Pulmonary Embolism Dr Megangela Christi Amores Venous Thromboembolism

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 PO 2) – inefficiency of O 2 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: S 1 Q 3 T 3 sign: • an S wave in lead I, Q wave in lead III, and inverted T wave in lead III • T-wave inversion in leads V 1 to V 4

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