Pulmonary Embolism: Difference between revisions
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== Mechanism of Injury / Pathological Process == | == Mechanism of Injury / Pathological Process == | ||
The initial cardiorepiratory state and size and number of emboli affects the severity of the of the change in pulmonary blood flow and respiration. a small blockage of the pulmonary artery may not be symptomatic but a large emboli can lead to several events which are deleterious the the individual. | The initial cardiorepiratory state and size and number of emboli affects the severity of the of the change in pulmonary blood flow and respiration. a small blockage of the pulmonary artery may not be symptomatic but a large emboli can lead to several events which are deleterious the the individual. The occlusion can be as a result of other emboli like air bolus , fat e.t.c. Pulmonary embolism causes wasted ventilation as it increases the alveoli dead space thus resulting in ventilation perfusion mismatch<ref name=":2">Hough, A. Physiotherapy in Respiratory Care; An evidence-based approach to respiratory and cardiac management. 3<sup>rd</sup> eds. United Kingdom: Nelson Thomes Ltd, 2001 </ref> and an increase in pulmonary artery pressures and right ventricular work.<ref>Hillegass E. Essential of Cardiopulmonary Physical Therapy. 3rd ed. Missouri,St. Louis: Saunders Elsevier. 2011</ref> Consequently, there is eventual right heart failure, accompanied by the left side of the heart due to decrease in blood volume and coronary perfusion to the left ventricle. Cardiac muscle dysfunction ensues; thus, the heart ceases to pump blood.<br> | ||
== Clinical Presentation<ref name=":2" /> == | |||
== Clinical Presentation == | |||
Pyrexia | Pyrexia | ||
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== Diagnostic Procedures == | == Diagnostic Procedures == | ||
PE is difficult to diagnose clinically as only few cases show the triad of chest pain, dyspnoea and haemoptysis <ref>Goldstein M, Cornil A. Clinical diagnosis of pulmonary embolism.Acta Chir Belg. 1986;86(2):79-83. | PE is difficult to diagnose clinically<ref name=":3">Pryor JA, Webber BA. Eds. Physiotherapy for Respiratory and Cardiac problems. 2<sup>nd</sup>edition. Churchill Livingstone, London. 1998; p47</ref> as only few cases show the triad of chest pain, dyspnoea and haemoptysis <ref>Goldstein M, Cornil A. Clinical diagnosis of pulmonary embolism.Acta Chir Belg. 1986;86(2):79-83. | ||
</ref> and some are even umsymptomatic with incidence of 2.6%<ref>Dentali F, Ageno W, Becattini C, Galli L, Gianni M, Riva N et al. Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis.Thromb Res. 2010;125(6):518-22. doi: 10.1016/j.thromres.2010.03.016. </ref> and upto 71.4% in patient with distal DVT.<ref name=":0">Krutman M, Wolosker N, Kuzniec S, de Campos Guerra JC, Tachibana A, de Almeida Mendes C. Risk of asymptomatic pulmonary embolism in patients with deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2013;1(4):370-5. doi: 10.1016/j.jvsv.2013.04.002. | </ref> and some are even umsymptomatic with incidence of 2.6%<ref>Dentali F, Ageno W, Becattini C, Galli L, Gianni M, Riva N et al. Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis.Thromb Res. 2010;125(6):518-22. doi: 10.1016/j.thromres.2010.03.016. </ref> and upto 71.4% in patient with distal DVT.<ref name=":0">Krutman M, Wolosker N, Kuzniec S, de Campos Guerra JC, Tachibana A, de Almeida Mendes C. Risk of asymptomatic pulmonary embolism in patients with deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2013;1(4):370-5. doi: 10.1016/j.jvsv.2013.04.002. | ||
</ref> | </ref> | ||
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</ref><ref name=":0" /> | </ref><ref name=":0" /> | ||
Chest X-ray may show a small pleural effusion or a peripheral wedge-shaped shadow indicating infarcted lung. | Chest X-ray may show a small pleural effusion or a peripheral wedge-shaped shadow indicating infarcted lung<ref>Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. Chest. 2000;118(1):33-8. | ||
</ref>.<ref>Shawn TSH, Yan LX, Lateef F. The chest X ray in pulmonary embolism: Westermark sign, Hampton's Hump and Palla's sign. What's the difference? Journal of Acute Disease. 2018; 7(3): 99-102 | |||
</ref> | |||
Ventilation/perfusion (V/Q) scan and 50% accurate | Ventilation/perfusion (V/Q) scan and 50% accurate | ||
Pulmonary angiography | Pulmonary angiography<ref name=":3" /> | ||
Computed tomographic angiography (CTA) which is a spiral CT with intravenous contrast medium is the best diagnostic tool as it is 90% conclusive. | Computed tomographic angiography (CTA) which is a spiral CT with intravenous contrast medium is the best diagnostic tool as it is 90% conclusive. | ||
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== Management / Interventions == | == Management / Interventions == | ||
'''Anticoagulant Therapy''' | |||
A fast acting fibrinolytic agent such as heparin should be administered. Heparin prevents blood clot progression. | |||
'''Sedation''' | |||
A sedative to decrease the patient’s anxiety and pain; | |||
'''Oxygen Therapy''' | |||
Oxygen to reduces the pulmonary artery pressure and improve PAO<sub>2</sub>. | |||
'''Embolectomy''' | |||
== Differential Diagnosis == | == Differential Diagnosis == | ||
Revision as of 11:53, 18 April 2019
Original Editor Uchechukwu Chukwuemeka
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This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (18/04/2019)
Introduction[edit | edit source]
add text here relating to clinically relevant anatomy of the condition
Causal Factors[edit | edit source]
- The main cause of PE is thrombosis dislodge and circulating in the blood stream to occlude the pulmonary artery. Blood clot can occur due to serious limb injury, surgery, prolonged bed rest and static lower limb posture for more than 6 hours.
