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Pulmonary Embolism
Dr. Meg-angela Christi Amores
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Venous Thromboembolism (VTE)
• Deep Vein Thrombosis (DVT)• Pulmonary Embolism (PE)
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Pulmonary Embolism (PE)
• Pathophysiology– Embolization • Venous thrombi dislodge• Enters the pulmonary circulation• Or paradoxically, to arterial circulation
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Pathophysiology
• Physiology– most common gas exchange abnormalities are
hypoxemia (decreased arterial PO2)
– inefficiency of O2 transfer across the lungs– Increased pulmonary vascular resistance – Impaired gas exchange – Alveolar hyperventilation – Increased airway resistance – Decreased pulmonary compliance
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Pathophysiology
• Right Ventricular Dysfunction– Progressive right heart failure is the usual cause of
death from PE– RV contraction continues even after the left
ventricle (LV) starts relaxing– the interventricular septum bulges into and
compresses an intrinsically normal left ventricle
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Diagnosis
• Clinical Evaluation– Nonspecific signs and symptoms– Known as “the Great Masquerader”– most frequent history is unexplained breathlessness– Dyspnea– Tachypnea– dyspnea, syncope, hypotension, or cyanosis– pleuritic pain, cough, or hemoptysis
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Diagnosis
• Laboratory– Blood tests: D dimer assay– Elevated cardiac markers: Troponin– ECG: S1Q3T3 sign: • an S wave in lead I, Q wave in lead III, and inverted T
wave in lead III
• T-wave inversion in leads V1 to V4
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Diagnosis
• Imaging– Venous Ultrasound– Chest XRay:• Westermark's sign - focal oligemia • Hampton's hump - a peripheral wedged-shaped density
above the diaphragm • Palla’s sign - an enlarged right descending pulmonary
artery
– Chest CT Scan with contrast– Lung Scan
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Treatment
• Anticoagulation• foundation for successful treatment• parenteral drug: unfractionated heparin (UFH), low
molecular weight heparin (LMWH), or fondaparinux• "bridge" to stable, long-term anticoagulation with a
vitamin K antagonist : WARFARIN
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Treatment
• IVC filter• Maintain adequate circulation• Fibrinolysis• Pulmonary Embolectomy• Pulmonary Thromboendarterectomy• Emotional Support