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Pulmonary embolism
Classification and external resources

Chest spiral CT scan with radiocontrast agent showing multiple filling defects of principal branches of the pulmonary arteries, due to acute and chronic pulmonary embolism.
ICD-10 I26.
ICD-9 415.1
DiseasesDB 10956
MedlinePlus 000132
eMedicine med/1958 emerg/490 radio/582
MeSH D011655
.Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism).^ A PE is usually a blockage of an artery in the lungs caused by a blood clot or thrombus that travels through the bloodstream to the lungs.
  • Pulmonary embolism imaging.(DIRECTED READING) - Entrepreneur.com 15 January 2010 13:10 UTC www.entrepreneur.com [Source type: Academic]

^ An embolism is a clot that travels through the bloodstream.
  • FreeMD® Pulmonary Embolism Definition 15 January 2010 13:10 UTC www.freemd.com [Source type: Academic]

^ A pulmonary embolism (PE) is a blood clot that develops in a blood vessel elsewhere in the body (most commonly from the leg), travels to an artery in the lung, and forms an occlusion (blockage) of the artery.
  • Pulmonary Embolism 15 January 2010 13:10 UTC www.healthsystem.virginia.edu [Source type: Academic]
  • http://medicalcenter.osu.edu/patientcare/healthcare_services/lung_diseases/lung/embolism/ 15 January 2010 13:10 UTC medicalcenter.osu.edu [Source type: Academic]
  • Pulmonary Embolism 15 January 2010 13:10 UTC healthlibrary.brighamandwomens.org [Source type: Academic]
  • Southeast Missouri Hospital - Pulmonary Embolism 15 January 2010 13:10 UTC www.southeastmissourihospital.com [Source type: Academic]
  • Pulmonary Embolism - Stanford Hospital & Clinics - Stanford Medicine 15 January 2010 13:10 UTC stanfordhospital.org [Source type: Academic]
  • Pulmonary Embolism 15 January 2010 13:10 UTC www.elcaminohospital.org [Source type: Academic]
  • Pulmonary Embolism - Respiratory Disorders - The Nebraska Medical Center 15 January 2010 13:10 UTC www.nebraskamed.com [Source type: Academic]
  • Main Line Health - Pulmonary Embolism 15 January 2010 13:10 UTC www.mainlinehealth.org [Source type: Academic]
  • OHSU Health Information: Pulmonary Embolism 15 January 2010 13:10 UTC www.ohsu.edu [Source type: Academic]
  • Pulmonary Embolism | Cooper Heart Institute - Serious Cardiac Care for South Jersey 15 January 2010 13:10 UTC www.cooperhealth.org [Source type: Academic]
  • Pulmonary Embolism | Cooper University Hospital - South Jersey, New Jersey & Philadelphia 15 January 2010 13:10 UTC www.cooperhealth.org [Source type: Academic]
  • Pulmonary Embolism - Meridian Health's Wellness Center 15 January 2010 13:10 UTC wellnesscenter.meridianhealth.com [Source type: Academic]

.Usually this is due to embolism of a thrombus (blood clot) from the deep veins in the legs, a process termed venous thromboembolism.^ A pulmonary embolism , or PE, is a sudden blockage of a lung artery, usually due to a blood clot that originally forms in a deep vein of the leg.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

^ Thrombus of   the leg veins and pulmonary embolus .
  • DEEP VEIN THROMBOSIS 20 November 2009 21:38 UTC www.totaljoints.info [Source type: FILTERED WITH BAYES]

^ Diagnosing a blood clot in the leg can be...
  • Pulmonary Embolus - HealthCentral 20 November 2009 21:38 UTC www.healthcentral.com [Source type: General]

.A small proportion is due to the embolization of air, fat or amniotic fluid.^ A small proportion is due to the embolization of air, fat or amniotic fluid.
  • Pulmonary Embolism Remedies on Earth Clinic, Your Source for Natural Cures. 15 January 2010 13:10 UTC www.earthclinic.com [Source type: General]

^ Fat, air, or amniotic fluid can also cause a blockage.
  • Non-Invasive Diagnostic Protocols for Pulmonary Embolism | EmpowHER - Women's Health Online 15 January 2010 13:10 UTC www.empowher.com [Source type: General]

^ More rarely, air bubbles, fat droplets, amniotic fluid, or clumps of parasites or tumor cells may obstruct the pulmonary vessels.
  • Signs and symptoms: Blood clot - lung, Pulmonary embolus 20 November 2009 21:38 UTC www.lungcancer.ucla.edu [Source type: Academic]

.The obstruction of the blood flow through the lungs and the resultant pressure on the right ventricle of the heart leads to the symptoms and signs of PE. The risk of PE is increased in various situations, such as cancer and prolonged bed rest.^ This obstruction to the flow of blood through the lungs can lead to high blood pressure within the lungs, a condtion known as pulmonary hypertension.
  • What is pulmonary embolism? Staten Island Heart - Board Certified Cardiologists, Staten Island, Brooklyn, New York 15 January 2010 13:10 UTC www.siheartdocs.com [Source type: FILTERED WITH BAYES]

^ To reach the lungs, thromboemboli travel through the right side of the heart.
  • Pulmonary Embolism: eMedicine Emergency Medicine 15 January 2010 13:10 UTC emedicine.medscape.com [Source type: Academic]

^ He or she will also listen to your heart and lungs, and will check your blood pressure.
  • OhioHealth - Pulmonary embolism 15 January 2010 13:10 UTC www.ohiohealth.com [Source type: General]

[1]
.Symptoms of pulmonary embolism include difficulty breathing, chest pain on inspiration, and palpitations.^ Symptoms of PE include shortness of breath...

