1) Pulmonary embolism is the third most common cause of death and second most common cause of unexpected death, with an incidence of 355,000 cases per year and 240,000 deaths per year in the US.
2) Clinical presentation can include chest pain, dyspnea, tachycardia, syncope, and hemoptysis. Diagnosis is often missed due to non-specific symptoms.
3) Diagnostic tests include D-dimer, V/Q scan, CT pulmonary angiogram, pulmonary angiogram, and echocardiogram. Treatment depends on severity and includes anticoagulation, thrombolysis, catheter-directed thrombolysis, surgical embolect
This document discusses the pathophysiology and treatment of acute pulmonary embolism (PE). It covers:
- The pathophysiological effects of PE on right ventricular function and hemodynamics.
- Clinical prediction rules and diagnostic strategies for PE including D-dimer testing and imaging modalities like CT, VQ scan, and angiography.
- Treatment options for PE including anticoagulants like heparin, low molecular weight heparin, fondaparinux, and newer oral agents; as well as thrombolytics, vena cava filters, and embolectomy. LMWH is recommended as first-line treatment due to superior safety compared to unfractionated heparin
PowerPoint presentation about pulmonary embolism -- Teaching at Zagazig university cardiology department ,
Egypt in 2013 by Islam Ghanem , assistant lecturer of cardiology
Management of Massive & Submassive Pulmonary EmbolismSun Yai-Cheng
This document provides definitions and treatment recommendations for massive, submassive, and low-risk pulmonary embolism (PE). It defines massive PE as presenting with hypotension, pulselessness, or bradycardia. Submassive PE is defined as having right ventricular dysfunction or myocardial necrosis without hypotension. Low-risk PE lacks these clinical signs. Treatment depends on risk categorization and includes anticoagulation, fibrinolysis for massive/high-risk submassive PE, and catheter or surgical embolectomy for massive PE with contraindications to fibrinolysis. Inferior vena cava filters are recommended for contraindications to anticoagulation but should be retrievable.
This document summarizes pulmonary embolism (PE), including its epidemiology, risk factors, pathophysiology, clinical features, diagnostic testing, and treatment. PE is the second most common cause of unexpected death, with risk factors including recent surgery, trauma, cancer, and inherited or acquired thrombophilias. Diagnosis involves assessing clinical probability then confirming with D-dimer, imaging like CT pulmonary angiogram, or lung scintigraphy. For acute PE, initial treatment is heparin or fondaparinux followed by long-term oral anticoagulation to prevent recurrence. New oral anticoagulants targeting factor Xa provide alternatives to warfarin.
Pulmonary Embolism- Diagnosis by Dr.Tinku JosephDr.Tinku Joseph
This document discusses diagnostic tests for pulmonary embolism (PE). It describes various imaging studies including chest x-rays, V/Q scans, CT scans, pulmonary angiograms, and echocardiograms. It also discusses laboratory tests like D-dimer, troponin, and BNP levels. CT pulmonary angiography is becoming the initial test of choice due to its speed and ability to directly visualize PEs. V/Q scans remain useful in pregnant patients due to their lower radiation exposure compared to CT scans. No single test is perfect, so a combination of clinical assessment, imaging, and lab tests is usually needed to diagnose PE.
A 65-year old male smoker presented with acute worsening of breathlessness. On examination, he had a pulse of 110 beats/min, blood pressure of 130/80 mmHg, and wheezing in both lungs. Chest X-ray and CT scan showed a pulmonary embolism. Risk factors for pulmonary embolism include inherited or acquired thrombophilias, endothelial injury, stasis, and hypercoagulability. Common symptoms are related to pulmonary infarction or nonthrombotic pulmonary embolism, which can masquerade as other illnesses, complicating diagnosis.
Pulmonary embolism is a blockage in the pulmonary artery or its branches, usually caused by blood clots from deep vein thrombosis. It occurs in over 600,000 patients annually in the US and contributes to 50,000-200,000 deaths per year. Common signs and symptoms include dyspnea, chest pain, tachycardia, and hypoxia. Diagnostic tests include chest x-rays, CT scans, D-dimer tests, V/Q scans, and blood gas analysis. Treatment involves anticoagulant therapy, thrombolytic therapy, bed rest, and in severe cases, surgical embolectomy.
Pulmonary embolism (PE) is a potentially life-threatening condition with an estimated incidence between 0.5-3% in the general population. Risk factors include previous DVT, immobilization, surgery, cancer, and certain genetic conditions. Symptoms are nonspecific but commonly include dyspnea, chest pain, and cough. Diagnostic tests include D-dimer, CT pulmonary angiogram (CTPA), ventilation-perfusion scan, and pulmonary angiogram. Clinical decision rules like Wells criteria are used to determine pre-test probability to guide appropriate testing. The diagnostic algorithm involves using Wells criteria and D-dimer to determine if CTPA is needed, with CTPA used to confirm or exclude the diagnosis in
This document discusses the pathophysiology and treatment of acute pulmonary embolism (PE). It covers:
- The pathophysiological effects of PE on right ventricular function and hemodynamics.
- Clinical prediction rules and diagnostic strategies for PE including D-dimer testing and imaging modalities like CT, VQ scan, and angiography.
- Treatment options for PE including anticoagulants like heparin, low molecular weight heparin, fondaparinux, and newer oral agents; as well as thrombolytics, vena cava filters, and embolectomy. LMWH is recommended as first-line treatment due to superior safety compared to unfractionated heparin
PowerPoint presentation about pulmonary embolism -- Teaching at Zagazig university cardiology department ,
Egypt in 2013 by Islam Ghanem , assistant lecturer of cardiology
Management of Massive & Submassive Pulmonary EmbolismSun Yai-Cheng
This document provides definitions and treatment recommendations for massive, submassive, and low-risk pulmonary embolism (PE). It defines massive PE as presenting with hypotension, pulselessness, or bradycardia. Submassive PE is defined as having right ventricular dysfunction or myocardial necrosis without hypotension. Low-risk PE lacks these clinical signs. Treatment depends on risk categorization and includes anticoagulation, fibrinolysis for massive/high-risk submassive PE, and catheter or surgical embolectomy for massive PE with contraindications to fibrinolysis. Inferior vena cava filters are recommended for contraindications to anticoagulation but should be retrievable.
This document summarizes pulmonary embolism (PE), including its epidemiology, risk factors, pathophysiology, clinical features, diagnostic testing, and treatment. PE is the second most common cause of unexpected death, with risk factors including recent surgery, trauma, cancer, and inherited or acquired thrombophilias. Diagnosis involves assessing clinical probability then confirming with D-dimer, imaging like CT pulmonary angiogram, or lung scintigraphy. For acute PE, initial treatment is heparin or fondaparinux followed by long-term oral anticoagulation to prevent recurrence. New oral anticoagulants targeting factor Xa provide alternatives to warfarin.
