Pulmonary Embolism

Dr. Meg-angela Christi Amores

Venous Thromboembolism (VTE)

• Deep Vein Thrombosis (DVT)• Pulmonary Embolism (PE)

Pulmonary Embolism (PE)

• Pathophysiology– Embolization • Venous thrombi dislodge• Enters the pulmonary circulation• Or paradoxically, to arterial circulation

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

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

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

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

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

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

Treatment

• IVC filter• Maintain adequate circulation• Fibrinolysis• Pulmonary Embolectomy• Pulmonary Thromboendarterectomy• Emotional Support