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SA respiratory > S6) Pulmonary Embolism > Flashcards

S6) Pulmonary Embolism Flashcards

1
Q

What is an embolism?

A

An embolism is the movement of material from one part of the circulation to another

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2
Q

What is a pulmonary embolism?

A

A pulmonary embolism is when and embolism passes through the right side of the heart and lodges in the pulmonary arteries

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3
Q

Identify 6 types of material that can cause an embolism

A
  • Thrombus
  • Tumour
  • Air
  • Fat
  • Amniotic fluid
  • Bullet
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4
Q

What is the most common cause for a pulmonary embolism?

A

90% of PE arise from a deep vein thrombosis (DVT) in the legs, particularly the popliteal vein and more proximal veins including pelvic veins

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5
Q

How many patients with a PE show signs/symptoms of a DVT?

A

25%

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6
Q

In terms of causes of death, where does PE fall?

A
  • 3rd commonest cause of vascular death (after MI and stroke)
  • Commonest cause of preventable death in hospital patients
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7
Q

Identify 8 risk factors for thrombo-embolism

A
  • Pregnancy (6x)
  • Contraceptive pill (3x)
  • Prolonged immobilisation (3x)
  • Previous thromboembolism (3x)
  • Cancer (2.8x)
  • Obesity (2.4x)
  • Surgery > 30 minutes (2.3x)
  • Age > 40 years (2.1 x)
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8
Q

Describe the presence of risk factors in patients with PE

A
  • 50% have an identifiable ‘temporary’ risk factor (surgery, oestrogen treatment, etc)
  • 25% have cancer (permanent risk factor)
  • 25% have no identifiable risk factor
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9
Q

What is the likelihood of sudden death after PE?

A

20%

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10
Q

Identify 3 effects of PE

A
  • Right ventricular overload
  • Respiratory failure
  • Pulmonary infarction
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11
Q

In four steps, explain how right ventricular overload occurs in the pathophysiology of PE

A

⇒ Pulmonary artery pressure increases if more than 30% of the total cross section of the pulmonary arterial bed is occluded

⇒ Right ventricular dilatation and strain

⇒ Inotropes are released to maintain systemic BP

⇒ Pulmonary artery vasoconstriction

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12
Q

What effect does right-to-left shunting through the foramen ovale have on the pathophysiology of PE?

A

May lead to severe hypoxaemia and an increased risk of paradoxical embolisation and stroke

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13
Q

How does respiratory failure occur in the pathophysiology of PE?

A

Respiratory failure is due to areas of ventilation perfusion mismatch and low right ventricle output

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14
Q

How does pulmonary infarction occur in the pathophysiology of PE?

A

Pulmonary infarction occurs as small distal emboli create areas of alveolar haemorrhage resulting in haemoptysis, pleuritis, and small pleural effusion

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15
Q

Identify 7 symptoms of PE

A
  • Dyspnoea (50%)
  • Pleuritic chest pain (39%)
  • Cough (23%)
  • Fever (10%)
  • Haemoptysis (8%)
  • Syncope (6%)
  • Unilateral leg pain (6%)
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16
Q

What are the main differential diagnosis for PE?

A
  • Myocardial infarction
  • Pneumothorax
  • Pneumonia/pleurisy
17
Q

Identify 2 physical signs in PE

A
  • Pleural rub in cases of pulmonary infarction
  • Raised JVP
18
Q

Identify and describe 4 investigations for PE

A
  • Chest X-ray used to exclude other diagnoses as (PE has normal CXR)
  • ECG may show signs of right ventricular strain (T wave inversion)
  • Blood gases may show hypoxaemia and hypocapnia due to hyperventilation
  • D-dimer as a negative value rules out PE in patients with a low likelihood
19
Q

What are D-dimers?

A

D-dimer is a fibrin degradation product, a small protein fragment released into the blood when a thrombus is degraded by fibrinolysis

20
Q

What imaging can be used for PE?

A
  • CT Pulmonary angiography
  • Ventilation perfusion lung scintigraphy
21
Q

What form of treatment is given to patients with both low and high risk of PE?

A

Immediate heparinisation as this reduces mortality

22
Q

How does heparinisation reduce mortality of PE?

A
  • Stops thrombus propagation in the pulmonary arteries

- Allows the body’s fibrinolytic system to lyse the thrombus

  • Stops thrombus propagation at the embolic source

- Reduces the frequency of further PE

23
Q

Identify 5 types of treatment in high risk patients for PE?

A
  • Haemodynamic support
  • Respiratory support
  • Exogenous fibrinolytics (streptokinase/tPA)
  • Percutaneous catheter directed thrombectomy
  • Surgical pulmonary embolectomy
24
Q

how can pulmonary infarction occur

A
  • small embolus can cause an alveoli to haemorrhage
  • heamoptysis (cough up blood), pleuritis, small pleural effusion
  • can see a small hump
25
Q

D dimer test

A
26
Q

treatment of an embolism

A

02

anticoagulants (warfarin and heparin)

thrombolysis

mechanical removal

27
Q

what is heparin induced thrombocytopenia

A
  • antibodies form against heparin
  • form heparin - platelet compounds
  • platelets become activated and clump up
  • thrombi form and propagate
  • thrombus spread through body
    *

SA respiratory (23 decks)

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