Pulmonary Embolism :

I just read an article from BMJ Learning regarding the topic.


Interesting facts :


1. Mortality of Pulmonary Embolism depends on :
- the haemodynamic status of patients
- presence of Right Ventricular Failure rather than embolic size!
- cardiogenic shock


2. Risk factors of PE include
- previous thromboembolic disease
- immobilisation
- morbid obesity
- malignancy
- cardiac failure
- pregnancy
- recent surgery


2. Thrombolytic agents (e.g STK) do not actually have mortality advantage over heparin, do not result in no change in disease recurrence as well as do not reduce risk of major haemorrhage. However, Thrombolytic agent is beneficial in patients with PE & Cardiopulmonary arrest. those without cardiac compromise, no need to add thrombolytic agent. 


3. no prove that any thrombolytic agent is superior than one another in PE. however, in case of patients with circulatory compromise, STK is asscociated with worsening hypotension. 


4. route of administration of Thrombolytic agents do not matter; either via pulmonary artery catheter or peripheral administration. IV or infusion? doesnt matter which. sama saja. 


5. complication of thrombolytic agent is : HAEMORRHAGE!


6. Alternative to thrombolytic therapy : surgical embolectomy and pulmonary catheterisation


Other notes to PE :


Ivx : 
1. D dimer test - if negative, can already rule out PE. if positive, doesnt confirm PE. find  other causes of increase D-Dimer! i.e infection / inflammation


2. ECG (S1Q3T3), but the most common finding is SINUS TACHYCARDIA!


3. CXR (normally normal finding) - wedge shaped infarct - Dilatation of pulmonary vessels proximal to embolism along with collapse of distal vessels, often with a sharp cut of. Hampton's hump a pleural-based wedge shaped area of increased opacity

4. ventilation/perfusion scan - the limit is in eg COPD patient. cannot differentiate since COPD patients will have mismatch anyway. so, ct angio is better for this kind of patient!

5. CT pulmonary angiogram - gold standard!


References : 
http://www.e-radiography.net/radpath/p/pe.htm
bmj learning