Definition of "Pulmonary embolism"

Last modified: 5 days



Venous thromboembolism (VTE) is where a blood clot breaks loose and travels in blood.

Pulmonary embolism (PE, DVT/PE) is where the DVT has moved to the lungs, causing blockage of the pulmonary artery, or one of its branches, by an embolus (i.e. clot travelled from elsewhere in the bloodstream). Most commonly results from DVT (deep vein thrombosis, blood clot of the leg) that breaks off, and migrates to the lung. Can also be caused by embolus of air or fat.

Patient information

What is PE, and how is it different from VTE?
VTE is where a blood clot breaks loose, and travels in blood to cause a blockage some place else. PE is where a DVT specifically moves from the legs up into the lungs, causing a blockage in the blood vessels of the lungs.

Sx
  • SOB
  • Chest pain
  • Palpitations
  • Tachypnea
  • Tachycardia
  • Low blood oxygen

Patient information

What happens if a clot goes into the lung's blood vessels?
Well the lungs are there to help get oxygen into the blood. So a clot will cause shortness of breath, chest pain, increased breath rate. In time, oxygen in blood will decrease, and heart rate will rise to counteract these issues.

Dx
  • Wells score, to predict the likelihood of PE, which provides a score of high (>6), moderate (2-6), low (<6):
    • Clinically suspected DVT, 3 points
    • Alternative Dx is less likely than PE, 3 points
    • Tachycardia (HR>100), 1.5 points
    • Immobilization (3 days+)/surgery in past 4 weeks, 1.5 points
    • Hx of DVT/PE, 1.5 points
    • Hemoptysis, 1 point
    • Malignancy (w/ Tx w/in 6 mo) or palliative, 1 point
  • D-dimer test, although it will give false positive in recent surgery, so only do if Wells score 4-
  • CT pulmonary angiography (aka CTPA, i.e. with contrast), done if Wells score >4
  • V/Q scan (i.e. showing areas of lung ventilated, but not perfused w/ blood, due to obstruction by clot)
  • CXR, often done on Pt's w/ SOB to rule out other causes, e.g. CHF and rib fracture. CXR in PE are rarely normal, but usually lack signs suggesting the Dx of PE. Nonetheless, signs can include:
    • Westermark sign
    • Hampton hump
  • ECG to rule out other causes of chest pain (heart attack)

Patient information

How can you work out if a clot has gone into the lung's blood vessels?
D-dimer can work out if there's a blood clot that's present generally in blood, so if you don't think there's PE, you can use it to rule it out. CTPA, which is CT scan of the lungs with contrast. V/Q scan, which shows which area of the lungs are ventilated, as supposed to perfused.

What do you use ECG for?
because PE presents with chest pain, and you might want to rule out a heart attack, which can show on an ECG.

Tx
  • Prevention, including:
    • Preventative drugs
    • Anti-thrombosis stockings
  • Anticoagulants (heparin, warfarin)
  • Long term aspirin, following completion of anticoagulants in Pt's w/ prior PE

Patient information

How do you treat PE?
Anticoagulants. so heparin and warfarin.

Is an antiplatelet like aspirin useful?
Only after the anticoagulant has been used.

Complications
  • Thrombophlebitis, an inflammatory reaction usually present in the superficial veins. However, this inflammatory reaction and the WBC's play a role in the resolution of venous clots
See also

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Definition of Pulmonary embolism | Autoprac


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