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