Pulmonary Thromboembolism Pathophysiology Clinical Features with Treatment

Pulmonary Thromboembolism

Pulmonary thromboembolismCOMPLICATIONS OF Acute Myocardial Infarction (AMI) AND TREATMENT -2. Read more ... » means the embo­lization and lodgment of thombi in the pulmo­nary vasculature.

Predisposing factors

• PE refers to obstruction of the pulmonary artery or one of its branches by material (eg, thrombus, tumorUses of Ayurveda for Improvement in Cancer Patients Treatment. Read more ... », air, or fat ) that originated elsewhere in the body.
• AcuteVisada Depression Ayurveda and Modern. Read more ... » pulmonary embolism (PE) is a common and often fatal diseaseVisada Depression Ayurveda and Modern. Read more ... ».
• Unfortunately, the clinicalVisada Depression Ayurveda and Modern. Read more ... » presentation of PE is variable and nonspecific, making accurate diagnosisVisada Depression Ayurveda and Modern. Read more ... » difficult.
• Mortality can be reduced by prompt diagnosis and therapy.
• Air travel
• preventing pulmonary embolism
• obesityMyxedema coma Diagnosis and Treatment. Read more ... »
• Cigarette smoking Oral contraceptivesPrimary Hypertension due to Endocrine adrenal Hypertension Adrenogenital syndrome Oral Contraceptives. Read more ... » Pregnancy
• Surgery
• Traum
• Antiphospholipid antibody syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... »
• CancerUses of Ayurveda for Improvement in Cancer Patients Treatment. Read more ... » ‘.
• Systemic
• hypertensionThyroid Disorders Examination and Laboratory tests. Read more ... »
• COPD.

Pulmonary Thromboembolism PathophysiologyAcute Myocardial Infarction (AMI) Causes PATHOPHYSIOLOGY and Etiology. Read more ... » Clinical Features with TreatmentVisada Depression Ayurveda and Modern. Read more ... »

Genetic Factors

• Autosomal dominant gene mutation – factor V Leiden and Prothrombin.

Pathophysiology of Pulmonary Thromboembolism

• Venous thrombi from pelvic and deep leg veins embolize to pulmonary arterial circulation or through patent foramen ovale j ASDAtrial Septal Defect ASD Clinical features Physical Exam with Treatment. Read more ... » to arterial circulation.
• There is increased pulmonary vascular resistance, impaired gas exchange, alveolar hyperventilation, decreased pulmonary compliance.
• Most PE arise from thrombi in the deep venous systemVisada Depression Ayurveda and Modern. Read more ... » of the lower extremities.
• There is right heartSupraventricular tachycardia and Ventricular fibrillation Causes Diagnosis with Treatment. Read more ... » failure, decreased LV output, coro­nary artery hypoperfusion, circulatory collapse and death.
• However, they may also originate in the right heart or the pelvic, renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... », or upper extremity veins.

Pulmonary Thromboembolism  EPIDEMIOLOGY —

• This study certainly underestimates the true incidence and prevalence of PE, since more than half of all PE are probably undiagnosed.
• preventing pulmonary embolism
• peripheral pulmonary stenosis, pulmonary toilet
• PE was the presumed cause of death in approximately 200,000.
• In a study of more than 42 million deaths that occurred over a 20-year duration, almost 600,000 patients (approximately 1.5 percent) were diagnosed with  PE  .