- Cancer or cancer treatments such as chemotherapy and radiotherapy could lead to possible thrombosis formation
- Other factors are overweight and hypercholesterolaemia as it could lead to fat embolism; pregnancy as there an increase rick of PE to in the first few weeks postpartum; smoking; some hormone replacement therapy (HRT).
- PE can also arise from the right side of the heart
- Non-thrombotic materials such as amniotic fluid, fat, air, bone and organ fragments.
Mechanism of Injury / Pathological Process[edit | edit source]
The initial cardiorepiratory state and size and number of emboli affects the severity of the of the change in pulmonary blood flow and respiration. a small blockage of the pulmonary artery may not be symptomatic but a large emboli can lead to several events which are deleterious the the individual. The occlusion can be as a result of other emboli like air bolus , fat e.t.c. Pulmonary embolism causes wasted ventilation as it increases the alveoli dead space thus resulting in ventilation perfusion mismatch[1] and an increase in pulmonary artery pressures and right ventricular work.[2] Consequently, there is eventual right heart failure, accompanied by the left side of the heart due to decrease in blood volume and coronary perfusion to the left ventricle. Cardiac muscle dysfunction ensues; thus, the heart ceases to pump blood.
Clinical Presentation[1][edit | edit source]
Pyrexia
Dyspnea and/or Tachypnea
Crackle lung sound on chest auscultation
Prounced second heart sound
Pleuritic chest pain
Profuse sweating
Cough with hemoptysis
Tachycardia with rapid feeble pulse, arrhythmia
Hypotension, lightheadedness, dizziness (occasionally induced
by exercise only)
Syncope
Cyanosis
Diagnostic Procedures[edit | edit source]
PE is difficult to diagnose clinically[3] as only few cases show the triad of chest pain, dyspnoea and haemoptysis [4] and some are even umsymptomatic with incidence of 2.6%[5] and upto 71.4% in patient with distal DVT.[6]
A test such as D-dimer and Doppler Ultrasound.to for thrombosis as more than 70% of patients with PE also has DVT[7][6]
Chest X-ray may show a small pleural effusion or a peripheral wedge-shaped shadow indicating infarcted lung[8].[9]
Ventilation/perfusion (V/Q) scan and 50% accurate
Pulmonary angiography[3]
Computed tomographic angiography (CTA) which is a spiral CT with intravenous contrast medium is the best diagnostic tool as it is 90% conclusive.
MRI is another option used if there fear of harm from other procedures especially in pregnant women.
Outcome Measures[edit | edit source]
Duke Anticoagulation Satisfaction Scale (DASS) [10][11]
Perception of Anticoagulation Treatment Questionnaire (PACT-Q).[10]
Management / Interventions[edit | edit source]
Anticoagulant Therapy
A fast acting fibrinolytic agent such as heparin should be administered. Heparin prevents blood clot progression.
Sedation
A sedative to decrease the patient’s anxiety and pain;
Oxygen Therapy
Oxygen to reduces the pulmonary artery pressure and improve PAO2.
Embolectomy
Differential Diagnosis[edit | edit source]
add text here relating to the differential diagnosis of this condition
Resources[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ 1.0 1.1 Hough, A. Physiotherapy in Respiratory Care; An evidence-based approach to respiratory and cardiac management. 3rd eds. United Kingdom: Nelson Thomes Ltd, 2001
- ↑ Hillegass E. Essential of Cardiopulmonary Physical Therapy. 3rd ed. Missouri,St. Louis: Saunders Elsevier. 2011
- ↑ 3.0 3.1 Pryor JA, Webber BA. Eds. Physiotherapy for Respiratory and Cardiac problems. 2ndedition. Churchill Livingstone, London. 1998; p47
- ↑ Goldstein M, Cornil A. Clinical diagnosis of pulmonary embolism.Acta Chir Belg. 1986;86(2):79-83.
- ↑ Dentali F, Ageno W, Becattini C, Galli L, Gianni M, Riva N et al. Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis.Thromb Res. 2010;125(6):518-22. doi: 10.1016/j.thromres.2010.03.016.
- ↑ 6.0 6.1 Krutman M, Wolosker N, Kuzniec S, de Campos Guerra JC, Tachibana A, de Almeida Mendes C. Risk of asymptomatic pulmonary embolism in patients with deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2013;1(4):370-5. doi: 10.1016/j.jvsv.2013.04.002.
- ↑ Edmondson, R. The causes and management of pulmonary embolism. Care Crit. Ill. 1194; 10:26-9.
- ↑ Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry. Chest. 2000;118(1):33-8.
- ↑ Shawn TSH, Yan LX, Lateef F. The chest X ray in pulmonary embolism: Westermark sign, Hampton's Hump and Palla's sign. What's the difference? Journal of Acute Disease. 2018; 7(3): 99-102
- ↑ 10.0 10.1 Essers BA, Prins MH. Methods to measure treatment satisfaction in patients with pulmonary embolism or deep venous thrombosis. Curr Opin Pulm Med. 2010;16(5):437-41.
- ↑ Samsa G, Matchar DB, Dolor RJ, Wiklund I. Hedner E, Wygant G et al. A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation. Health Qual Life Outcomes. 2004; 2: 22. doi: 10.1186/1477-7525-2-22
