This presentation provides information about Embolic and thromboembolic diseases and how to detect them

1. EMBOLIC AND
THROMBOEMBOLIC DISEASES
Aziza Al-Amri ..

2. WHAT ARE THROMBOEMBOLIC DISEASES ?
They are caused when a blood vessel is
obstructed by a blood clot (embolus) that has
been carried in the bloodstream from the site of
its formation.
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3. CONT.
3
TED
VTE
DVTPE
Arterial thrombosis

4. PULMONARY EMBOLISM

5. OBJECTIVES
• Definition
• Incidence
• Symptoms
• Risk factors and causes
• Clinical presentation
• Complications
• Exams and Tests
• Treatment
• Prevention
• Case study
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6. WHAT IS PULMONARY EMBOLISM ?
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In Other Words : PE is the sudden
blockage of a major blood vessel (artery)
in the lung, usually by a blood clot.

7. WHAT HAPPENS ?
If a large blood clot blocks the artery in
the lung, blood flow may be completely
stopped, causing sudden death.
A smaller clot reduces the blood flow and may
cause damage to lung tissue.
if the clot dissolves on its own, it may not
cause any major problems. 7

8. WHERE DOES IT HAPPENS ?
• It can happen anywhere in the lungs
– But since more blood flows into the bases of the lungs
• Pulmonary Embolism is more in the lower parts
– And less in the upper portion
» As a result of gravity
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9. INCIDENCE
• 600,000 per year get PE In the US
• This results in 50,000-200,000 deaths per year.
Based on the estimates on 2012
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10. SYMPTOMS
Begins suddenly ..
 Sudden shortness of breath.
 Sharp chest pain that is worse with cough or deep breath.
 A cough that brings up pink, foamy mucus.
 Rapid breathing
can also cause more general symptoms such as :
 anxiety
 sweating a lot
 feeling lightheaded
 fainting
 fast heart rate or palpitations. 10

11. CAUSES
Blood clot in the leg that breaks loose and
travels to the lungs .
Deep vain thrombosis .
Other things can block the artery, such as tumors,
air bubbles, amniotic fluid, or fat that is released
into the blood vessels when a bone is broken. But
these are rare. 11

12. RISK FACTORS
 Being inactive for long periods.
 Recent surgery that involves the legs, hips, belly, or brain.
 Some diseases, such as cancer, heart failure, stroke, or a
severe infection.
 Pregnancy and childbirth (cesarean section).
 Taking birth control pills or hormone therapy.
 Smoking.
 Older than 70
 Extremely overweight (obese).
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13. PRESENTATION
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Most Common
Symptoms
 Dyspnea at rest or with
exertion
 Pleuritic pain
 Cough
 >2-pillow orthopnea
 Calf or thigh pain
 Calf or thigh swelling
 Wheezing
 Rapid onset of dyspnea
Most Common Signs
 Tachypnea
 Tachycardia
 Rales
 Decreased breath
sounds
 Jugular venous
distension

