Pulmonary Embolism and VTE Overview
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Questions and Answers

What is the third most frequent cause of cardiovascular death?

  • Pulmonary Embolism (PE)
  • Acute Coronary Syndrome (ACS) (correct)
  • Heart Failure
  • Stroke

    • What is the most frequent cause of pulmonary embolism?

  • Fat embolism
  • Air embolism
  • Thrombus (correct)
  • Tumor embolism

    • What is the incidence of Pulmonary Embolism in the general population per 100,000 people per year?

  • 60-120 cases (correct)
  • 300-500 cases
  • 30 cases
  • 120-150 cases

    • Which of the following is NOT a major predisposing factor for Deep Venous Thrombosis (DVT) as described in the text?

    <p>Prolonged immobilization in a seated position</p> Signup and view all the answers

    Which of the following is NOT a moderate predisposing factor for Deep Venous Thrombosis (DVT) as described in the text?

    <p>Chronic Obstructive Pulmonary Disease (COPD)</p> Signup and view all the answers

    What is the term used to describe the situation when the cause of Pulmonary Embolism is unknown?

    <p>Idiopathic</p> Signup and view all the answers

    What is one of the hemodynamic consequences of pulmonary embolism?

    <p>Acute pulmonary hypertension</p> Signup and view all the answers

    What is the term used to describe the percentage of lung tissue that has been affected by a pulmonary embolism?

    <p>Infarct size</p> Signup and view all the answers

    What are the symptoms commonly associated with pulmonary embolism?

    <p>Dyspnea and pleuritic chest pain</p> Signup and view all the answers

    What is the most frequent ECG change seen in a patient with pulmonary embolism?

    <p>Tachycardia</p> Signup and view all the answers

    Which imaging technique is primarily used for excluding other causes of symptoms in potential pulmonary embolism cases?

    <p>Chest X-ray</p> Signup and view all the answers

    Which score is utilized to assess the probability of venous thromboembolism?

    <p>Wells probability score</p> Signup and view all the answers

    What is the typical clinical presentation of a distal pulmonary embolism compared to a proximal one?

    <p>Less pronounced clinical presentation</p> Signup and view all the answers

    What is the main advantage of using ultrasound for lower limb DVT evaluation?

    <p>It is a quick and non-invasive method.</p> Signup and view all the answers

    When would an echocardiogram be considered as a diagnostic tool for pulmonary embolism (PE)?

    <p>If the patient presents with severe symptoms of PE and CTPA is not immediately available.</p> Signup and view all the answers

    What is the main limitation of V/Q scanning in the diagnosis of pulmonary embolism?

    <p>It can produce false-positive results due to other lung pathologies.</p> Signup and view all the answers

    Which of the following is NOT a treatment option for acute pulmonary embolism (PE)?

    <p>Radiotherapy.</p> Signup and view all the answers

    What is the primary goal of anticoagulation therapy in the treatment of pulmonary embolism (PE)?

    <p>Preventing the formation of new blood clots.</p> Signup and view all the answers

    Which of the following is a key component of prophylaxis for pulmonary embolism (PE)?

    <p>Early post-operative mobilization.</p> Signup and view all the answers

    How long should anticoagulation therapy be continued for patients with an unprovoked pulmonary embolism (PE)?

    <p>At least 6 months.</p> Signup and view all the answers

    Which of the following is NOT a characteristic of pulmonary embolism (PE)?

    <p>PE has a predictable and consistent presentation in all patients.</p> Signup and view all the answers

    Study Notes

    Pulmonary Embolism (PE)

    • PE is a pulmonary arterial bed occlusion, most commonly due to a thrombus.
    • It is the 3rd most common cause of cardiovascular death, after ACS and stroke.
    • It's one of the most preventable causes of death in hospitalized patients.

    Virchow's Triad

    • Virchow's Triad describes the causes of blood clots:
      • Venous return decreases
      • Blood stagnates
      • Thrombus forms

    Venous Thrombembolism (VTE)

    • VTE is a common condition. Deep venous thrombosis (DVT) and pulmonary thromboembolism (PE) are its two main components.

    Epidemiology

    • The general population incidence is approximately 60-120 cases per 100,000 people per year.
    • Older individuals (70-79 years old) have a higher incidence: 300-500 cases per 100,000.
    • Incidence is higher in hospitalized patients

    Predisposing factors

    • Factors related to PE/DVT are categorized based on:
      • Degree of risk increase (major, moderate, minor)
      • History (genetically inherited or acquired)
      • Duration (transient or persistent)

    Major predisposing factors for DVT

    • Major surgical intervention
    • Hip or knee replacement
    • Lower limb fractures
    • Spinal cord injuries
    • Major trauma

    Moderate predisposing factors for DVT

    • Pregnancy/hormonal treatments/birth control pills
    • Chronic heart failure
    • Thrombophilia
    • Central venous catheters
    • Chemotherapy
    • Malignancy

    Minor predisposing factors for DVT

    • Age

    • Obesity

    • Varicose veins

    • Laparoscopic surgery

    • Prolonged immobilization

    • Up to 30% of PE cases are idiopathic (unknown cause).

