Dr. Meg-angela Christi Amores 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