^ The classic symptoms for a pulmonary embolism are shortness of breath and chest pain.
  • Wrongful Death from failure to diagnose a pulmonary embolism., Harry S. Cohen & Associates — Pittsburgh, Pennsylvania Medical Malpractice Lawyers 15 January 2010 13:10 UTC www.cohenmalpractice.com [Source type: FILTERED WITH BAYES]

^ Symptoms References Pulmonary embolism.
  • Pulmonary embolism - MayoClinic.com 15 January 2010 13:10 UTC www.mayoclinic.com [Source type: Academic]

.Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate.^ Low oxygen levels in your blood.
  • Pulmonary Embolism: symptoms, treatment, cause, prevention, statistics, complications, long-term outlook 15 January 2010 13:10 UTC mamashealth.com [Source type: FILTERED WITH BAYES]

^ Rapid heart rate.

^ Other clinical features include tachycardia, productive cough (sputum may be blood-tinged), low-grade fever, and pleural effusion.

.Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death.^ In severe cases this can lead to death.
  • Pulmonary Embolism | ThirdAge Articles 15 January 2010 13:10 UTC www.thirdage.com [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism ; Seattle Washington WA 15 January 2010 13:10 UTC www.swedish.org [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism | NYU Langone Medical Center Department of Surgery 15 January 2010 13:10 UTC surgery.med.nyu.edu [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism | NYU Cardiac & Vascular Institute | NYU Langone Medical Center | New York, New York 10016 15 January 2010 13:10 UTC cvi.med.nyu.edu [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism 15 January 2010 13:10 UTC www.halifaxhealth.org [Source type: Academic]
  • Pulmonary Embolism | Lifescript.com 15 January 2010 13:10 UTC www.lifescript.com [Source type: General]
  • Northern Arizona Healthcare - Pulmonary Embolism 15 January 2010 13:10 UTC www.nahealth.com [Source type: Academic]
  • Pulmonary Embolism - Content Viewer 15 January 2010 13:10 UTC www.svmh.com [Source type: FILTERED WITH BAYES]
  • News Archive - Valley Health 15 January 2010 13:10 UTC www.valleyhealthlink.com [Source type: Academic]
  • Pulmonary embolism - Beth Israel Deaconess Medical Center 15 January 2010 13:10 UTC www.bidmc.org [Source type: Academic]

^ Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death.
  • Pulmonary Embolism Remedies on Earth Clinic, Your Source for Natural Cures. 15 January 2010 13:10 UTC www.earthclinic.com [Source type: General]

^ This is called a PE. While the vast majority of PEs are caused by blood clots, it is worth noting that in rare cases they are caused by tumors, air, fat or amniotic fluid.

[1]
.Diagnosis is based on these clinical findings in combination with laboratory tests (such as the D-dimer test) and imaging studies, usually CT pulmonary angiography.^ These findings may be applied to the diagnosis of pulmonary diseases.
  • Arterial Gas Embolism 15 January 2010 13:10 UTC www.scuba-doc.com [Source type: Academic]

^ Accuracy of the clinical diagnosis of pulmonary embolism.
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]

^ One such test is the D-dimer blood test.
  • Pulmonary Embolism - a knol by Taylor 15 January 2010 13:10 UTC knol.google.com [Source type: Academic]

.Treatment is typically with anticoagulant medication, including heparin and warfarin.^ Treatment is with anticoagulant medication, such as warfarin.
  • Pulmonary Embolism Support Group - DailyStrength 15 January 2010 13:10 UTC www.dailystrength.org [Source type: General]

^ Treatment is anticoagulation, typically with low molecular weight heparin followed by 6 months of warfarin.
  • RACGP | Pulmonary embolism 15 January 2010 13:10 UTC www.racgp.org.au [Source type: Academic]

^ The treatment includes anticoagulants such as heparin and warfarin (Coumadin).
  • Pulmonary embolism definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms 15 January 2010 13:10 UTC www.medterms.com [Source type: FILTERED WITH BAYES]

.Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention via pulmonary thrombectomy.^ In a severe case, surgery may be necessary.
  • Pulmonary Embolism - Division of Vascular Surgery - Strong Heart and Vascular Center 15 January 2010 13:10 UTC www.stronghealth.com [Source type: Academic]

^ Oxygen may be administered via an oxygen mask or, in severe cases, a respirator.

^ These include streptokinase, urokinase, and tissue plasminogen activator (tPA).
  • CardioSmart: Pulmonary Embolism 15 January 2010 13:10 UTC www.cardiosmart.org [Source type: Academic]

[1]

Contents

Signs and symptoms

.Symptoms of PE are sudden-onset dyspnea (shortness of breath), tachypnea (rapid breathing), chest pain of a "pleuritic" nature (worsened by breathing), cough and hemoptysis (coughing up blood).^ Symptoms of PE include shortness of breath...