    Hemodynamic consequences

    • Thrombus obstruction leads to:
      • Acute pulmonary hypertension
      • Increased right ventricular (RV) afterload
      • RV failure
      • Hemodynamic collapse
      • Death

    Thrombus size

    • Small thrombi travel and block smaller arteries (distal PE).
    • Larger thrombi block lobar or main pulmonary arteries (proximal PE).
    • Proximal PE has a more dramatic clinical picture.
    • Distal PE has a milder course

    Symptoms

    • Common symptoms include dyspnea (80%), pleuritic chest pain (52%), retrosternal chest pain (12%), cough (20%), syncope (19%), and hemoptysis (11%).

    Signs

    • Common signs include tachypnea (70%), tachycardia (26%), DVT associated signs (15%), cyanosis (11%), and fever (7%).

    Diagnosis

    • Diagnosis relies on a combination of:
      • Clinical presentation
      • Risk factors
      • Imaging (e.g., CTPA, V/Q scan, ultrasound)
      • Wells probability score

    Wells Score for DVT Assessment

    • Used to assess the probability of PE/DVT.

    ECG

    • Tachycardia is the most frequent change.
    • RV strain pattern is seen in inferior leads (V1-V4).
    • S1Q3T3 pattern has high specificity but low sensitivity, can highlight other pathologies

    Chest X-ray

    • Used to exclude other causes, but has low sensitivity and specificity.
    • Can show abnormalities like atelectasis, pleural effusion, or cardiomegaly.
    • Specific signs such as Westermark or Hampton hump, but also low sensitivity

    ABG (arterial blood gas)

    • Used to assess O2 and CO2 levels, pH of the blood.
    • Moderate sensitivity and very low specificity
    • Can evaluate the need for ventilation

    Cardiac Biomarkers

    • BNP, NT-proBNP, troponins can increase due to RV strain.
    • Low specificity.

    D-Dimers

    • Fibrin degradation products.
    • High sensitivity, low specificity.
    • Used to rule out low-probability cases

    Ultrasound of lower limbs

    • Fast, non-invasive.
    • Evaluates for DVT.
    • Highlights non-compressibility of veins.
    • Visualizes the thrombus; higher sensitivity for proximal DVT.

    CTPA (Computed Tomography Pulmonary Angiography)

    • High sensitivity and specificity.
    • Quick, relatively available.
    • Highlights alternative diagnosis when PE is ruled out.

    V/Q scan

    • Alternative to CTPA.
    • Lower availability, higher cost.
    • Lower radiation doses.
    • Can be false-positive due to other lung pathologies.

    Echocardiography

    • Fast, non-invasive.
    • Used in emergency scenarios if other imaging techniques are unavailable/too slow.
    • Detects acute pulmonary hypertension and RV strain/failure.
    • Can show McConnell sign.

    PESI- Pulmonary embolism severity score

    • A scoring tool to assess PE severity to guide management, useful for determining appropriate intensity of care.

    Treatment

    • Treatment approaches for PE/DVT include
      • Reperfusion (e.g., thrombolysis, mechanical thrombectomy).
      • Anticoagulation (used to prevent future clots).
      • Prophylaxis (e.g., to prevent thrombus formation).

    Acute Phase

    • Supportive therapy based on the case; oxygen therapy.
    • Saline, inotropes (dobutamine), and vasopressors, as needed

    Thrombolysis

    • Use of thrombolytic agents (tPA) to dissolve the thrombus..
    • Can be used during the first two weeks following suspected thrombus formation, but not suitable for low-risk patients.

    Mechanical Thrombectomy

    • Surgical intervention to remove the thrombus, when IV thrombolysis is contraindicated.

    Anticoagulation

    • Prevents the formation of new clots.

    • Heparins (unfractionated, low-molecular-weight heparins), Vitamin K antagonists, and Direct Oral Anticoagulants (DOACs) are used.

    Chronic Phase

    • Prolonged anticoagulation is required for patients with provoked PE for 3 months.
    • Prolonged anticoagulation is required for patients with unprovoked PE for at least 6 months, depending on the risk factors.
    • Lifetime anticoagulation is needed for patients with recurrent or idiopathic PE.

    Prophylaxis

    • Early post-operative mobilization.
    • Graduated compression stockings.
    • Intermittent pneumatic compression.
    • inferior vena cava (IVC) filters
    • Anticoagulation

    Take Home Messages

    • PE can rapidly progress and present dramatically.
    • Timely diagnosis and appropriate treatment (anti-coagulation and thrombolytics) are crucial.
    • Probability scores and severity scores guide the management of PE.
    • Preventative measures in high-risk patients are essential.

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    Pulmonary Embolism - PDF

    Description

    This quiz covers essential aspects of pulmonary embolism (PE) and venous thromboembolism (VTE). Participants will learn about the causes, epidemiology, and predisposing factors of these conditions. Test your knowledge on Virchow's Triad and the significance of PE in hospitalized patients.

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