14. COMPLICATIONS
Cardiac arrest and sudden death
Shock
Abnormal heart rhythms
Death of part of the lung, called pulmonary
infarction
Pleural effusion
Pulmonary hypertension
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15. EXAMS AND TESTS
Diagnosing pulmonary embolism is difficult,
because there are many other medical
conditions, such as a heart attack or an anxiety
attack, that can cause similar symptoms.
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16. EXAMS AND TESTS
1. D-Dimer: is a blood test that measures a
substance that is released when a blood clot
breaks up.
Elevated in thrombosis, malignancy,
pregnancy, elderly, hospitalized patients.
Normal results can rule out PE.
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17. EXAMS AND TESTS
2.Electrocardiogram (ECG):
Only 10% of patients
can have the S1 Q3 T3
so not reliable .
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18. EXAMS AND TESTS
3.Chest Radiography:
Not a sensitive or specific test for the
diagnosis of PE.
Atelectasis, Pleural effusion, or a pulmonary
parenchymal abnormality is noted most
commonly
Only a small portion of patients with PE have a
normal CXR.
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19. CXR
• Westermark and Fleishner’s sign
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20. CXR
• Hamptons Hump sign
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21. EXAMS AND TESTS
4. CT Angiogram
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22. EXAMS AND TESTS
5.Pulmonary Angiography
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23. EXAMS AND TESTS
Pulmonary Angiography:
The “gold standard”
A negative pulmonary angiogram excludes
clinically relevant PE.
The risk of embolization in patients with a
negative angiogram is extremely low
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24. EXAMS AND TESTS
• More tests can be used , like what ?!
6. MRI
7. ABG “ sudden drop in O2 level”
8. Doppler ultrasound “reflected sound waves to
determine whether a blood clot is present in the
large veins of the legs”
9.Echo “detects abnormalities in the size of right
ventricle”
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25. AFTER DETERMINATION PE ..
Other tests can help guide treatment and
suggest how well the pt. will recover :
• Brain natriuretic peptide:
A blood test to check the level of the hormone
( level heart under stress )
• protein troponin:
( level damage to the heart’s muscle )
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26. TREATMENT
Anticoagulant medications
If symptoms are severe and life-threatening, aggressive
treatment is needed
 Thrombolytic medications ( risk of sever bleeding )
Remove the clot ( Embolectomy)
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27. If surgery or medicines are not
options, is there other methods to
prevent pulmonary embolism ?
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28. YES !
Vena cava filter :
This filter can prevent blood clots in the leg or
pelvic veins from traveling to the lungs and
heart, may be permanent or removable.

29. PREVENTION
Exercise
Getting up out of bed as soon as possible after
an illness or surgery
Quit smoking
Wear compression stockings

30. CLINICAL CASE …

31. • A 25 year old white female reports to the
Emergency Room because of sharp left sided
chest pain and shortness of breath of one day
duration. The patient was in excellent health
until yesterday. She was awakened from her
sleep by sharp left sided chest pain. The pain
worsened with motion and deep breathing. The
pain has been progressively increasing in
severity and she now has severe left shoulder
pain. She complains of shortness of breath and
is very apprehensive about dying. She denies
any cough, fever, sputum production or
hemoptysis.

32. • She is married and had one normal delivery three
years ago. She is currently on birth control pills.
She has never been hospitalized except for labor
and delivery. Review of systems are negative. She
denies any past history of venous problems.
• She reveals having a similar transitory minor
episode of chest pain approximately one year ago
while she was in a vacation.
• She works as a computer programmer. She
smokes one pack of cigarettes a day for the past
eight years. She considers herself a social drinker.

33. ON PHYSICAL EXAMINATION
• BP=114/80 ; pulse 118 ; T= 37.0
• She appears to be in moderate respiratory
distress. She is well developed and nourished.
• Pertinent findings include a RR of 30 and
shallow breathing. There is dullness,
decreased chest expansion and decreased
breath sounds in the left base. There were no
rales or rubs.

34. CONT.
• Abdomen, pelvic and rectal exams are normal.
• The extremities reveal no evidence of edema,
cyanosis or clubbing.
• Patient has negative Homan's Sign.
• Joint exam revealed shoulder movements
complete in range. No warmth or tenderness
noted. The rest of the patient's joints are
normal.

35. FOLLOWING TESTS WERE DONE :
• ABG:
FI02 .21
pH 7.39
PCO2 30
HCO3 20
PaO2 80
SaO2 95%
No drop on Oxygen level

36. CXR reveals pleural effusion in the left base.
The left diaphragm is elevated.
Shoulder x-ray is normal.
There was a small amount of fluid in the left
pleural space.

38. Doppler exam revealed deep vein thrombosis
of the left lung , why ?

39. This patient did have CTA performed, which
confirmed presence of PE.
She was subsequently started on
anticoagulation

40. THANK YOU
Any questions?