Pulmonary Embolism- Diagnosis by Dr.Tinku JosephDr.Tinku Joseph
This document discusses diagnostic tests for pulmonary embolism (PE). It describes various imaging studies including chest x-rays, V/Q scans, CT scans, pulmonary angiograms, and echocardiograms. It also discusses laboratory tests like D-dimer, troponin, and BNP levels. CT pulmonary angiography is becoming the initial test of choice due to its speed and ability to directly visualize PEs. V/Q scans remain useful in pregnant patients due to their lower radiation exposure compared to CT scans. No single test is perfect, so a combination of clinical assessment, imaging, and lab tests is usually needed to diagnose PE.
A 65-year old male smoker presented with acute worsening of breathlessness. On examination, he had a pulse of 110 beats/min, blood pressure of 130/80 mmHg, and wheezing in both lungs. Chest X-ray and CT scan showed a pulmonary embolism. Risk factors for pulmonary embolism include inherited or acquired thrombophilias, endothelial injury, stasis, and hypercoagulability. Common symptoms are related to pulmonary infarction or nonthrombotic pulmonary embolism, which can masquerade as other illnesses, complicating diagnosis.
Pulmonary embolism is a blockage in the pulmonary artery or its branches, usually caused by blood clots from deep vein thrombosis. It occurs in over 600,000 patients annually in the US and contributes to 50,000-200,000 deaths per year. Common signs and symptoms include dyspnea, chest pain, tachycardia, and hypoxia. Diagnostic tests include chest x-rays, CT scans, D-dimer tests, V/Q scans, and blood gas analysis. Treatment involves anticoagulant therapy, thrombolytic therapy, bed rest, and in severe cases, surgical embolectomy.
Pulmonary embolism (PE) is a potentially life-threatening condition with an estimated incidence between 0.5-3% in the general population. Risk factors include previous DVT, immobilization, surgery, cancer, and certain genetic conditions. Symptoms are nonspecific but commonly include dyspnea, chest pain, and cough. Diagnostic tests include D-dimer, CT pulmonary angiogram (CTPA), ventilation-perfusion scan, and pulmonary angiogram. Clinical decision rules like Wells criteria are used to determine pre-test probability to guide appropriate testing. The diagnostic algorithm involves using Wells criteria and D-dimer to determine if CTPA is needed, with CTPA used to confirm or exclude the diagnosis in
1. Imaging plays a key role in the diagnosis of pulmonary embolism (PE), with computed tomography pulmonary angiography (CTPA) now considered the gold standard.
2. Other modalities discussed include ventilation-perfusion scintigraphy, venous ultrasound, echocardiography, and magnetic resonance imaging/angiography, each with their own strengths and limitations for diagnosing PE.
3. Dual-energy CT is highlighted as a promising technique that provides both anatomic and functional information about PE through iodine mapping and perfusion imaging.
The document summarizes advances in pulmonary embolism imaging. It reviews the importance of clinical prediction scores and various imaging modalities for diagnosing pulmonary embolism such as CT pulmonary angiography, ventilation-perfusion scanning, ultrasound, and MRI. It also discusses findings on CT imaging including signs of right ventricular strain and thrombus burden. New techniques such as low-dose CT and dual-energy CT are introduced.
The document discusses diagnostic criteria for acute and chronic pulmonary embolism (PE) based on CT imaging findings. For acute PE, findings include complete arterial occlusion seen as an enlarged artery, partial filling defects known as the "polo mint" or "railway track" signs, and peripheral intraluminal defects. Chronic PE criteria consist of complete occlusions that are smaller than adjacent vessels, peripheral crescent-shaped defects, recanalized smaller arteries, webs or flaps, and bronchial collaterals. The document also reviews methods of assessing PE severity including pulmonary artery clot load scores and signs of right heart strain. Common causes of misdiagnosing PE include mimic pathologies and technical imaging factors.
Pulmonary embolism is a potentially deadly condition caused by blood clots in the lungs. It is difficult to diagnose due to non-specific symptoms. Imaging tests like CT scans and ventilation-perfusion scans are used to identify clots in the lungs. Prompt diagnosis and treatment are important to reduce the high mortality rate associated with untreated pulmonary embolism.
This document summarizes the diagnostic criteria and causes of misdiagnosis for computed tomography angiography (CTA) of pulmonary embolism (PE). It outlines the diagnostic criteria for acute and chronic PE seen on CTA images, including signs such as intraluminal filling defects and vessel occlusion. It then discusses numerous technical, anatomic and pathological factors that can cause misdiagnosis of PE on CTA images, such as respiratory motion artifact, image noise, vascular bifurcations and lymph node enlargement. Patient-related, equipment and interpretation factors are all reviewed in detail to help reduce incorrect diagnosis.
This document discusses imaging in pulmonary embolism. It begins with background information on pulmonary embolism, noting that it is a life-threatening condition caused by blood clots blocking arteries in the lungs. It then reviews facts about the prevalence and mortality of pulmonary embolism. The document then discusses various imaging modalities for pulmonary embolism including chest x-rays, ultrasound, V/Q scans, CT pulmonary angiography, and echocardiography. It provides details on the techniques and findings of these different tests.
A 58-year-old female presented to the emergency room with anxiety and shortness of breath after climbing stairs. She has been feeling stressed due to social stressors and recently took a trip to Italy. On examination, she was tachycardic but her lungs were clear to auscultation. A chest x-ray showed blunted costophrenic sulci and opacity of the left lung bases indicating increased blood flow to the left lung. The patient was given oxygen and intravenous fluids, and anticoagulation therapy was started given her risk for pulmonary embolism.
Presentation1.pptx, radiological imaging of pulmonary embolism.Abdellah Nazeer
This document discusses pulmonary embolism (PE), which occurs when a blood clot or other substance blocks a pulmonary artery in the lungs. PE is commonly caused by deep vein thrombosis. The document outlines common symptoms of PE and risk factors. It then describes various radiological imaging techniques used to diagnose PE, including chest X-rays, CT scans, ultrasound, V/Q scans, pulmonary angiograms, and MRI. The document discusses diagnostic criteria for PE on CT imaging and provides examples of images showing acute and chronic PE. It also covers D-dimer testing and describes the appearance of massive, saddle, and bilateral PE on CT scans.