Pulmonary Thromboembolism  Clinical Features

• Embolism may be thrombus, fat embolism, tumor embolism, air embolism, IV drugVisada Depression Ayurveda and Modern. Read more ... » user substance embolism, amniotic fluid embolism.
• RISK FACTORS —
• pulmonary toilet
• While much of the data related to risk factors are from patients with DVT, a few studies have looked specifically at patients with acute PE
• PE is a common complicationHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » of deep vein thrombosis (DVT), occurring in more than 50 percent of cases with phlebographically confirmed DVT

Pulmonary Thromboembolism Symptoms and signs are

• Dyspnoea Tachypnoea Syncope
• peripheral pulmonary stenosis
•  Cyanosis
• Pleuritic pain
• Cough
• Hemoptysis
• FeverThyrotoxic crisis or Thyroid storm. Read more ... »
• Chest painApproach to Chest Pain Differential diagnosis of chest pain. Read more ... »
• Angina pectoris
• HypotensionDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... »
• TachycardiaHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... »
• Distended neck veins
• Loud P, (loud pulmonary component of second heart soundCardiac Examination Auscultation of the Heart. Read more ... »)
• RV failure.
• Massive PE may be accompanied by acute right ventricular failure, manifested by increased jugular venous pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... »,
• The most common symptomsVisada Depression Ayurveda and Modern. Read more ... » were dyspnea at rest or with exertion
• Circulatory collapse was uncommon
• Symptoms or signsVisada Depression Ayurveda and Modern. Read more ... » of lower extremity deep venous thrombosis (DVT) were common

Diagnosis of Pulmonary Thromboembolism

• Blood test:

  • Plasma D-dimer enzyme linked immuno sorbent assay (ELISA) level is increased more than 500ngjml.

• ECGSupraventricular tachycardia and Ventricular fibrillation Causes Diagnosis with Treatment. Read more ... »:

  • shows sinus tachycardiaPSVT (Paroxysmal supraventricular Tachycardia) TACHYARRHYTHMIAS SINUS TACHYCARDIA. Read more ... », AF(atrial fibrillationAtrial fibrillation Causes and Treatment Indications of DC Cardioversion. Read more ... »), S in lead 1, Q in lead 3, inverted T in lead 3.

• Chest X-ray:

  • is normal. There may be focal oligemia (decreased blood supply) called Westermark’s sign, wedge-shaped obesity called Hampton’s Hump, en­larged right descending pulmonary artery called Palla’s sign.

• Venous Doppler

  • shows DVT – Deep vein thrombo­sis.

• Chest CT :

  • Large central PE (pulmonary embolism) seen.
  • Multislice scanners can show pulmonary blood ves­sels obstruction.

• Lung scan:

  • Albuminlabeled radionuclide shows pul­monary capillary blood flow and perfusion defects.

• MRI :

  • MR pulmonary angiographyCoronary Angiography -Indications of Coronary Arteriography (Angiography). Read more ... » using gadolinium
  • . is non-nephrotoxic, safe, and shows organic as well as functional lung disease.

• Echocardiography :

  • evidence of MI, cardiacSupraventricular tachycardia and Ventricular fibrillation Causes Diagnosis with Treatment. Read more ... » tam~ ponade, RV dyskinesia, RVF seen.
  • Pulmonary angiography: may not be required.

Treatment of Pulmonary Thromboembolism

• Thrombolysis  Embolectomy
• preventing pulmonary embolism
• pulmonary catheter
• Anticoagulation with heparin, warfarin Secondary prevention of embolization by infe­rior vena cava filters NSAIDs
• Dobutamine for positive inotropic support and pulmonary vasodilatation
• Volume loading
• Low molecular weight heparinDeep Vein Thrombosis Embolizations Antiplatelet Anticoagulant Treatment Therapy. Read more ... ».

• Anticoagulation with heparin and warfarin preventing  pulmonary  embolism

  • Heparin is given along with warfarin for 5 days.
  • preventing pulmonary embolism
  • Dose of heparin is 5-10,000 units IV bolus followed by 1,000 units/hour.
  • Dose of warfarin is 5 mg dail ad’usted accordin -.10 I R.
  • Then he arin discontinued after 5 days and warfarin continued for 6 months to maintain INR of 1.5-3.

• Prevention of Pulmonary Thromboembolism

  • preventing pulmonary embolism
  • Graduated compression stockings.
  • Pneumatic compression devices .
  • prophylaxis with anticoagulants in confined patients.