S6.2 Pulmonary Embolism

Question 1

What is a PE?

Answer 1

The movement of material from one part of the circulation to another.
Lodges in the pulmonary arteries, can be caused by a thrombus, air or tumour.
Most cased by DVT

Question 2

What are the risk factors for DVT?

Answer 2

Pregnancy, surgery, obesity, cancer

Question 3

How does PE cause right ventricular overload?

Answer 3

Pulmonary artery pressure increases if more than 30% of the arterial bed is occluded. This leads to right ventricular dilatation and strain.

Question 4

What are the symptoms of PE?

Answer 4

Dyspnoea, cough, fever, chest pain.

Question 5

What are the differentials and physical signs of PE?

Answer 5

Differential diagnoses – MI, Pneumothorax

Physical signs in PE - Pleural rub in cases of pulmonary infarction, Raised JVP

Question 6

What investigation are carried out on a PE?

Answer 6

CXR – to exclude other diagnoses.
ECG – T wave inversion.
Blood gases – may show hypoxaemia or hypocapnia.
D-dimer – a fibrin degradation product, a small protein fragment released into the blood when a thrombus is degraded by fibrinolysis

Question 7

What is the treatment of PE?

Answer 7

Give heparin, this stops thrombus propagation and allows the body’s fibrinolytic system to lyse the thrombus