^ Symptoms include shortness of breath, chest pain that gets worse with deep breathing, coughing.
  • B-line | Pulmonary Embolism 15 January 2010 13:10 UTC www.bline.ie [Source type: General]

^ Sudden chest pain that becomes worse with deep breathing.
  • Pulmonary Embolism | Causes, Symptoms, Treatment | PDRHealth 15 January 2010 13:10 UTC www.pdrhealth.com [Source type: General]

.More severe cases can include signs such as cyanosis (blue discoloration, usually of the lips and fingers), collapse, and circulatory instability.^ In addition, pulmonary embolism may cause pleural friction rub and signs of circulatory collapse (weak, rapid pulse; hypotension) and hypoxia (rest-lessness).

^ Common symptoms include a SUDDEN onset of shortness of breath and chest pain which is usually "sharp" and is more severe upon breathing in (pleurisy).

^ Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death.
  • Pulmonary Embolism Remedies on Earth Clinic, Your Source for Natural Cures. 15 January 2010 13:10 UTC www.earthclinic.com [Source type: General]

About 15% of all cases of sudden death are attributable to PE.[1]
.On physical examination, a pleural rub may be audible by stethoscope over affected areas of the lung.^ If pleural lung surfaces are affected, a pulmonary rub may be heard.
  • Pulmonary Embolism Information 15 January 2010 13:10 UTC www.mac-paper.com [Source type: FILTERED WITH BAYES]

^ Prognosis is dependent on the size of the affected area of the lung and other co-morbidities or underlying symptoms and conditions.

^ In addition, pulmonary embolism may cause pleural friction rub and signs of circulatory collapse (weak, rapid pulse; hypotension) and hypoxia (rest-lessness).

.Strain on the right ventricle may be detected as a left parasternal heave, a loud pulmonary component of the second heart sound, raised jugular venous pressure, and more rarely leg swelling.^ A normal right ventricle is rarely able to achieve this pressure acutely and thus may fail.
  • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

^ About a third of the time, the pulmonary component of the second heart sound is increased.
  • Stabilization of Chest Pain - Mad Scientist Software 15 January 2010 13:10 UTC www.madsci.com [Source type: FILTERED WITH BAYES]

^ The pulmonary embolism can cause a strain on the heart.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

[1]
.A fever though usually low grade is present in 14% of people with pulmonary embolism.^ Fever in acute pulmonary embolism.
  • Wiley::Pulmonary Embolism, 2nd Edition 15 January 2010 13:10 UTC ca.wiley.com [Source type: Academic]
  • Wiley::Pulmonary Embolism, 2nd Edition 15 January 2010 13:10 UTC www.wiley.com [Source type: Academic]

^ Also, some people with pulmonary embolism do not have symptoms.
  • Health Information 15 January 2010 13:10 UTC www.mountauburnhospital.org [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ D-dimer levels are usually high in people with pulmonary embolism.
  • Health Information 15 January 2010 13:10 UTC www.mountauburnhospital.org [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism - Quest Diagnostics Patient Health Library 15 January 2010 13:10 UTC www.questdiagnostics.com [Source type: FILTERED WITH BAYES]
  • Health Information, Drug and Herbal Information and Health News 15 January 2010 13:10 UTC www.cpmc.org [Source type: FILTERED WITH BAYES]
  • Health Library - 15 January 2010 13:10 UTC myhealth.ucsd.edu [Source type: FILTERED WITH BAYES]

[2]

Diagnosis

.The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes of chest pain and shortness of breath.^ PE unlikely > 4 = PE likely Differential diagnosis 8 Other causes of collapse, chest pain or dyspnoea, importantly: .
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

^ Symptoms of PE include shortness of breath...

^ This test was not performed on Shelby because she never complained of chest pain.
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

The decision to do medical imaging is usually based on clinical grounds, i.e. the medical history, symptoms and findings on physical examination, followed by an assessment of clinical probability.[1]
.The most commonly used method to predict clinical probability, the Wells score, is a clinical prediction rule, whose use is complicated by multiple versions being available.^ This prediction rule is one of the oldest and most frequently used decision rules.
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

^ Pretest probability of DVT by Wells’ clinical prediction rules 8 (%) .
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

^ Anticoagulant drugs are most commonly used.
  • Pulmonary Embolism | NYU Cardiac & Vascular Institute | NYU Langone Medical Center | New York, New York 10016 15 January 2010 13:10 UTC cvi.med.nyu.edu [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism 15 January 2010 13:10 UTC www.halifaxhealth.org [Source type: Academic]
  • Pulmonary Embolism – UPMC, Pittsburgh, PA, USA 15 January 2010 13:10 UTC www.upmc.com [Source type: FILTERED WITH BAYES]
  • Northern Arizona Healthcare - Pulmonary Embolism 15 January 2010 13:10 UTC www.nahealth.com [Source type: Academic]
  • Pulmonary Embolism - Content Viewer 15 January 2010 13:10 UTC www.svmh.com [Source type: FILTERED WITH BAYES]
  • News Archive - Valley Health 15 January 2010 13:10 UTC www.valleyhealthlink.com [Source type: Academic]
  • Pulmonary embolism - Beth Israel Deaconess Medical Center 15 January 2010 13:10 UTC www.bidmc.org [Source type: Academic]