1) A prospective multicenter study evaluated the use of thoracic ultrasound (TUS) to diagnose pulmonary embolism (PE) in 352 patients with clinically suspected PE.
2) TUS identified PE in 194 patients (55%), with CT pulmonary angiography used as the reference standard. TUS visualized more lung lesions than CT on average.
3) TUS criteria for diagnosing PE included seeing two or more typical subpleural triangular or rounded hypoechoic lesions, or one such lesion with a pleural effusion.
(250ml/5mins)
250ml/ 5mins or transfusion
1) This document provides guidance on evaluating and treating shock in patients. It discusses the different types of shock (hypovolemic, cardiogenic, distributive), their causes, signs, and treatments.
2) The initial approach involves taking a thorough history, performing a full physical exam, and obtaining basic lab tests to help identify the type and cause of shock.
3) Mixed venous oxygen saturation (SvO2) and central venous pressure (CVP) measurements can help guide fluid resuscitation and vasopressor use depending on whether the values are low or normal. Fluid challenges are recommended initially
CT Angiography is an important technique for diagnosing pulmonary embolism (PE). It allows direct visualization of blood clots in the lungs. A 16-slice CT scan can cover the entire chest in less than 10 seconds with 1mm resolution, evaluating vessels down to the 6th order branches. While CTPA is fast, non-invasive and highly sensitive and specific, limitations include potential allergic reactions to contrast dye or risks for patients with kidney problems or pregnancy. Proper technique including timing of contrast injection is important to avoid motion artifacts.
1) Pulmonary embolism occurs when a blood clot lodges in the pulmonary arteries, often originating from deep vein thromboses. It can be difficult to diagnose due to non-specific symptoms.
2) Evaluation involves assessing clinical probability, D-dimer levels, and imaging. D-dimers are elevated in pulmonary embolism but nonspecific. Imaging options include CT pulmonary angiography, ventilation-perfusion scanning, and pulmonary angiography.
3) CT pulmonary angiography has become the initial test of choice due to its high sensitivity and specificity for detecting emboli as well as being readily available and minimally invasive. Ventilation-perfusion scanning provides functional information and has a lower radiation dose
The document discusses pulmonary embolism (PE), which is a blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body, such as a blood clot. Deep vein thrombosis (DVT) in the legs is the most common source of PE. Key signs and symptoms of PE include shortness of breath, chest pain, and tachycardia. Diagnostic tests include chest x-rays, CT scans, ventilation-perfusion scans, echocardiograms, and D-dimer tests. Treatment focuses on anticoagulation medications to prevent further clotting.
This document summarizes CT findings that are useful for diagnosing chronic pulmonary thromboembolism (CPTE). It describes risk factors, clinical manifestations, and CT features of CPTE including vascular signs like pulmonary artery obstruction and dilation, parenchymal signs like scarring and mosaic perfusion patterns, and signs of pulmonary hypertension. Differential diagnoses including idiopathic pulmonary hypertension and acute PE are also discussed. CT is important for identifying treatable CPTE in patients with unexplained pulmonary hypertension.
Pulmonary embolism - Diagnosis and managementDr Vivek Baliga
Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
This document summarizes pulmonary embolism (PE), including epidemiology, symptoms, diagnostic criteria like the Wells criteria and PERC rule, diagnostic tests like CT pulmonary angiography and V/Q scan, treatment with anticoagulation and thrombolytics, and classifications of massive versus submassive PE.
Pulmonary embolism (PE) is a common clinical disorder associated with high morbidity and mortality. PE occurs when deep vein thrombi detach and embolize to the pulmonary circulation, obstructing blood flow and impairing gas exchange. Clinical presentation of PE is variable but often includes dyspnea, tachypnea, tachycardia, and pleuritic chest pain. Diagnosis involves assessment of clinical probability, d-dimer testing, imaging studies like CT pulmonary angiography, ventilation-perfusion scanning, echocardiography and assessment of right ventricular function. Prompt diagnosis and treatment are important to prevent complications including right heart failure and death.
Pulmonary embolism is caused by a blockage in the pulmonary artery from substances traveling through the bloodstream, most commonly from deep vein thrombosis. It is a common and potentially lethal condition. Diagnosis is challenging as symptoms are non-specific and it is often overlooked or missed. Imaging tests like CT pulmonary angiography, ventilation-perfusion scans, and pulmonary angiography are used to diagnose pulmonary embolism, while ultrasound of the legs can identify deep vein thrombosis, a major risk factor. Prompt diagnosis and treatment are important to prevent mortality from this potentially serious condition.
This document provides an overview of pulmonary embolism (PE). It discusses the historical context, pathophysiology, risk factors, clinical presentation, diagnostic testing and treatment of PE. Some key points include:
- PE is a common cause of preventable death, with over 600,000 cases annually in the US.
- Virchow's triad of hypercoagulability, stasis, and endothelial injury contributes to the development of PE.
- Clinical presentation is often nonspecific, and the classic triad of symptoms occurs in less than 20% of cases.
- Diagnostic testing includes D-dimer, chest CT, ventilation-perfusion scanning and pulmonary angiography. Early treatment with antico
1. Imaging plays a key role in the diagnosis of pulmonary embolism (PE), with computed tomography pulmonary angiography (CTPA) now considered the gold standard.
2. Other modalities discussed include ventilation-perfusion scintigraphy, venous ultrasound, echocardiography, and magnetic resonance imaging/angiography, each with their own strengths and limitations for diagnosing PE.
3. Dual-energy CT is highlighted as a promising technique that provides both anatomic and functional information about PE through iodine mapping and perfusion imaging.
The document summarizes advances in pulmonary embolism imaging. It reviews the importance of clinical prediction scores and various imaging modalities for diagnosing pulmonary embolism such as CT pulmonary angiography, ventilation-perfusion scanning, ultrasound, and MRI. It also discusses findings on CT imaging including signs of right ventricular strain and thrombus burden. New techniques such as low-dose CT and dual-energy CT are introduced.
The document discusses diagnostic criteria for acute and chronic pulmonary embolism (PE) based on CT imaging findings. For acute PE, findings include complete arterial occlusion seen as an enlarged artery, partial filling defects known as the "polo mint" or "railway track" signs, and peripheral intraluminal defects. Chronic PE criteria consist of complete occlusions that are smaller than adjacent vessels, peripheral crescent-shaped defects, recanalized smaller arteries, webs or flaps, and bronchial collaterals. The document also reviews methods of assessing PE severity including pulmonary artery clot load scores and signs of right heart strain. Common causes of misdiagnosing PE include mimic pathologies and technical imaging factors.
