Pulmonary Embolism

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Pulmonary Embolism

  1. 1. Pulmonary Embolism  Prof. M.C.Bansal  MBBS;MS. FICOG. MICOG.  Founder Principal & Controller, Jhalawar Medical College and Hospital Jhalawar.  Ex Principal and Controller,  Mahatma Gandhi Medical College & hosptal ; Sitapura Jaipur.
  2. 2. Introduction  It is not an uncommon cause of MMR— responsible for 10%MMR.  Occurs as 1:7000 pregnancy.  Incidence are equal in ANC and purperium , but MMR is more in delivered women.  70% 0f women developing PE have pre existing DVT.  50% of DVT cases may develop silent PE due to dislodgement of small / tiny thrombus.
  3. 3. PE Clinical Presentation  Massive embolism i.e. obstruction of >50% of pulmonary arterial circulation is likely to be associated with right side heart failure.  Massive embolism leads to haemodynamic instability. Increased pulmonary vascular resistance and hypertension,which develops when 60-70 % pulmonary vascular tree is occluded by embolus . Right ventricular dilatation develops.  Not to forget PE may be silent
  4. 4. Investigations  Ventilation perfusion scintigraphy (lung scan )  MRI  Pulmonary angiography.  Echo cardiography.  X ray chest PA & lateral view.  ECG .  Diagnostic tests for Coagulation and fibrinolysis.  PO2 studies in pulmonary and aortic circulation .
  5. 5. Diagnostic Tests--  Clinical examination alone is able to confirm only 20-30% of cases of DVT  BloodTests  the D-dimer  International Normalised Ratio (INR).  Current D-dimer assays have predictive value for DVT, and PE  INR is useful for guiding the management of patients with known DVT who are on warfarin (Coumadin)
  6. 6.  Xray Chest--Loss of vascular markings in the lung field where blood circulation is blocked by embolus. Atelectasis, hemidiaphragm elevation , pleural effusion.  Echocardiography ---- dilatation of right ventricle., increased pulmonary vascular resistance and pulmonary hypertension.  ECG---Right axis deviationT wave inversion in anterior chest leads. Sinus tachycardia,S1 Q3T 3 pattern.
  7. 7. D-dimmer  D-dimmer is a specific degradation product of cross-linked fibrin. Because concurrent production and breakdown of clot characterize thrombosis, patients with thromboembolic disease have elevated levels of D-dimer  three major approaches for measuring D- dimer  ELISA  latex agglutination  blood agglutination test
  8. 8.  recent (within 10 days) surgery or trauma,  recent myocardial infarction or stroke,  acute infection,  disseminated intravascular coagulation,  pregnancy or recent delivery,  active collagen vascular disease, or metastatic cancer False-positive D-dimers  occur in patients with PE D – Dimer tests to be done ---
  9. 9. Embolus in Pulmonary Trunk
  10. 10. Pulmonary Embolism
  11. 11. Pulmonary Embolism

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