.In 1995, Wells et al. initially developed a prediction rule (based on a literature search) to predict the likelihood of PE, based on clinical criteria.^ Structured clinical likelihood scores, as suggested by Wells et al.
  • Clinicians' Response to Radiologists' Reports of Isolated Subsegmental Pulmonary Embolism or Inconclusive Interpretation of Pulmonary Embolism Using MDCT -- Eyer et al. 184 (2): 623 -- American Journal of Roentgenology 15 January 2010 13:10 UTC www.ajronline.org [Source type: Academic]

^ Exclusion criteria are similar to those developed by Wells et al.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ Pretest probability of PE by Wells’ clinical prediction rules 19 (%) .
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

[3] .The prediction rule was revised in 1998[4] This prediction rule was further revised when simplified during a validation by Wells et al. in 2000.[5] In the 2000 publication, Wells proposed two different scoring systems using cutoffs of 2 or 4 with the same prediction rule.^ Structured clinical likelihood scores, as suggested by Wells et al.
  • Clinicians' Response to Radiologists' Reports of Isolated Subsegmental Pulmonary Embolism or Inconclusive Interpretation of Pulmonary Embolism Using MDCT -- Eyer et al. 184 (2): 623 -- American Journal of Roentgenology 15 January 2010 13:10 UTC www.ajronline.org [Source type: Academic]

^ Wells P, et al.
  • Emergency Medicine 15 January 2010 13:10 UTC www.emedmag.com [Source type: Academic]

^ Stollberger C et al, 2000, Austria .
  • BestBets: Diagnostic utility of chest xray for investigation of pulmonary embolism 15 January 2010 13:10 UTC www.bestbets.org [Source type: Academic]

[5] .In 2001, Wells published results using the more conservative cutoff of 2 to create three categories.^ Result further showed that clot strength and its elasticity reduction were observed more using colloids rather then ringer lactate (22).
  • Management of Pulmonary Embolism 15 January 2010 13:10 UTC www.priory.com [Source type: Academic]

^ The modified Wells score adds intravenous drug use as 3.0 points (S Jones et al , unpublished observation, 2001) to Wells score.
  • Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study -- Hogg et al. 23 (2): 123 -- Emergency Medicine Journal 15 January 2010 13:10 UTC emj.bmj.com [Source type: Academic]

^ One centre uses surgical embolectomy for patients with submassive or large PEs (as well as for massive PE) and claims good results.
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

[6] .An additional version, the "modified extended version", using the more recent cutoff of 2 but including findings from Wells's initial studies[3][4] were proposed.^ A test called V/Q scan - a nuclear ventilation-perfusion study of the lungs - may be used, as well as a pulmonary angiography.
  • Diagnose-Me: Condition: Pulmonary Embolism 15 January 2010 13:10 UTC www.diagnose-me.com [Source type: Academic]

^ Prospective studies correlating bronchial arterial findings with pulmonary arterial pressures could prove useful.
  • Bronchial Artery Dilatation on MDCT Scans of Patients with Acute Pulmonary Embolism: Comparison with Chronic or Recurrent Pulmonary Embolism -- Hasegawa et al. 182 (1): 67 -- American Journal of Roentgenology 15 January 2010 13:10 UTC www.ajronline.org [Source type: Academic]

^ In addition, combining one of these interventions with heparin may be more effective than using either method alone.
  • Pulmonary Embolism as a Complication of Major Depressive Disorder with Catatonic Features: A Case Report | Psychiatry MMC 15 January 2010 13:10 UTC www.psychiatrymmc.com [Source type: Academic]

[7] .Most recently, a further study reverted to Wells's earlier use of a cutoff of 4 points[5] to create only two categories.^ Two studies that used lower cutoffs warrant specific comment.
  • Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis -- Brown et al. 49 (11): 1846 -- Clinical Chemistry 15 January 2010 13:10 UTC www.clinchem.org [Source type: Academic]

^ A test called V/Q scan - a nuclear ventilation-perfusion study of the lungs - may be used, as well as a pulmonary angiography.
  • Diagnose-Me: Condition: Pulmonary Embolism 15 January 2010 13:10 UTC www.diagnose-me.com [Source type: Academic]

^ In any case, realized that this use of the D-dimer study is likely to be the subject of further study before its utility is generally accepted.

[8]
.There are additional prediction rules for PE, such as the Geneva rule.^ A score over 2 in our prediction rule Patients with a PE requiring thrombolysis or surgical thrombectomy Patients with right ventricular dyskinesia in echocardiography at 48 hours from heparin therapy.
  • Home Treatment of Pulmonary Embolism - Full Text View - ClinicalTrials.gov 15 January 2010 13:10 UTC clinicaltrials.gov [Source type: Academic]

^ Providers may also consult tools such as the Wells Prediction Rule in order to better assess the probability of PE in a patient based on the available clinical data.
  • The Journal of Urgent Care Medicine: March 2009 Issue 15 January 2010 13:10 UTC www.jucm.com [Source type: Academic]

^ A well-validated clinical prediction rule provides a reliable estimate of the pretest probability of PE. .
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