Pulmonary embolism is a potentially deadly condition caused by blood clots in the lungs. It is difficult to diagnose due to non-specific symptoms. Imaging tests like CT scans and ventilation-perfusion scans are used to identify clots in the lungs. Prompt diagnosis and treatment are important to reduce the high mortality rate associated with untreated pulmonary embolism.
This document summarizes the diagnostic criteria and causes of misdiagnosis for computed tomography angiography (CTA) of pulmonary embolism (PE). It outlines the diagnostic criteria for acute and chronic PE seen on CTA images, including signs such as intraluminal filling defects and vessel occlusion. It then discusses numerous technical, anatomic and pathological factors that can cause misdiagnosis of PE on CTA images, such as respiratory motion artifact, image noise, vascular bifurcations and lymph node enlargement. Patient-related, equipment and interpretation factors are all reviewed in detail to help reduce incorrect diagnosis.
This document discusses imaging in pulmonary embolism. It begins with background information on pulmonary embolism, noting that it is a life-threatening condition caused by blood clots blocking arteries in the lungs. It then reviews facts about the prevalence and mortality of pulmonary embolism. The document then discusses various imaging modalities for pulmonary embolism including chest x-rays, ultrasound, V/Q scans, CT pulmonary angiography, and echocardiography. It provides details on the techniques and findings of these different tests.
A 58-year-old female presented to the emergency room with anxiety and shortness of breath after climbing stairs. She has been feeling stressed due to social stressors and recently took a trip to Italy. On examination, she was tachycardic but her lungs were clear to auscultation. A chest x-ray showed blunted costophrenic sulci and opacity of the left lung bases indicating increased blood flow to the left lung. The patient was given oxygen and intravenous fluids, and anticoagulation therapy was started given her risk for pulmonary embolism.
Presentation1.pptx, radiological imaging of pulmonary embolism.Abdellah Nazeer
This document discusses pulmonary embolism (PE), which occurs when a blood clot or other substance blocks a pulmonary artery in the lungs. PE is commonly caused by deep vein thrombosis. The document outlines common symptoms of PE and risk factors. It then describes various radiological imaging techniques used to diagnose PE, including chest X-rays, CT scans, ultrasound, V/Q scans, pulmonary angiograms, and MRI. The document discusses diagnostic criteria for PE on CT imaging and provides examples of images showing acute and chronic PE. It also covers D-dimer testing and describes the appearance of massive, saddle, and bilateral PE on CT scans.
1) A prospective multicenter study evaluated the use of thoracic ultrasound (TUS) to diagnose pulmonary embolism (PE) in 352 patients with clinically suspected PE.
2) TUS identified PE in 194 patients (55%), with CT pulmonary angiography used as the reference standard. TUS visualized more lung lesions than CT on average.
3) TUS criteria for diagnosing PE included seeing two or more typical subpleural triangular or rounded hypoechoic lesions, or one such lesion with a pleural effusion.
(250ml/5mins)
250ml/ 5mins or transfusion
1) This document provides guidance on evaluating and treating shock in patients. It discusses the different types of shock (hypovolemic, cardiogenic, distributive), their causes, signs, and treatments.
2) The initial approach involves taking a thorough history, performing a full physical exam, and obtaining basic lab tests to help identify the type and cause of shock.
3) Mixed venous oxygen saturation (SvO2) and central venous pressure (CVP) measurements can help guide fluid resuscitation and vasopressor use depending on whether the values are low or normal. Fluid challenges are recommended initially
CT Angiography is an important technique for diagnosing pulmonary embolism (PE). It allows direct visualization of blood clots in the lungs. A 16-slice CT scan can cover the entire chest in less than 10 seconds with 1mm resolution, evaluating vessels down to the 6th order branches. While CTPA is fast, non-invasive and highly sensitive and specific, limitations include potential allergic reactions to contrast dye or risks for patients with kidney problems or pregnancy. Proper technique including timing of contrast injection is important to avoid motion artifacts.
1) Pulmonary embolism occurs when a blood clot lodges in the pulmonary arteries, often originating from deep vein thromboses. It can be difficult to diagnose due to non-specific symptoms.
2) Evaluation involves assessing clinical probability, D-dimer levels, and imaging. D-dimers are elevated in pulmonary embolism but nonspecific. Imaging options include CT pulmonary angiography, ventilation-perfusion scanning, and pulmonary angiography.
3) CT pulmonary angiography has become the initial test of choice due to its high sensitivity and specificity for detecting emboli as well as being readily available and minimally invasive. Ventilation-perfusion scanning provides functional information and has a lower radiation dose
The document discusses pulmonary embolism (PE), which is a blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body, such as a blood clot. Deep vein thrombosis (DVT) in the legs is the most common source of PE. Key signs and symptoms of PE include shortness of breath, chest pain, and tachycardia. Diagnostic tests include chest x-rays, CT scans, ventilation-perfusion scans, echocardiograms, and D-dimer tests. Treatment focuses on anticoagulation medications to prevent further clotting.
This document summarizes CT findings that are useful for diagnosing chronic pulmonary thromboembolism (CPTE). It describes risk factors, clinical manifestations, and CT features of CPTE including vascular signs like pulmonary artery obstruction and dilation, parenchymal signs like scarring and mosaic perfusion patterns, and signs of pulmonary hypertension. Differential diagnoses including idiopathic pulmonary hypertension and acute PE are also discussed. CT is important for identifying treatable CPTE in patients with unexplained pulmonary hypertension.
Pulmonary embolism - Diagnosis and managementDr Vivek Baliga
Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
This document summarizes pulmonary embolism (PE), including epidemiology, symptoms, diagnostic criteria like the Wells criteria and PERC rule, diagnostic tests like CT pulmonary angiography and V/Q scan, treatment with anticoagulation and thrombolytics, and classifications of massive versus submassive PE.
Pulmonary embolism (PE) is a common clinical disorder associated with high morbidity and mortality. PE occurs when deep vein thrombi detach and embolize to the pulmonary circulation, obstructing blood flow and impairing gas exchange. Clinical presentation of PE is variable but often includes dyspnea, tachypnea, tachycardia, and pleuritic chest pain. Diagnosis involves assessment of clinical probability, d-dimer testing, imaging studies like CT pulmonary angiography, ventilation-perfusion scanning, echocardiography and assessment of right ventricular function. Prompt diagnosis and treatment are important to prevent complications including right heart failure and death.
