Pulmonary Thromboembolism Pathophysiology Clinical Features with Treatment

Pulmonary Thromboembolism

Pulmonary thromboembolism 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, tumor, air, or fat ) that originated elsewhere in the body.
  • Acute pulmonary embolism (PE) is a common and often fatal disease.
  • Unfortunately, the clinical presentation of PE is variable and nonspecific, making accurate diagnosis difficult.
  • Mortality can be reduced by prompt diagnosis and therapy.
  • Air travel
  • preventing pulmonary embolism
  • obesity
  • Cigarette smoking Oral contraceptives Pregnancy
  • Surgery
  • Traum
  • Antiphospholipid antibody syndrome
  • Cancer ‘.
  • Systemic
  • hypertension
  • COPD.

Pulmonary Thromboembolism

Pulmonary Thromboembolism Pathophysiology Clinical Features with Treatment


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 ASD 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 system of the lower extremities.
  • There is right heart failure, decreased LV output, coro­nary artery hypoperfusion, circulatory collapse and death.
  • However, they may also originate in the right heart or the pelvic, renal, 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 drug 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 complication 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
  • Fever
  • Chest pain
  • Angina pectoris
  • Hypotension
  • Tachycardia
  • Distended neck veins
  • Loud P, (loud pulmonary component of second heart sound)
  • RV failure.
  • Massive PE may be accompanied by acute right ventricular failure, manifested by increased jugular venous pressure,
  • The most common symptoms were dyspnea at rest or with exertion
  • Circulatory collapse was uncommon
  • Symptoms or signs 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.
  • ECG:

    • shows sinus tachycardia, AF(atrial fibrillation), 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 angiography using gadolinium
    • . is non-nephrotoxic, safe, and shows organic as well as functional lung disease.
  • Echocardiography :

    • evidence of MI, cardiac 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 heparin.
  • 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.
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