This document provides tips and instructions for using a PowerPoint presentation (PPT) on pulmonary embolism: 1. The PPT can be freely downloaded, edited, and modified. It includes some blank slides for notes. 2. The instructor should first show blank slides to elicit what students already know, then show slides with content. 3. This approach, repeating with questions and answers, allows for an active learning session. 4. The PPT can also be used for self-study, with notes and bibliography provided.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Learning Objectives

3. Learning Objectives
1. Introduction & History
2. Relevant Anatomy, Physiology
3. Aetiology
4. Pathophysiology
5. Pathology
6. Classification
7. Clinical Features
8. Investigations
9. Management
10. Prevention
11. Guidelines
12. Take home messages

4. Introduction & History.
•

5. Introduction & History.
• Embolus is a body foreign to blood stream.
• Thrombus is a clot that forms inside blood
vessel or heart.
• A thrombus that breaks loose and travels
from one location in the body to another is
called an embolus.
• Pulmonary embolism (PE) is when a
thrombus becomes lodged in an artery in the
lung and blocks blood flow to the lung.

6. Introduction & History.
• Pulmonary embolism usually arises from a
thrombus that originates in the deep venous
system of the lower extremities;
• Rarely may originate in the pelvic, renal,
upper extremity veins, or the right heart
chambers .
• After traveling to the lung, large thrombi
can lodge at the bifurcation of the main
pulmonary artery or the lobar branches and
cause hemodynamic compromise.

7. Etiology

8. Etiology
• Three primary influences predispose a
patient to blood clot formation; these form
the Virchow triad-
1. Endothelial injury
2. Stasis or turbulence of blood flow
3. Blood hypercoagulability

9. Etiology:Predisposing conditions
• Venous stasis
• Hypercoagulable
states
• Immobilization
• Surgery and trauma
• Pregnancy
• Oral contraceptives
and estrogen
replacement
• Malignancy
• Hereditary factors
• Acute medical illness
• individuals with HIV
infection individuals
with HIV infection

10. Pathophysiology

11. Pathophysiology
• Pulmonary thromboembolism is a
complication of underlying venous
thrombosis.
• To reach the lungs, thromboemboli travel
through the right side of the heart. RA, right
atrium; RV, right ventricle; LA, left atrium;
LV, left ventricle.

12. Demography

13. Demography
• The incidence of pulmonary embolism in
the United States is estimated to be 1 case
per 1000 persons per year.
• Pulmonary embolism is present in 60-80%
of patients with DVT, even though more
than half these patients are asymptomatic.
• Pulmonary embolism is the third most
common cause of death in hospitalized
patients/

14. Demography
• Pulmonary embolism is increasingly prevalent
among elderly patientsPulmonary embolism is
increasingly prevalent among elderly patients
• In patients younger than 55 years, the incidence of
pulmonary is higher in females.
• in the older population is greater among men than
women.
• higher in blacks than in whites
• whites have been 50% higher than those for
people of other races (eg, Asians, Native
Americans).
• Asian/Pacific Islanders/American Indian patients

15. Demography
• association between idiopathic pulmonary
embolism and hours spent sitting each
week.
• Frequency is increasing due to increased
use of central venous lines.
• DVT and pulmonary embolism are rare in
pediatric practice.
• Pulmonary embolism may account for 15%
of all postoperative deaths.

16. Symptoms

17. Symptoms
• The classic presentation of PE is the abrupt onset
of pleuritic chest pain, shortness of breath, and
hypoxia.
• Most patients with pulmonary embolism have no
obvious symptoms at all.
• Symptoms may vary from sudden catastrophic
hemodynamic collapse to gradually progressive
dyspnea.
• The diagnosis of pulmonary embolism should be
suspected in patients with respiratory symptoms
unexplained by an alternative diagnosis.

18. Atypical Symptoms
• Seizures
• Syncope
• Abdominal pain
• Fever
• Productive cough
• Wheezing
• Decreasing level of
consciousness
• New onset of atrial
fibrillation
• Hemoptysis
• Flank pain [1]
• Delirium (in elderly
patients) [2]

19. Physical signs
• Tachypnea
(respiratory rate
>16/min): 96%
• Rales: 58%
• Accentuated second
heart sound: 53%
• Tachycardia (heart
rate >100/min): 44%
• Fever (temperature
>37.8°C [100.04°F]):
43%
• Diaphoresis: 36%
• S3 or S4 gallop: 34%
• Clinical signs and
symptoms suggesting
thrombophlebitis: 32%
• Lower extremity
edema: 24%
• Cardiac murmur: 23%
• Cyanosis: 19

20. Massive pulmonary embolism
• Defined as presenting with a systolic arterial
pressure less than 90 mm Hg.
• As a cause of sudden death, massive pulmonary
embolism is second only to sudden cardiac death.
• The mortality for patients with massive pulmonary
embolism is between 30% and 60%,
• Autopsy studies of patients who died unexpectedly
in a hospital setting have shown approximately
80% of these patients died from massive
pulmonary embolism.

21. Prognosis

22. Prognosis
• Approximately 10% die within the first
hour, and 30% die subsequently from
recurrent embolism.
• Anticoagulant treatment decreases mortality
to less than 5%.
• The mortality in patients with undiagnosed
pulmonary embolism is 30%.

23. Investigations

24. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology
– Germ line Testing and Molecular Analysis
• Diagnostic Laparotomy.

25. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histlogy

26. Investigations
• Laboratory Studies
– Coagulogram.

27. Investigations in Malignancy
•

28. Investigations in Malignancy
• For diagnosis
• For staging
• For Screening
• For Monitoring

29. Diagnostic Studies
Imaging Studies

30. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

31. Imaging Studies
• Computed tomography angiography
• Pulmonary angiography:
• Chest radiography: nonspecific
• V/Q scanning: Ventilation Perfusion Scan.
• ECG: tachycardia and nonspecific ST-T
wave abnormalities
• MRI
• Transesophageal echocardiography .

32. Imaging Studies
• Venography:
• Duplex ultrasonography: Noninvasive
diagnosis of pulmonary embolism by
demonstrating the presence of a DVT at any
site

33. Management

34. Management
• Immediate full anticoagulation is mandatory
for all patients suspected of having DVT or
PE
• Long-term anticoagulation is critical to the
prevention of recurrence of DVT or
pulmonary embolism
• Surgical options-
– Catheter embolectomy and fragmentation or
surgical embolectomy
– Placement of vena cava filters

35. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

36. Get this ppt in mobile

37. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl
=0
• https://www.facebook.com/doctorpradeeppa
nde/?ref=pages_you_manage