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Pulmonary Embolism 1.pptx
- 7. Adm for CCF or AF over the past 3 mo Major trauma PreviousVTE Central venous lines Intravenous catheters and leads Cancer (high risk of Mets) Chemotherapy CCF or Resp Failure Post-partum period Hormone replacement therapy Oral contraceptive therapy Immobility due to sitting
- 14. • A dyspnoeic patient with raised JVP and clear lung fields on auscultation is suggestive of Right Heart Failure.
- 15. ehz405.pdf
- 31. ehz405.pdf
- 44. • Balance between risk of recurrence and anticoagulant-related bleeding.
Editor's Notes
- The other pulmonary diseases of vascular origin are 1. Pulmonary Hypertension 2. Diffuse Alveolar Hemorrhage Syndromes. Less common types of emboli – fat droplets, bubbles of air or nitrogen, atherosclerosis, tumor fragments, bone marrow fragments and amniotic fluid. PE & DVT are same disease occurring at different parts of the body.
- (VTE), clinically presenting as DVT or PE, is globally the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke Approximately one-third of patients with VTE present with PE, and two-thirds present with DVT Mortality rate of PE – 200,000 per year in the USA --------Most cases are not diagnosed before death
- > 95% of PE originate from deep veins of the lower limbs
- The three primary abnormality that leads to formation of thrombus are Endothelial injury a. Exposes subendothelium b. Reduces anticoagulants c. Increases procoagulants Abnormal blood flow (Turbulence and Stasis) --- Turbulent blood flow cause arterial or cardiac thrombosis Endothelial cell activation Contact of platelet and WBC with endothelial cells. Slow washout of clotting factors Hypercoagulability Predisposes patient to forming thrombus b. Genetic or Acquired 2. Based on the virchows triad one can carve out the various risk factors of VTE.
- 4.8 c
- Most thrombus formed in veins are formed in the deep veins of the lower limbs Migrating thrombus that are formed in these deep veins eventually end up in the pulmonary vascular bed
- When an area of visceral pleura is also deprived of blood, it becomes infl amed (pleuritis) and irritates or becomes fused to the sensitive parietal pleura, resulting in pain. In central PE, chest pain may have a typical angina character, possibly reflecting RV ischaemia, andrequiring differential diagnosis from an acute coronary syndrome or aortic dissection.
- The diagnosis of pulmonary embolism should be sought actively in patients with respiratory symptoms unexplained by an alternative diagnosis.
- High negative predictive value The value of the D-dimer assay resides with a negative test result that suggests a lower likelihood of DVT or PE Raid diagnostic test
- If symptoms have been present for 3 days or more, pulmonary infarction sometimes shows an apex-central, pleural-based, wedge-shaped area of infiltrate, producing the Hampton’s hump finding
- Pericardial tamponade, acute valvular dysfunction, LV dysfunction etc.
- However, the most important contribution of CT-based assessment of a patient with suspected PE is visualization of the entire thoracic cavity and, hence, ruling out of any other potential pathologies as part of the differential diagnosis-----lung parenchyma (inflammation, tumour, emphysema and the above lung infarction), mediastinum (tumours, inflammation, pneumomediastinum), pleural cavity (fluidothorax, pneumothorax, tumours), pericardial space (fluidopericardium, pericardial tumours), and the thoracic aorta (aneurysm, aortic dissection, coarctation of the aorta
- The diagnosis of acute PE is based on direct evidence of a thrombus in two projections, either as a filling defect or as amputation of a pulmonary arterial branch. Thrombi as small as 1 - 2 mm within the subsegmental arteries can be visualized by digital subtraction angiography, but there is substantial interobserver variability at this level
- Why isit called compression USG
- Obstructive shock is a form of shock associated with physical obstruction of the great vessels or the heart itself