.More importantly, the use of any rule is associated with reduction in recurrent thromboembolism.^ Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events.
  • Overview of acute pulmonary embolism 15 January 2010 13:10 UTC www.uptodate.com [Source type: Academic]

^ To rule out other possible causes of your symptoms, your doctor may use one or more of the following tests.
  • Diagnose, tests for pulmonary embolism 15 January 2010 13:10 UTC www.nhlbi.nih.gov [Source type: General]

^ To rule out other possible causes of the symptoms, the doctor may use one or more of the following tests.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

[9]
The Wells score:[10]
  • clinically suspected DVT - 3.0 points
  • alternative diagnosis is less likely than PE - 3.0 points
  • tachycardia - 1.5 points
  • immobilization/surgery in previous four weeks - 1.5 points
  • history of DVT or PE - 1.5 points
  • hemoptysis - 1.0 points
  • malignancy (treatment for within 6 months, palliative) - 1.0 points
Traditional interpretation[5][6][11]
  • Score >6.0 - High (probability 59% based on pooled data[12])
  • Score 2.0 to 6.0 - Moderate (probability 29% based on pooled data[12])
  • Score <2.0 - Low (probability 15% based on pooled data[12])
Alternate interpretation[5][8]
  • Score > 4 - PE likely. .Consider diagnostic imaging.
  • Score 4 or less - PE unlikely.^ A pretest clinical probability score ≤4 means that PE is unlikely.
    • When Is a Computed Tomography Angiogram Necessary to Rule Out Pulmonary Embolus in the Emergency Department? 20 November 2009 21:38 UTC xnet.kp.org [Source type: Academic]

    ^ DVT and PE may be less readily considered complications of the immobility inherent in catatonia than are the more immediate concerns for dehydration and decreased urine output.
    • Pulmonary Embolism as a Complication of Major Depressive Disorder with Catatonic Features: A Case Report | Psychiatry MMC 15 January 2010 13:10 UTC www.psychiatrymmc.com [Source type: Academic]

    ^ For patients seen in the office or emergency department, D-dimer testing may be the next recommended test, especially if PE is considered less likely.
    • Pulmonary Embolism - a knol by Taylor 15 January 2010 13:10 UTC knol.google.com [Source type: Academic]

    Consider D-dimer to rule out PE.

Blood tests

In low/moderate suspicion of PE, a normal D-dimer level (shown in a blood test) is enough to exclude the possibility of thrombotic PE.[13]
.When a PE is being suspected, a number of blood tests are done, in order to exclude important secondary causes of PE. This includes a full blood count, clotting status (PT, APTT, TT), and some screening tests (erythrocyte sedimentation rate, renal function, liver enzymes, electrolytes).^ Faulty blood clotting is an uncommon cause.
  • Deep Vein Thrombosis 20 November 2009 21:38 UTC www.e-radiography.net [Source type: FILTERED WITH BAYES]

^ Once a PE is being suspected, a number of blood tests are also done, in order to exclude important secondary causes of PE. This includes a full blood count, clotting status (PT, APTT, TT), and some screening tests ( Erythrocyte sedimentation rate , renal function , liver enzymes , electrolytes).
  • Pulmonary embolism - The Doctors Lounge(TM) 15 January 2010 13:10 UTC www.doctorslounge.com [Source type: Academic]

^ Blood clots can cause some women to have miscarriages.
  • Hypercoagulation: Excessive Blood Clotting -- familydoctor.org 20 November 2009 21:38 UTC familydoctor.org [Source type: General]

.If one of these is abnormal, further investigations might be warranted.^ If one of these is abnormal, further investigations might be warranted.
  • Pulmonary embolism - The Doctors Lounge(TM) 15 January 2010 13:10 UTC www.doctorslounge.com [Source type: Academic]
  • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

^ The risk of a blood clot is further increased in people who use one of these medications and smoke or are overweight.
  • Pulmonary embolism 15 January 2010 13:10 UTC www.uptodate.com [Source type: Academic]

^ I am not sure if that might be a connection to your left leg swelling and I would need to investigate that further if it was placed in your left groin.
  • Pulmonary Embolism in SCI - Page 2 - CareCure Forums 15 January 2010 13:10 UTC sci.rutgers.edu [Source type: Academic]

Medical imaging

.
Selective pulmonary angiogram revealing significant thrombus (labelled A) causing a central obstruction in the left main pulmonary artery.
^ Thrombus in right and left main pulmonary artery were seen in 2(8%) patients.
  • Role of CT angiography in pulmonary embolism and its comparative evaluation with conventional pulmonary angiography Sood S, Negi A, Dhiman DS, Sood RG, Negi PC, Sharma S - Indian J Radiol Imaging 15 January 2010 13:10 UTC www.ijri.org [Source type: Academic]

^ A pulmonary embolism is caused by an obstruction of the arteries that carry blood to the lungs.
  • Pulmonary Embolism - Kosmix : Reference, Videos, Images, News, Shopping and more... 15 January 2010 13:10 UTC health.kosmix.com [Source type: Academic]

^ Thrombus and emboli removed from left pulmonary artery .
  • Acquired Left Ventricle to Right Atrial Shunt (Gerbode Defect) and Massive Pulmonary Embolus 20 November 2009 21:38 UTC www.ctsnet.org [Source type: Academic]

