What is a PE?
Thrombus within pulmonary arterial circulation
How does a PE normally arise?
Venous thromboembolism (VTE): emobilisation of proximal DVT from lower limb through R heart
What is the spectrum of severity for a PE?
Large central saddle embolus to small subsegmental emboli
What triad describes factors casually related to venous thromboembolism (VTE)?
Virchow’s triad
What is Virchow’s triad? (3)
- Hypercoagulability
- Endothelial injury
- Venous blood flow stasis
What are the types of venous thromboembolism (VTE)? (3)
- Provoked by transient significant risk factor
- Persistent significant risk factor
- Unprovoked
What are the transient risk factors that could provoke a VTE? (6)
- Recent surgery
- Hospitalisation
- Pregnancy
- Oestrogen therapy (pill/HRT)
- Lower limb immobilisation
- Past DVT
What are the persistent risk factors that could lead to a VTE? (4)
- Active cancer
- Inflammatory disorder (e.g IBD)
- Age
- Sex
What are the consequences of PE?
- Death
- Chronic thromboembolic pulmonary hypertension (CTEPH)
What are the symptoms of chronic thromboembolic pulmonary hypertension (CTEPH)?
- Chronic breathlessness
- Hypoxia
- Right heart failure
What is CTEPH caused by? (2)
- Major pulmonary artery obstruction
- Fibrous tissue replaces clots
What is the treatment for CTEPH?
Lifelong anticoagulation
PE treatment if wells score above 4? (2)
- Gentle anticogulant (low molecular weight heparin)
- CTPA
PE treatment if wells score below 4? (2)
- D dimer
- If positive=CTPA/LMWH
