PE Flashcards
What is the pathophysiology of a PE?
venous thrombi, usually from DVT pass into through veins through right side of heart then in pulmonary circulation and block blood flow to lungs, source is often occult
What are risk factors for a PE?
- Increasing age
- Diagnosis of DVT
- Surgery last 2 months
- Bed rest >5days
- Previous VT event
- Fhx VTE
What conditions can be RF for PE?
- Factor V Leiden mutation
- Prothrombin G20210A mutation
- Antithrombin deficiency
- Protein C deficiency
- Protein S deficiency
- Antiphospholipid antibody syndrome
What are symptoms and signs of a PE?
- Dyspnoea
- Chest pain / pleurtic chest pain
- Signs of concurrent DVT
- RF
- Hypoxaemia
- Failure to meet PERC rule
- Positive Wells score
What are possible differentials for a PE?
- Angina (untable)
- NSTEMI
- STEMI
- Pneumonia (community aquired)
- Bronchitis (acute)
What investigations should you order for suspected PE?
- Computed tomographic pulmonary angiography (CTPA)
- Echocardiography
- D-dimer
- FBC
- ECG
- Urea and Electrolytes
- Coagulation studies
- LFTs
Which investigation will give confirmation of PE?
Computed tomographic pulmonary angiography (CTPA)
What would an ECHO show in PE?
if haemodynamically unstable patients who cannot have CTPA – presence of RV dysfunction can confirm diagnosis of PE
What will d-dimer levels be for PE?
elevated
What is the management plan for PE?
- Urgent reperfusion (thrombolysis, anticoag and supportive care)
- 1st line: unfractioned heparin or fondaparinux
- Thrombolysis is haemodynamically unstable e.g. alteplase 10mg IV/blous
- The ongoing: DOAC or warfarin
What are possible complications of PE?
- Acute bleeding during treatment
- Pulmonary infarction
- Cardiac arrest/death
- Heparin thromboembolic pulmonary hypertension
- Recurrent venous thromboembolic event
- Acute bleeding during treatment
What is the patho of a PE?
- a blockage in one of the pulmonary arteries in the lungs
- One or more emboli, usually arising from a thrombus formed in the veins, are lodged in and obstruct the pulmonary arterial system, causing severe respiratory dysfunction
What is an acute massive PE?
sudden complete occlusion of pulmonary artery
What are the symptoms of an acute massive PE?
- Collapse
- Central crushing pain
- Severe dyspnoea
What may you see on ECG for an acute massive PE?
- S1Q3T3 pattern:
- Right axis deviation (RAD)
- Right bundle branch block (RBBB)