Pulmonary embolism is caused by a blockage in the pulmonary artery from substances traveling through the bloodstream, most commonly from deep vein thrombosis. It is a common and potentially lethal condition. Diagnosis is challenging as symptoms are non-specific and it is often overlooked or missed. Imaging tests like CT pulmonary angiography, ventilation-perfusion scans, and pulmonary angiography are used to diagnose pulmonary embolism, while ultrasound of the legs can identify deep vein thrombosis, a major risk factor. Prompt diagnosis and treatment are important to prevent mortality from this potentially serious condition.
This document provides an overview of pulmonary embolism (PE). It discusses the historical context, pathophysiology, risk factors, clinical presentation, diagnostic testing and treatment of PE. Some key points include:
- PE is a common cause of preventable death, with over 600,000 cases annually in the US.
- Virchow's triad of hypercoagulability, stasis, and endothelial injury contributes to the development of PE.
- Clinical presentation is often nonspecific, and the classic triad of symptoms occurs in less than 20% of cases.
- Diagnostic testing includes D-dimer, chest CT, ventilation-perfusion scanning and pulmonary angiography. Early treatment with antico
Pulmonary embolism (PE) is a common and potentially deadly condition where blood clots block the pulmonary arteries in the lungs. The document discusses the pathophysiology, risk factors, clinical presentation and diagnostic workup of PE. Treatment involves anticoagulation with heparin or warfarin to prevent further clotting. A simplified diagnostic algorithm is proposed utilizing pre-test probability, D-dimer testing and CT angiography to efficiently evaluate for PE.
This document discusses acute pulmonary embolism (PE), including its presentation, risk factors, diagnostic workup, and management. PE is a potentially life-threatening condition that is often missed or difficult to diagnose due to vague symptoms. Timely treatment is important as untreated PE has a 20-30% mortality rate. Diagnostic tests include D-dimer, CT pulmonary angiogram, ventilation-perfusion scan, and angiogram. Initial treatment involves anticoagulation with heparin or fondaparinux. Long-term anticoagulation with warfarin is recommended to prevent recurrence. Thrombolysis or embolectomy may be considered for massive PE with hemodynamic instability.
Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE), represent a major global health problem. VTE has significant morbidity and mortality but is also potentially treatable. The incidence of VTE is increasing due to factors like population aging and higher rates of comorbidities. Risk factors for VTE include hypercoagulability, stasis, vascular injury, cancer, immobilization, and surgery. Diagnosis involves assessment of clinical probability with tools like the Wells criteria and D-dimer testing. Imaging options include ultrasound, CT, ventilation-perfusion scanning, and pulmonary angiography. Treatment involves anticoagulation with drugs like heparin or
Ischemic injury - nonclinical models of heart failureCorDynamics
The document discusses various animal models used to study heart failure, including models that induce heart failure through ischemic injury by temporarily or permanently ligating the left anterior descending coronary artery in rats and mice, as well as models that induce cardiac stress through transverse aortic constriction or isoproterenol administration. Details are provided on the surgical procedures, endpoints measured, and advantages and disadvantages of different models for studying heart failure with reduced ejection fraction.
Rodent Models of Heart Failure and Cardiac Ischemic InjuryCorDynamics
1) The document describes several animal models used to study heart failure, including models that induce heart failure through myocardial infarction or pressure overload.
2) The left anterior descending coronary artery ligation model is commonly used in rats and mice to induce myocardial infarction, producing reductions in ejection fraction that mimic human heart failure.
3) Ischemia-reperfusion injury models, where the coronary artery is temporarily occluded then reperfused, are also used and can assess treatments administered prior to or after the ischemic event.
This document discusses pulmonary embolism (PE), including:
- PE is the second most common cause of unexpected death and occurs when a thrombus blocks the pulmonary arteries.
- Risk factors include fractures, surgery, heart failure, cancer, and hereditary factors like Factor V Leiden.
- PE causes right ventricular strain and failure. Biomarkers like troponin and BNP indicate RV dysfunction.
- Diagnosis involves assessing clinical probability, D-dimer testing, CXR, CTPA, V/Q scan, echocardiogram and arterial blood gases. CTPA is now the initial recommended imaging test.
The document summarizes various congenital heart defects that can cause cyanosis in infants, including tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous return, tricuspid atresia, pulmonary atresia, and Ebstein's anomaly. It describes the characteristic features, causes, evaluations, and treatments for each condition. For the scenario presented, the assistant would start prostaglandin E1 treatment and call cardiology to perform an echocardiogram to determine the specific heart defect.
This document discusses pulmonary embolism (PE) and the use of CT angiography (CTA) for diagnosis. It provides information on the epidemiology and risk factors for PE. It describes the signs and symptoms of PE and clinical diagnostic criteria. The document outlines the technique for CTA for PE diagnosis including contrast injection parameters and common pitfalls. It details CT findings of acute, chronic and evolving PE and discusses prognostic factors seen on CTA such as right ventricular enlargement.
This document discusses acute pulmonary embolism, including its causes, symptoms, diagnosis, and treatment. It notes that PE is a leading cause of preventable hospital death and that diagnosis can be difficult due to non-specific symptoms. The diagnosis involves a clinical probability assessment, d-dimer test, and CT scan. Treatment depends on risk stratification and may involve anticoagulation, thrombolysis for massive PE, or placement of an IVC filter. Prevention through prophylaxis in at-risk patients is emphasized.
This document contains several case studies in cardiology presented by Dr. Magdi Awad Sasi from the CCU department of Octoper Hospital in Benghazi, Libya.
The first case discusses a 55-year-old man presenting with chest pain and risk factors for cardiovascular disease. The most appropriate initial diagnostic procedure is listed as cardiac catheterization.
The second case involves a 35-year-old woman who died of pulmonary embolism, and upon autopsy was found to have mitral stenosis, likely due to previous rheumatic fever.
The third case describes a 74-year-old man found to have widening of the mediastinum and aortic insufficiency murmur, indicating
This document discusses pulmonary embolism (PE), including its definition, epidemiology, pathophysiology, risk factors, diagnosis, and treatment. PE refers to obstruction of the pulmonary artery or its branches by material originating elsewhere in the body. It affects around 5 million people annually worldwide and can be life-threatening. Diagnosis involves evaluating risk factors, symptoms, imaging tests like CT scans, and blood tests like D-dimer. Timely diagnosis and treatment are important to prevent right heart failure or death from PE.
This document discusses several pulmonology cases involving medical malpractice litigation. Case 1 describes a patient who died from an undiagnosed pulmonary embolism during treatment for diabetic ketoacidosis. Case 2 involved failure to examine a leg injury that later resulted in a fatal pulmonary embolism. The document emphasizes the importance of considering pulmonary embolism in patients presenting with respiratory complaints, using validated assessment tools, and thorough documentation.