ECG tracing shown at bottom.
CT pulmonary angiography (CTPA) showing a saddle embolus and substantial thrombus burden in the lobar branches of both main pulmonary arteries.
.
Ventilation-perfusion scintigraphy in a woman taking hormonal contraceptives and valdecoxib.
^ Ventilation-perfusion Scintigraphy .
  • Imaging of pulmonary embolism 15 January 2010 13:10 UTC www.c2i2.org [Source type: Academic]

^ As far as the tendency for the blood to clot easier when a woman is taking birth control pills it is because the hormone is primarily degraded in the liver affecting the clotting of the blood.
  • Pulmonary Embolism in SCI - Page 2 - CareCure Forums 15 January 2010 13:10 UTC sci.rutgers.edu [Source type: Academic]

^ Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy.
  • Clinicians' Response to Radiologists' Reports of Isolated Subsegmental Pulmonary Embolism or Inconclusive Interpretation of Pulmonary Embolism Using MDCT -- Eyer et al. 184 (2): 623 -- American Journal of Roentgenology 15 January 2010 13:10 UTC www.ajronline.org [Source type: Academic]


.(A) After inhalation of 20.1 mCi of Xenon-133 gas, scintigraphic images were obtained in the posterior projection, showing uniform ventilation to lungs.^ Axial MDCT scan obtained at level of aortic arch shows undilated right bronchial artery ( arrow) adjacent to posterior wall of carina.
  • Bronchial Artery Dilatation on MDCT Scans of Patients with Acute Pulmonary Embolism: Comparison with Chronic or Recurrent Pulmonary Embolism -- Hasegawa et al. 182 (1): 67 -- American Journal of Roentgenology 15 January 2010 13:10 UTC www.ajronline.org [Source type: Academic]

^ The final image shows the lung tissue showing the embolus lodged in the blocked pulmonary artery.
  • Mechanism of Pulmonary Embolism - Medical Illustration, Human Anatomy Drawing, Anatomy Illustration 15 January 2010 13:10 UTC catalog.nucleusinc.com [Source type: General]

^ The dye shows up on the images, allowing physicians to track blood flow through the lungs.
  • CardioSmart: Pulmonary Embolism 15 January 2010 13:10 UTC www.cardiosmart.org [Source type: Academic]


.(B) After intravenous injection of 4.1 mCi of Technetium-99m-labeled macroaggregated albumin, scintigraphic images were obtained, shown here in the posterior projection.^ After 3.5 min from the start of the contrast injection, 5-mm axial images are obtained every 2 cm from the iliac crest to the knees to evaluate the iliac, femoral, and popliteal veins.
  • Clinicians' Response to Radiologists' Reports of Isolated Subsegmental Pulmonary Embolism or Inconclusive Interpretation of Pulmonary Embolism Using MDCT -- Eyer et al. 184 (2): 623 -- American Journal of Roentgenology 15 January 2010 13:10 UTC www.ajronline.org [Source type: Academic]

This and other views showed decreased activity in multiple regions.
.The gold standard for diagnosing pulmonary embolism (PE) is pulmonary angiography.^ Pulmonary angiography, an accurate, invasive test used to diagnose pulmonary embolism.
  • Pulmonary Embolism (PE, PTE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]

^ Pulmonary angiography or aortography is the reference standard test for diagnosing pulmonary embolism.
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

^ How is a pulmonary embolism diagnosed?
  • Pulmonary Embolism (Health & Wellbeing: Respiratory Problems) 15 January 2010 13:10 UTC www.videojug.com [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

.Pulmonary angiography is used less often due to wider acceptance of CT scans, which are non-invasive.^ Pulmonary angiography, an accurate, invasive test used to diagnose pulmonary embolism.
  • Pulmonary Embolism (PE, PTE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]

^ Digital subtraction angiography and MRI are less invasive and use less dye than pulmonary angiography.
  • THE MERCK MANUAL OF GERIATRICS, Ch. 77, Pulmonary Embolism 15 January 2010 13:10 UTC www.merck.com [Source type: Academic]

^ Traditionally, ventilation-perfusion scans and pulmonary angiography have been used.
  • Emergent Surgery for Massive Pulmonary Embolism 15 January 2010 13:10 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

Non-invasive imaging
.CT pulmonary angiography (CTPA) is a pulmonary angiogram obtained using computed tomography (CT) with radiocontrast rather than right heart catheterization.^ Computed tomography (CT) angiogram .

^ Spiral CT scan or CT pulmonary angiogram.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

^ CT, computed tomography; PE, pulmonary embolism.
  • Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study -- Hogg et al. 23 (2): 123 -- Emergency Medicine Journal 15 January 2010 13:10 UTC emj.bmj.com [Source type: Academic]

.Its advantages are clinical equivalence, its non-invasive nature, its greater availability to patients, and the possibility of identifying other lung disorders from the differential diagnosis in case there is no pulmonary embolism.^ Accuracy of the clinical diagnosis of pulmonary embolism.
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]

^ Kearon C. Diagnosis of pulmonary embolism.
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

^ Pulmonary embolism occurs in the lungs.

