vfsdvac

1. 1
UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
PULMONARY
TROMBOEMBOLIA
STUDENTS
William Cruz
Kevin Herrera
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

2. 2
Pulmonary Tromboembolia
Definition
Pulmonary embolism is a medical condition in which the sudden occlusion of the
pulmonary artery is caused by a thrombus that emerges from the deep venous system
at the lower limbs level. Venous thromboembolism encompasses deep vein
thrombosis and pulmonary embolism It is one of the three major cardiovascular
diseases along with myocardial infarction and stroke. Pulmonary thromboembolism is
the leading cause of preventable death in hospitalized patients. It is crucial that
current physicians manage to clear and treatment of this pathology, and that they
implement prophylactic schemes routinely in hospitalized patients in which they are
indicated in order to reduce mortality to a minimum.

3. 3
Etiology
In most cases (approximately 95% of them) the thrombus or clot forms in the veins of
the lower limbs and migrates to the pulmonary artery. Less frequently it can be air
(gaseous piston) or fat (fatty embolus). This occlusion mainly affects the lungs and
the heart:
 A zone of the lungs does not receive venous blood (poor in oxygen) and
therefore can not oxygenate it and this will negatively affect the oxygen that
will later reach the rest of the patient's organs and tissues.
 The heart will continue to pump blood to the lungs but as a result of such
occlusion, you will encounter an obstacle and the pressure will increase inside
the pulmonary artery, weakening the right ventricle of the heart (the heart
chamber that sends oxygen-free blood to the lungs).
The most common clinical manifestations or symptoms are dyspnea (shortness of
breath), chest pain and dizziness or fainting, although fever and coughing up blood
may also occur when accompanied by a pulmonary infarction (a lung area is necrotic
or dies as a result of lack of irrigation). When the thrombus is very large and obstructs
the main pulmonary artery it can even cause death.
Signs and symptoms
Symptoms include:
 Short of breath
 Fast breathing
 Chest pain or discomfort that usually gets worse when you cough or breathe
deeply
 Incrise of cardiac frecuency
 Cough blood
 Very low blood pressure, dizziness or fainting

4. 4
Occasionally, people with pulmonary embolism show no symptoms until they have
serious complications, such as pulmonary hypertension (high blood pressure in the
arteries of the lungs).
Diagnosis
Deep vein thrombosis occurs as pain and localized edema along the deep venous
system of the lower or upper extremities. The main complications of DVT are PE and
post-thrombotic syndrome. Superficial thrombophlebitis should also be included in
this pathological spectrum, since concomitant DVT is present in up to 25% of cases.
A D-dimer test with appropriate sensitivity (ELISA or advanced turbidimetric
method) in a patient with low clinical probability discards DVT with tranquility.
Patients with moderate or high clinical probability should undergo venous duplex
Doppler ultrasound of the entire limb to exclude or confirm the diagnosis. In central
locations such as the subclavian or pelvic region, additional images such as computed
tomography or magnetic resonance imaging may be required.
Of all the proximal DVTs of the lower extremities, 50% embolize the lung, often
asymptomatically. The symptoms that are most frequently associated with PE are
dyspnea, pleuritic chest pain, hemoptysis, syncope and cough. Upon physical
examination, patients may present tachypnea, tachycardia and hypotension. On chest
radiography (usually normal), elevated hemidiaphragm can be seen due to loss of
lung volume, segmental opacities, pleural effusion or linear atelectasis. The
electrocardiogram (altered less than 10% of the time) may show sinus tachycardia,
S1Q3T3, right QRS deviation, transient BCRD, T wave inversion, and ST-segment
depression in right-sided perchondials. In arterial blood gases, which can be normal
in up to 40% of PE, hypoxemia, hypocapnia and increased alveolar-arterial oxygen
difference may occur.

5. 5
When facing a patient with suspected PE, the risk factors and clinical elements must
be analyzed to arrive at a clinical probability bet. It is always recommended to
implement in Emergency Services some scoring system for the diagnostic probability
of PE prior to the exams (D-dimer or angioTAC). The most used is the Simplified
Wells Score (Table 1), which has a similar performance to more complex ones
(Original Wells or Revised Geneva) 1. Separates patients into two risk groups: low
and high. As in DVT, if the clinical probability is low for PE and the D-dimer is
normal, no further study or treatment is required, since the negative predictive value
(NPV) is 99%. There is current evidence that suggests that the D-dimer cut-off point
should be adjusted by age in patients over 50 years2. If the cut-off point is 500 mcg /
L, it must be multiplied by age by 10 (ie at 60 years the normal value is 600 mcg / L
and at 75, 750 mcg / L).
Treatment
Treatment in the acute or initial phase aims to stabilize the patient, relieve their
symptoms, resolve the vascular obstruction and prevent new episodes. In most cases
it is achieved with parenteral anticoagulation (administered by endovenous or
subcutaneous puncture, not oral) during the first 5-10 days. The most used medication
in these cases is heparin. In a minority of patients, usually the most critical or in those
who can not receive anticoagulants, other treatments are required such as fibrinolysis
to accelerate the dissolution of the clot or placement of a filter in the vena cava to
prevent new thrombi from migrating to the lung .
After the first days and once at home, the patient must take oral anticoagulants
(Sintrom, Xarelto, Eliquis, Pradaxa and Lixiana) for a minimum period of 3 months.
This period should be prolonged in some patients who have a higher risk of suffering
from another PE, such as those who have several predisposing risk factors or those
who have already had a second PE. In these cases anticoagulation can be even for
life.

6. 6
Prevention
The prevention of the formation of new blood clots can prevent pulmonary embolism.
Prevention can include:
 Continue to take anticoagulants: It is also important to have regular check-ups
with your doctor, to verify that the dose of your medications is working to
prevent the formation of blood clots, but at the same time not causing
bleeding
 Changes in the healthy lifestyle for the heart: as a heart-healthy diet, exercise
and, if you smoke, stop smoking
 Wear compression stockings to prevent deep vein thrombosis
 Move legs when sitting for a long time (as on long trips)
 Move as soon as possible after surgery or be bedridden.
Bibliography
 Chalikias GK, Tziakas DN, Stakos DA, Konstantidines SV. Management of
acute pulmonary embolism: A contemporary, risktailored approach. Hellenic J
Cardiol 2010; 51: 437-450.
 Jenab Y, et al. Effect of delay in hospital presentation on clinical imaging
findings in acute pulmonary thromboembolism. The Journal of Emergency
Medicine 2014; 46 (4); 465-471
Konstantidines SV, et al. 2014 ESC Guidelines on the diagnosis and management of
acute pulmonary embolism. European Heart Journal 2014; 35: 3033-