Question 5

What are the risk factors for thrombus formation/PE within the venous circulation?

Answer 5

• Venous stasis
• Injury to vessel wall
• Hypercoagulability (Virchow triad)
• Inherited gene defects

Question 6

When diagnosing PE, patients typically have one or more of the following:

Answer 6

• dyspnea
• chest pain
• hemoptysis
• syncope

Question 7

What are some essentials for diagnosis of PE?

Answer 7

• predisposition (usually LE)
• dyspnea, chest pain, hemoptysis, syncope
• tachypnea with a widened alveolar-arterial PO2 diff
• Elevated rapid D-dimer and characteristic defects on CT arteriogram, ventilation-perfusion lung scan, or pulmonary angiogram

Question 8

Where do thrombi arise?

Answer 8

can arise anywhere in venous circulation or heart, but most often originated in the deep veins of the lower extremities

Question 9

How does venous stasis increase?

Answer 9

Immobility
Hyperviscosity (Polycythemia)
Increased central venous pressures (low cardiac output states, pregnancy)

Question 10

How does hypercoaguability occur?

Answer 10

• Medication (oral contraceptives, hormonal replacement)
• Disease
• Inherited gene defects

Question 11

What are the ECG findings on most patients with PE?

Answer 11

• sinus tachycardia and nonspecific ST and T wave changes

- Sometimes P pulmonale, right ventricular hypertrophy, right axis deviation, and right bundle branch block

Question 12

What are the arterial blood gas findings in most patients with PE? Is it diagnostic?

Answer 12

• Acute respiratory alkalosis due to hyperventilation

- Not well diagnostic

Question 13

How are plasma levels of D-dimer in patients with PE?

Answer 13

• elevated in the presence of a thrombus (between 300 and 500 ng/mL?)

Question 14

What is D-dimer?

Answer 14

A degradation product of cross-linked fibrin

Question 15

What is used as the initial diagnostic study in North America for suspected PE?

Answer 15

Helical CT pulmonary angiography

Question 16

What are some other options for imaging PE?

Answer 16

• Ventilation perfusion lung scanning
• Venous thrombosis studies
• chest radiography
• pulmonary angiography
• MRI

Question 17

What are the most common findings on a chest radiograph of a patient with PE?

Answer 17

atelectasis, parenchymal infiltrations, pulmonary effusion

Question 18

What are some anticoagulation therapies that can be used? What must you consider?

Answer 18

Heparin or low molecular weight heparin

- age, risk factors, likelihood of hemmorhage, preferences

Question 19

What is some thrombolytic therapy that can be used for PE?

Answer 19

Streptokinae, Urokinase, recombinant tissue plasminogen activator (rt-PA / alteplase)

Question 20

What are some additional measures that can be taken when treating PE, other than anticoagulants and thrombolytic therapy?

Answer 20

Inferior vena cava filter

Mechanical or surgical extraction of thrombus

Question 21

When is thrombolytic therapy indicated?

Answer 21

patients at high risk for death in whom the more rapid resolution of thrombus mat be lifesaving

Question 22

PE is estimated to cause more than ________ death anually.

Answer 22

50,000

Question 23

True or False: in majority of deaths, PE is not recognised antemortem or death occurs before treatment

Answer 23

True

Question 24

What is the outlook for patients diagnosed and appropriately treated for PE?

Answer 24

generally good