.Assessing the accuracy of CT pulmonary angiography is hindered by the rapid changes in the number of rows of detectors available in multidetector CT (MDCT) machines.^ Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial.
  • Pulmonary Embolus - Symptoms, Diagnosis, Treatment of Pulmonary Embolus - NY Times Health Information 20 November 2009 21:38 UTC health.nytimes.com [Source type: FILTERED WITH BAYES]
  • Pulmonary embolus - Lee Memorial Health System 20 November 2009 21:38 UTC www.leememorial.org [Source type: Academic]
  • Pulmonary embolus - Health Diseases & Medical Conditions - South Florida Hospital 20 November 2009 21:38 UTC www.mhs.net [Source type: Academic]
  • Pulmonary embolus: MedlinePlus Medical Encyclopedia 15 January 2010 13:10 UTC www.nlm.nih.gov [Source type: Academic]
  • WakeMed Raleigh, NC - Pulmonary embolus. A pulmonary embolus is a blockage ... 15 January 2010 13:10 UTC www.wakemed.org [Source type: Academic]
  • DHMC | Anticoagulation Program | Pulmonary Embolism 15 January 2010 13:10 UTC www.dhmc.org [Source type: Academic]
  • Pulmonary Embolus :: BestHealth.com :: Wake Forest University Baptist Medical Center 15 January 2010 13:10 UTC www.besthealth.com [Source type: Academic]

^ Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome.
  • Overview of acute pulmonary embolism 15 January 2010 13:10 UTC www.uptodate.com [Source type: Academic]

^ Computed tomography (CT) pulmonary angiography is highly specific for pulmonary embolism.
  • Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study -- Hogg et al. 23 (2): 123 -- Emergency Medicine Journal 15 January 2010 13:10 UTC emj.bmj.com [Source type: Academic]

[14] .A study with a mixture of 4 slice and 16 slice scanners reported a sensitivity of 83% and a specificity of 96%.^ Studies indicate that helical CT scanning detects large PEs, with a sensitivity and specificity of nearly 90 percent for the identification of main and lobar emboli.
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

^ Taking PA as gold standard, the sensitivity and specificity of CTA in our study came out to be 80% and 85.7% respectively.
  • Role of CT angiography in pulmonary embolism and its comparative evaluation with conventional pulmonary angiography Sood S, Negi A, Dhiman DS, Sood RG, Negi PC, Sharma S - Indian J Radiol Imaging 15 January 2010 13:10 UTC www.ijri.org [Source type: Academic]

^ When there is little variability of both the test sensitivity and specificity among studies, the SROC curve does not provide additional information over averaged sensitivity or specificity values ( 14 ).
  • Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis -- Brown et al. 49 (11): 1846 -- Clinical Chemistry 15 January 2010 13:10 UTC www.clinchem.org [Source type: Academic]

.This study noted that additional testing is necessary when the clinical probability is inconsistent with the imaging results.^ Five patients were excluded from the study due to low clinical probability and normal D-dimer levels.

^ It is worth noting that in most patients (464/583, or 80%) clinical probability of PE and perfusion lung scan results were concordant (high or intermediate clinical probability paired with a PE+ scan in 277 patients, and low clinical probability paired with a PE scan in 187).
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]

^ The clinical probability of PE defined above was used as pretest probability to calculate the posterior probability of PE, i.e., the probability of PE conditioned by perfusion lung scan results.
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]

[15] .CTPA is non-inferior to VQ scanning, and identifies more emboli (without necessarily improving the outcome) compared to VQ scanning.^ In fact, the usefulness of VQ scanning is highest if interpretation is limited to one of three possibilities: 1) high probability, 2) non-diagnostic, or 3) normal.
  • Pulmonary embolism article by Cal Shipley, M.D. 15 January 2010 13:10 UTC www.trialimagestore.com [Source type: FILTERED WITH BAYES]

^ (B) Computed tomographic scan obtained on admission shows massive pulmonary emboli in the bilateral pulmonary artery, while part of the local extension to the inferior vena cava has disappeared.
  • Successful Management of Massive Pulmonary Tumor Embolism From Renal Cell Carcinoma -- Kubota et al. 61 (2): 708 -- The Annals of Thoracic Surgery 15 January 2010 13:10 UTC ats.ctsnetjournals.org [Source type: Academic]

^ And because standard chest X-rays may not be able to spot the potentially fatal condition, more sophisticated CT scans may be needed to identify the risk, the researchers said.
  • Pulmonary Embolism - Kosmix : Reference, Videos, Images, News, Shopping and more... 15 January 2010 13:10 UTC health.kosmix.com [Source type: Academic]

[16]
.Ventilation/perfusion scan (or V/Q scan or lung scintigraphy), which shows that some areas of the lung are being ventilated but not perfused with blood (due to obstruction by a clot).^ Usually, the perfusion scan is done with a lung ventilation scan.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Another test is the ventilation perfusion lung scan.
  • Pulmonary Embolism - a knol by Taylor 15 January 2010 13:10 UTC knol.google.com [Source type: Academic]

^ Ventilation-perfusion scanning 21 .
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

This type of examination is used less often because of the more widespread availability of CT technology, however, it may be useful in patients who have an allergy to iodinated contrast or in pregnancy due to lower radiation exposure than CT.[17]
Low probability diagnostic tests/non-diagnostic tests
.Tests that are frequently done that are not sensitive for PE, but can be diagnostic.^ The electrocardiogram is a frequently performed test in patients with suspected PE. Despite its lack of sensitivity and specificity, the EKG may have some value in determining the extent of the clot burden.
  • Echocardiography 15 January 2010 13:10 UTC www2.umdnj.edu [Source type: Academic]

^ For the diagnosis of PE, ventilation/perfusion (V/Q) lung scanning is frequently performed as the first diagnostic method.