This document defines pericardial effusion and cardiac tamponade, discusses their pathophysiology, etiology, clinical presentation, investigations, and management. Pericardial effusion is an abnormal amount of fluid in the pericardial space, while cardiac tamponade is acute heart failure caused by compression of the heart from a large or rapidly developing effusion. Clinical manifestations depend on the rate of fluid accumulation and include chest pain, lightheadedness, and decreased pulse pressure. Investigations include echocardiography, electrocardiography, and pericardiocentesis. Management involves bed rest, medications, drainage procedures, and surgery in severe cases.
The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
The document describes a case of a 46-year-old male who presented with sudden onset chest and back pain that progressed to weakness in his lower extremities. Imaging revealed an aortic dissection involving the ascending aorta and descending aorta. He underwent surgery to replace the dissected ascending aorta but later developed multiple complications and died. The document also reviews the classification, presentation, risk factors, diagnosis and management of aortic dissections.
A 60-year-old male presented to the emergency department with the worst headache of his life along with nausea and vomiting. Subarachnoid hemorrhage (SAH) occurs when blood enters the subarachnoid space surrounding the brain. The most common cause is a ruptured brain aneurysm. Initial management included a CT scan, which has high sensitivity in detecting SAH, control of blood pressure to reduce risk of rebleeding, administration of nimodipine to prevent vasospasm, and neurosurgical consultation. The patient was admitted to the ICU for monitoring and treatment of potential complications of SAH such as rebleeding, vasospasm, hydrocephalus, and seizures.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic hypercoagulable states. Diagnosis involves assessing clinical probability, d-dimer testing, imaging like CT scans or V/Q scans, and echocardiography. Treatment consists of anticoagulants like heparin or warfarin to prevent further clotting while the body breaks down existing clots.
This document provides an introductory tutorial on big data in medicine and healthcare. It defines big data as large volumes of structured, semi-structured, and unstructured data that can be mined for information, often referring to sizes in petabytes and exabytes. The key dimensions of big data are described as volume, velocity, variety, and veracity. Hadoop is presented as an open-source framework for distributed storage and processing of large datasets across clusters of commodity servers. Examples of using Hadoop and MapReduce for medical applications like predictive modeling, genomic research, and data integration are also provided.
This document provides an outline on eating disorders that includes:
- A brief history noting the first descriptions of anorexia nervosa in 1873.
- Definitions of key terms like body mass index and diagnostic criteria for conditions like anorexia, bulimia, and binge eating disorder.
- Statistics on the epidemiology, gender differences, and cultural factors related to eating disorders.
- Discussions of etiology, risk factors, physical and psychological symptoms, common comorbidities, course and burden of illness, treatment approaches, and prevention strategies.
This document provides information on bipolar disorder, including its subtypes, diagnostic criteria, epidemiology, clinical presentation, etiology and risk factors, comorbidity, and treatment. It discusses bipolar disorder types I and II, as well as cyclothymic disorder. It outlines the DSM-5 diagnostic criteria for mania, hypomania, and depression. It notes the prevalence of bipolar disorder in adults and youth, gender and age of onset differences, burden of illness, and course of the disorder. It covers etiology, risk factors, and high rates of comorbidity with other psychiatric disorders. It also discusses clinical presentations, differential diagnosis, assessment, and treatment approaches including pharmacotherapy, sleep hygiene, psychosocial
EKG Patterns of SCD - Can't Miss EKG Patterns for Generalist & PsychiatristFrank Meissner
This document discusses several electrocardiogram patterns that can indicate risk of sudden cardiac death. It presents six case studies and the corresponding ECG patterns:
1) Wolf-Parkinson-White syndrome seen in a 34-year-old with palpitations, shown by a short PR interval and delta wave.
2) Brugada syndrome in a 36-year-old with chest pain, shown by ST elevation in right precordial leads.
3) Arrhythmogenic right ventricular dysplasia in a 28-year-old with dizziness, shown by epsilon waves and T wave inversion.
4) Long QT syndrome in a 44-year-old with dizziness and
1. This case presentation discusses a 27-year-old Hispanic female who presented with syncope and anemia and was ultimately diagnosed with pulmonary embolism.
2. An echocardiogram revealed signs consistent with pulmonary embolism including right ventricular dysfunction, severe tricuspid regurgitation, and elevated pressures in the inferior vena cava.
3. A CT scan showed saddle emboli in the main pulmonary artery and clots throughout both lungs. Interventional procedures discussed for treating massive pulmonary embolism when thrombolysis fails include catheter-directed techniques like embolectomy and balloon angioplasty.
This document provides an overview of pediatric delirium, including its epidemiology, clinical characteristics, diagnosis, treatment, and potential sequelae. Some key points:
- Pediatric delirium occurs in 20-30% of critically ill children and is underrecognized. It can be hyperactive, hypoactive, or mixed in presentation.
- Diagnosis involves assessing for disturbances in attention, cognition, and awareness that fluctuate and are caused by medical conditions or treatments. Scales are used to aid diagnosis.
- Treatment of hyperactive delirium involves starting low doses of haloperidol or risperidone and monitoring for side effects, while hypoactive delirium has no established treatments.
- D
1. The document discusses two case studies of patients who experienced Takotsubo cardiomyopathy, which is a type of temporary heart muscle weakening or dysfunction brought on by severe emotional or physical stress.
2. The authors propose that abnormal adult attachment, as manifested through transitional objects like a cherished vehicle, is a risk factor for later developing Takotsubo cardiomyopathy if that transitional object is lost.
3. They present models showing how unresolved or complicated grief over past losses can lead to Takotsubo cardiomyopathy months or years later if a symbolic replacement for the loss is then damaged or taken away.
1. A 48-year-old female taking amitriptyline and fluoxetine for over 5 years presented with dizziness and was found to have Type 1 Brugada syndrome on her EKG.
2. Brugada syndrome is a rare cardiac condition caused by a genetic mutation that can increase the risk of sudden cardiac death, and certain drugs including amitriptyline are known to potentially induce Brugada syndrome.
3. While baseline EKGs are often normal in Brugada syndrome, serial monitoring is recommended for patients taking drugs known to induce it, as this case highlights the potential for late onset of changes when exposed long term to triggering medications.
This document discusses the importance of cultural competence in psychiatric care for children on the Texas-Mexico border. It describes two cases of young Hispanic females who experienced hallucinations and were treated by both local curanderos (faith healers) and psychiatrists. The treatment team took time to understand the families' cultural beliefs and integrate them into the treatment plans. It emphasizes that cultural competence is essential for physicians due to increasing diversity and the role of culture in shaping illness perceptions and treatments.
