Pulmonary embolism

Question 1

Thrombosis

Answer 1

a blood clot that forms within a vein

Question 2

Deep vein thrombosis

Answer 2

a blood clot forms within the deep veins of the leg or pelvis

Question 3

Pulmonary embolism

Answer 3

thrombus dislodges and travels to pulmonary arteries via the right side of the heart

Question 4

Venous thromboembolism

Answer 4

A term used to refer to both a DVT or a PE

Question 5

Virchow’s triad

Answer 5

causes of clotting are;
• Local trauma to the vessel wall
• Hypercoaguability
• Statsis of blood flow

Question 6

Risk factors for DVT forming

Answer 6

• Chronic heart failure
• Malignancy ( cancer)
• Obesity
• Birth control
* Pregnancy
• Age > 70

• Venous statsis - long journeys, prolonged bed rest,
• Previous DVT

Question 7

Symptoms of pulmonary embolism

Answer 7

• Breathlessness and shortness of breath
• Cough
• Leg swelling
• Wheezing
• Angina like pain
• Pleuritic chest pain
• Haemoptysis

Question 8

Complications of a DVT

Answer 8

• Pulmonary embolism

* Chronic leg swelling

Question 9

Differential diagnosis

Answer 9

• MI
• Pneumonia
• Bronchitis
• Ashtma
• Pneumothorax

Question 10

Clinical presentation of severe PE

Answer 10

the bigger the PE, the greater the CVS symptoms
1. angina like symptoms, palpitation, AF
Severe;
2. Systemic hypotension, DVT, 3. Progress right heart failure
• Elevated JVP
• ECG - right axis dev
• Elevated tropnin - cardiac muscle damage
• Elevated BPN - markers of heart failure

Question 11

CT pulmonary angiogram

Answer 11

• Pulmonary artery width is greater than aorta due to blockage
• Right ventricle pushing into left due to back pressure

Question 12

Clinical presentation of a small PE

Answer 12

• No right hand ventricle dysfunction
• Impaired gas exchange - breathlessness
• Poorly perfused alveoli may have hypoxemia
• Alveolar hyperventilation - increase in ventilation leading to low CO2 levels
• Pulmonary infarction - death of portion of lung as blood supply is occluded

Question 13

Odd PE

Answer 13

• Non thrombotic pulmonary embolism
- fat/amniotic fluid embolism

• Paradoxial embolism

• Clot travels from DVT to heart, enters left atrium via patent foramen
• enters cerebral circulation and presents as a stroke

Question 14

Diagnostic investigation

Answer 14

1. Medical historu
2. Physical examination
3. Chest x ray
4. V/Q scan - ventilation perfusion scan
5. Well’s score

Question 15

Well’s score (DVT likelihood calulated)

Answer 15

• Points for features and symptoms of a DVT
• < 3 points - low likelihod
- d dimer test
•  >3 points - high likelihood
- CTPA

Question 16

D dimer test

Answer 16

• D dimer is the breakdown product of a clot
• Any irrelevant clotting activity/ trauma can increase D dimer levels
• Postive - no signficant
• Negative - exclude PE

Question 17

Treatment

Answer 17

1. ABC supportive therapy
2. Body left to break down clots on their own
   - embolectomy/thrombolectomy - surgical removal of a v large clot
3. Low molecular weight heparin - intial response to stop another clot forming
4. NOAC, Warfarin, LMWH
   - prevents additional thrombus forming, on for min 3 months