1. Dr. Meg-angela Christi Amores
Pulmonary Embolism
Dr. Meg-angela Christi Amores

2. Venous Thromboembolism (VTE)
Deep Vein Thrombosis (DVT)
Pulmonary Embolism (PE)

3. Pulmonary Embolism (PE)
Pathophysiology
Embolization
Venous thrombi dislodge
Enters the pulmonary circulation
Or paradoxically, to arterial circulation

4. 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

5. 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

6. 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

7. 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

9. 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

10. 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

11. Treatment IVC filter Maintain adequate circulation Fibrinolysis
Pulmonary Embolectomy
Pulmonary Thromboendarterectomy
Emotional Support