- A 24-year-old male college student overdosed on Coricidin cough and cold medicine ("Triple C's") to get high, resulting in grand mal seizures. He was intubated and treated with magnesium and bicarbonate for severe lactic acidosis and prolonged QTc interval.
- "Triple C's" or dextromethorphan (DXM) is a cough suppressant that is abused for its euphoric and dissociative effects but can cause seizures, cardiac issues like prolonged QTc, and death in high doses.
- The patient required intensive care for 7 days but survived after aggressive treatment of his lactic acidosis, seizures, and prolonged QTc
This document discusses the importance of obtaining a detailed sleep history in evaluating and managing post-traumatic stress disorder (PTSD). It presents two case studies to illustrate this point. The first case involves a veteran experiencing night terrors related to combat trauma memories as well as significant dissociative experiences during the day. The second case describes a veteran with delayed onset PTSD who is experiencing REM sleep behavior disorder and progressive memory problems, suggesting an underlying neurodegenerative process. The document argues that a thorough examination of a patient's sleep phenomena, rather than just noting the presence of nightmares, can provide crucial insights into their psychological presentation and lead to improved treatment.
This document provides guidance on the initial assessment and management of a patient with burns. It details the patient's history of a 39-year-old man who suffered scalding burns after losing cold water in the shower. The physical exam found burns covering 9%, 18%, 18%, 18%, 9%, and 1% of the patient's body surface area. Key priorities for burn treatment include airway, breathing, circulation, exposing the skin, and wound care. Initial labs and assessments should evaluate for potential complications like inhalation injuries. Fluid resuscitation is critical and guidelines are provided for calculating fluid volumes based on the patient's weight, burn percentage, and urine output goals. Airway management may require intubation depending on signs
This document discusses a 27-year-old male patient presenting with fever, renal failure, and hemorrhagic symptoms who is diagnosed with Korean hemorrhagic fever (KHF). KHF is caused by hantaviruses carried by rodents. It presents initially as fever and progresses through hypotensive, oliguric, and diuretic stages. While severe cases have high mortality, intravenous ribavirin treatment was shown to reduce mortality and complications in a Chinese clinical trial. KHF and related illnesses like nephropathia epidemica are occupational hazards for those exposed to infected rodents.
This document presents a case of a 41-year-old Kenyan male presenting with wheezing, cough, and orthopnea. On exam, he has elevated blood pressure, wheezing, increased jugular venous pressure, and an abnormal EKG. The document then reviews various tropical cardiac diseases including protein-calorie malnutrition, beriberi heart disease, idiopathic cardiomyopathy, tropical endomyocardial fibrosis, pericardial diseases, rheumatic fever, and various infectious myocardiopathic diseases that can present in tropical regions.
This document discusses a case of Schistosomiasis haematobium in a 25-year-old male from Kenya. Laboratory tests found eggs of S. haematobium in the patient's urine. The document then provides details on the life cycle, epidemiology, clinical manifestations, diagnosis, and treatment of schistosomiasis. Schistosomiasis remains a major public health problem worldwide, with certain areas of Africa and the Philippines having high infection rates. Praziquantel is the treatment of choice.
The patient is a native of Kenya who recently spent 9 months in Croatia and presents with progressively decreased vision in the left eye over 3 weeks. Exam finds eczematoid dermatitis and hypopigmentation of the legs with sclerosing keratitis of the left cornea. Labs show 90% eosinophilia. The document discusses onchocerciasis, caused by the filarial nematode Onchocerca volvulus transmitted by blackflies in equatorial Africa and other regions. Clinical manifestations include skin lesions, subcutaneous nodules, and eye involvement that can lead to blindness. Diagnosis involves skin snip biopsy and treatment is diethylcarbamazine or ivermectin
- 34 year old male from Pakistan presents with fever, rigors, and sweats for 3 days after travel to Croatia 14 days prior. Physical exam is notable for fever of 102.7F but otherwise unremarkable.
- Malaria is endemic in parts of Pakistan, transmitted by several mosquito species. P. falciparum is increasing and causes the most severe disease.
- The patient likely has malaria acquired in Pakistan or Croatia, with P. falciparum or P. vivax being the most common causes. He will be treated with intravenous quinidine followed by oral therapy if parasites decrease sufficiently.
Visceral leishmaniasis is caused by the L. donovani parasite and transmitted through sandfly bites. It is endemic in parts of Asia, Africa, South America, and around the Mediterranean. The patient is a 45-year-old male from Pakistan presenting with fever, weight loss, and wasting for 4-5 weeks. Laboratory findings show anemia, thrombocytopenia, and leukopenia. Sodium stibogluconate is the first-line treatment, though amphotericin B or pentamidine may be used if initial treatment fails.
This document discusses the evaluation and diagnosis of chest pain. It notes that the chest x-ray is an important initial test that can provide clues to life-threatening causes of chest pain other than coronary artery disease. A thorough history is also essential in evaluating stable patients with chest pain. The document then lists and describes various life-threatening and non-life-threatening potential causes of chest pain, as well as abnormalities that may be seen on electrocardiogram, chest x-ray, and lab tests in different conditions.
This document discusses various types of cardiomyopathies including dilated, restrictive, hypertrophic, and infectious cardiomyopathy. It provides details on specific cases including symptoms, diagnostic studies, treatment, and prognosis. Causes of cardiomyopathy discussed include viruses, bacteria, fungi, parasites, drugs, toxins, malnutrition, and genetic factors. Infectious etiologies like Coxsackie virus are among the most common causes. Diagnosis involves echocardiogram, biopsy, and identifying an infectious agent. Treatment focuses on the underlying cause and managing heart failure symptoms.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
1. Pulmonary Embolism
For Housestaff
Heuristics, Hoopla, and Heroics
Frank W Meissner, MD, RDMS
FACP, FACC, 1 FCCP, FASNC, CPHIMS, CCDS
2. Basic Definition
MPA > Ao =>
PAH
Occlusion of pulmonary blood vessels by embolus.
2
3. Startling Facts
3rd most common cause of death
2nd most common of unexpected
death
60% of pxts dying in hospital have
P.E.
Diagnosis is missed 70% time
3
4. Incidence/
Mortality
In U.S. 355,000 cases per year
240,000 deaths per year
=> crude mortality rate 240/355
= 68%
4
5. US AMI Deaths
959.2
1,000
750
Deaths (thousands)
544.7
500
250
93.8
32.7
0
CHD Cancer Accidents HIV/AIDS
American Heart Association. Heart and Stroke Statistical Update 2007.
