Pulmonary embolism Flashcards
1
Q
What is the definition of a PE?
A
A portion of a blood clot that has lodged into a pulmonary vein
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2
Q
How common is a PE?
A
Incidence of VTW is from 1-1.5/1000 person years
3
Q
What is the pathology of a PE?
A
- Usually arise from thrombi in the iliofemoral veins (DVT)
- Rarely PE results from clot formation in the right heart
- Clot obstructions the right ventricular outflow tract
- = sudden ↑ in pulmonary vascular resistance
- Causes acute right heart failure
- Lung tissue is ventilated but not perfused
- Risk of developing clots is based on Virchow’s triangle
- ↑ coagulability
- ↓ mobility
- Blood vessel abnormality
4
Q
What are the risk factors/aetiology of a PE?
A
- Pregnancy
- Recent surgery/hospitalisation
- Varicose veins
- Malignancy
- Previous VTE
- Hypertension
- Congenital heart disease
- Congestive heart failure
- OCT/HRT
- Haematological disorders
5
Q
What are the signs/symptoms of a PE?
A
- Small/medium PE’s
- Breathlessness
- Pleuritic chest pain
- Haemoptysis
- Tachyponoeic
- Pleural rub
- Exudative pleural effusion – occasionally bloodstained
- Massive PE
- Severe central chest pain
- Sudden shock – pale, sweaty, tachypnoea, tachycardia
- Syncope
- Death
- Central cyanosis
- ↑ JVP
- Right ventricular heave
- Accentuation of the 2nd heart sound
- Gallop rhythm (abnormal rhythm, 3 or 4 beats) – acute right hearted failure
6
Q
What investigations would be conducted for a suspected PE?
A
- Geneva score – predicts likelihood of PE
- CXR
- ↓ vascular markings
- ↑ hemidiaphragm
- Wedge shaped opacity adjacent to the pleural edge
- Pleural effusion sometimes
- ECG
- Sinus tachycardia
- New onset AF
- Tall peaked T waves in Lead II
- Right axis deviation
- Right bundle branch block
- Blood gases
- D- dimer
- CTPA
- V/Q scan
- Echocardiogram
- Doppler
7
Q
What are the surgical treatments for a PE?
A
- Surgical embolectomy
* Insertion of vena caval filter – used to prevent further emboli
8
Q
What are the pharmacological treatments for a PE?
A
- High flow O2
- Thrombolysis e.g. LMWH
- Analgesia e.g. morphine
- Warfarin/LMWH – prevent further PE’s
- IV fluids
