Pulmonary Embolism

Question 1

what test is used to diagnose PE?

Answer 1

CT pulmonary angiogram (CTPA)

Question 2

what is the scoring system used to assess risk in suspected PE?

Answer 2

well’s score

Question 3

describe well’s score

Answer 3

3 points:
* clincal signs and symptoms of DVT
* no alternative diagnosis is more likely than a PE

1.5 points:
* tachycardia
* immobile for >3 days or major surgery <1 month
* previous PE or DVT

1 point:
* presents with haemoptysis
* active malignancy

Well’s </=4 = d-dimer
Well’s >4 = CTPA +/- low-molecular weight heparin

Question 4

what is the initial management of a PE?

Answer 4

either:
* low-molecular weight heparin
* DOAC (e.g. apixban or rivaroxaban)
* warfarin

Question 5

how long should a patient remain on a DOCA post unprovoked PE?

Answer 5

6 months

Question 6

how long should a patient remain on a DOCA post provoked PE?

Answer 6

3 months

Question 7

what is the target INR of a patient with VTE while on warfarin?

Answer 7

INR 3-4

Question 8

when is thrombolysis performed in a PE?

Answer 8

massive PE in a haemodynamically unstable patient

Question 9

what are the contraindications for thrombolysis?

Answer 9

• previous intracranial haemorrhage
• recent ischaemic stroke (<3 months)
• recent head injury
• recent surgery
• current active bleeding or bleeding disorder

Question 10

what are the classical symptoms of a PE?

Answer 10

• sudden onset SOB
• pleuritic chest pain
• haemoptysis

massive PE may present with syncope/shock

Question 11

what are the ECG changes in a PE?

Answer 11

• sinus tachycardia
• S1Q3T3
• massive PE = right-heart strain

Question 12

what is S1Q3T3?

Answer 12

• deep S waves in lead I
• pathological Q waves in lead III
• inverted T waves in lead III

Question 13

what is thrombolysis?

Answer 13

IV alteplase