5
6. AMI per Day
5%
CRUDE
MORTALITY
RATE
68%
Vs CRUDE MORTALITY RATE
PE per Day
6
7. Primary Internship Heuristic
Why is my cross cover patient
not having an AMI, Pulmonary
Embolism, or Sepsis Syndrome?
If you can always explain why
NOT - you will never have
innocent blood on your hands.
7
14. Dos Heuristic
New Onset Atrial Fibrillation =
Pulmonary Embolism until proven
not to be the case
Pulmonary embolism MOST easily
corrected (obstructive) shock state
∴ never < #2 Differential Dx
Unexplained sudden shock
Collapsed patient
14
15. Clinical Syndromes
Classic Triad (Pleuritic Chest Pain,
Dyspnea, Hemoptysis) < 20% of cases
3 discrete presentations
Pulmonary Infarction
Submassive PE
Massive PE
15
16. Graphics, Labs, Images
Two Classical EKG Patterns
N0-4 Boards
S1-
Q3 RAE >2.5 mm RV
T3
= p pulmonale Strain
16
18. Classical Chest X-ray Findings
N0-4 Boards
Westermark’s
Sign
Dilitation of Pulmonary
Artery Proximal to
embolus with collapse of
distal vessels with sharp
cutoff of vessel contour
Hampton’s Hump
Triagnular or rounded
pleural-based infiltrate
with the apex toward the
hilum, usually located
adjacent to the hilum.
18
19. Pulse Ox & ABG Myths
Hypoxia
Most Pxts with PE will have nml
oximetry and nml A-a gradient
with PE
A-a gradient measure of gas
exchange
Classical finding of PE is
increased dead space ventilation
19
20. Dead Space
Ventilation
Tv 500 ml, paCO2 42 mmHg, ETCO2 40 mmHg
ETCO2 surrogate for expired CO2 ETCO2
According to Bohr Equation
Normal Alveolar Dead Space is
negligible in PE can become large
20
21. D-Dimer
A Fibrin split product
Multitude of False (+) causes
Marker of clot lysis
Circulating T1/2 approx 4-6 hr
Quantitative Assay
sensitivity 80-85%
negative predictive value 93-100%
21
32. Pulmonary
Angio
“gold standard” Test
Interluminal defect or cutoff sign
‘Court of Last Resort’
Less radiation and less dye than CT
32
33. Echo Dx of Pulm Embolism
More than 80% have R-heart Abnmlty
Direct Viz of thrombus
RV Dilatation
RV hypokinesis with apical sparing
Abnml intraventricular septal motion
TR - acute
PA Dilatation
Lack of inspiratory collapse of IVC
33
39. LE Ultrasound
Useful only if (+)
unless pxt has symptomatic LE findings
(swelling or pain) DVT Test Criteria
30-40% ‘negative’ studies Criteria Sensitivity Specificity PPV NPV
In Asymptomatic LE Thrombus 50% 92% 95% 37%
Have MD-CT Dx’ed PE Incompressible 79% 67% 88% 50%
No Spontaneous
76% 100% 100% 57%
Flow
Critical Care Ultrasonography: Levitov, Absent Phasic
92% 92% 97% 79%
Mayo, Slonim - 2009 - pg 300/Table Flow
26.1 - McGraw Hill Medical
39
40. Tables
TABLE 2
Massive PE
TABLE 1
-Systolic arterial pressure <90 mm Hg or drop in 40
Modified Wells Criteria
mm
Hg from baseline
Clinical Assessment for pulmonary embolism
-Shock manifested by signs of tissue hypoperfusion
Clinical Symptoms of DVT (leg swelling, pain with palpation)
Submassive PE
3.0
-Right ventricular dysfunction or pulmonary
Other Diagnosis less likely then pulmonary embolism 3.0
hypertension
Heart rate > 100 1.5
-Hemodynamically stable
Immobilization (≥ 3 days) or surgery in the previous 4
-No evidence of shock
weeks 1.5
Previous DVT/PE 1.5
TABLE 3
Hemoptysis 1.0
Thrombolytic Therapy Contraindications
Malignancy 1.0
Absolute
Simplified clinical probability assessment Score
History of hemorrhagic stroke
PE likely >4.0
Active intracranial neoplasm
PE unlikely ≤4.0
Recent (<2 months) intracranial surgery or trauma
Active or recent internal bleeding in prior 6 months
PERC Score Applies only to
low risk pxt Relative
(<15%) Bleeding diathesis
Age < 50 Uncontrolled severe hypertension
HR < 100 -(systolic BP >200mmHG or diastolic BP > 110mmHG)
If all 8 criteria
O2 Sat RA >94% Surgery within the previous 10 Days
are meet than
No past Hx/o DVT/PE Thrombocytopenia
clinical
No recent trauma or surgery
probability <2%
No hemoptysis
and CT imaging
No exogenous estrogen
is not necessary
No clinical signs of DVT
40
41. Immediately Administer
1) Unfractionated heparin (UH) 80 units/
kg/bolus
Diagnostic Treatment Algorithm for Suspected or followed by 18 units/kg/hr
or
2) Lovenox 1 mg/kg SQ
Diagnosed Submassive/Massive Pulmonary Embolism -Consider renal function
-Consider need for procedures or
surgery
+
TABLE 1 1) LE Dopplers 3) Stabilize patient and transfer to MICU/
Modified Wells Criteria 2)Consider SICU
TABLE 2
Pulmonary ( - ) Spiral Chest CT +
angiogram or 4) Obtain EKG
Massive PE repeat (PE Protocol CT)
Submassive PE test in 24
*Note normal troponin I and
TABLE 3
hours if
clinical
( + ) pro-BNP values have been
associated with low mortality
Thrombolytic Therapy suspicion
and anticoagulation alone may
remains high
Contraindications Echo
Echo Order
Troponin I
Echo & pro-BNP* Hemodynamically
1) IVC Filter
Unstable
2) Consider Surgical Embolectomy
Submassive PE Massive or Submassive
Hemodynamically
1) Continue UH
or Stable 1) TPA 100 mg over 2 hr
-Consider contraindications
2) Continue Lovenox
(Table 4)
-Consider renal function
or
or 2) Catheter Embolectomy/TPA
Absolute contraindication 3) TPA 100 mg over 2 hr or
anticoagulation -Consider contraindications 3) Surgical Embolectomy
(Table 3) and
or 4) UH/LMWH after 1,2,3
4) Catheter directed and
If clinical 5) Consider IVC filter
embolectomy/TPA
placement
deterioration
41