^ Sensitivity ( left ) and specificity ( right ) plots for turbidimetric D-dimer tests in the diagnosis of PE. The reference number for each study is listed between the plots.
  • Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis -- Brown et al. 49 (11): 1846 -- Clinical Chemistry 15 January 2010 13:10 UTC www.clinchem.org [Source type: Academic]

.
  • Chest X-rays are often done on patients with shortness of breath to help rule-out other causes, such as congestive heart failure and rib fracture.^ A chest x ray can be normal or show fluid or other signs and rule out other diseases.
    • Pulmonary Embolism - Definition, Description, Causes and symptoms, Diagnosis, Treatment, Prognosis, Prevention 15 January 2010 13:10 UTC health.stateuniversity.com [Source type: Academic]

    ^ Sometimes shortness of breath or chest pain is thought to be from other conditions, such as a heart or asthma attack, pneumonia, or a bruised rib.
    • Pulmonary Embolism - a knol by Taylor 15 January 2010 13:10 UTC knol.google.com [Source type: Academic]

    ^ It is a serious medical problem that can cause chest pain, shortness of breath, fast heart rate, among others.
    • Pulmonary Embolus - HealthCentral 20 November 2009 21:38 UTC www.healthcentral.com [Source type: General]

    .Chest X-rays in PE are rarely normal,[18] but usually lack signs that suggest the diagnosis of PE (e.g.^ The results of an ECG and a chest X-ray were normal.
    • Pulmonary Embolism and Severe Depression -- ARNONE et al. 159 (5): 873 -- Am J Psychiatry 15 January 2010 13:10 UTC ajp.psychiatryonline.org [Source type: Academic]

    ^ E. Clinical presentation DVT pain and tenderness of calf swelling (unilateral) positive Homan's sign (non-specific) warmth PE sudden onset SOB, tachycardia pleuritic chest pain cough, hemoptysis (not always) F. Diagnosis DVT a.
    • Pulmonary Embolism 15 January 2010 13:10 UTC www.uic.edu [Source type: Academic]

    ^ Diagnosis of a PE is made by a ventilation-perfusion (V-Q) scan, or a spiral CT of the chest as was done in our patient.
    • Pulmonary Embolism as a Complication of Major Depressive Disorder with Catatonic Features: A Case Report | Psychiatry MMC 15 January 2010 13:10 UTC www.psychiatrymmc.com [Source type: Academic]

    .Westermark sign, Hampton's hump).
  • Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis (DVT).^ Deep vein thrombosis (DVT) .
    • DEEP VEIN THROMBOSIS 20 November 2009 21:38 UTC www.totaljoints.info [Source type: FILTERED WITH BAYES]
    • Deep Vein Thrombosis and Pulmonary Embolism Overview - SIR 15 January 2010 13:10 UTC www.sirweb.org [Source type: FILTERED WITH BAYES]

    ^ PE = pulmonary embolism; DVT = deep venous thrombosis .
    • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

    ^ Thrombolytic therapy for deep venous thrombosis.
    • Wiley::Pulmonary Embolism, 2nd Edition 15 January 2010 13:10 UTC ca.wiley.com [Source type: Academic]
    • Wiley::Pulmonary Embolism, 2nd Edition 15 January 2010 13:10 UTC www.wiley.com [Source type: Academic]

    .The presence of DVT, as shown on ultrasonography of the legs, is in itself enough to warrant anticoagulation, without requiring the V/Q or spiral CT scans (because of the strong association between DVT and PE).^ Spiral CT scan or CT angiogram.
    • LUNG DISORDERS - Pulmonary Embolism (PE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]

    ^ The presence of deep venous thrombosisis in itself enough to warrant anticoagulation, without requiring the V/Q or spiral CT scans, and leg ultrasoundcan be used as a surrogate.
    • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

    ^ Spiral CT scan or CT pulmonary angiogram.
    • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

    .This may be valid approach in pregnancy, in which the other modalities would increase the risk of birth defects in the unborn child.^ Pregnancy increases the risk.
    • Deep Vein Thrombosis 20 November 2009 21:38 UTC www.e-radiography.net [Source type: FILTERED WITH BAYES]

    ^ This may be valid approach in pregnancy, in which the other modalities would increase the risk of birth defects in the unborn child.
    • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

    ^ As early as 1995 studies had shown there was an increased risk of venous thrombosis (blood clots) in contraceptives containing desogestrel compared to second generation birth control that contained other types of progestins.
    • Nuvaring Lawsuit News | Nuva Ring Side Effects Birth Control Ring Blood Clots Lawyer – Attorney | 15 January 2010 13:10 UTC www.birthcontrolringlawsuitcenter.com [Source type: General]

    However, a negative scan does not rule out PE, and low-radiation dose scanning may be required if the mother is deemed at high risk of having pulmonary embolism.

Electrocardiogram findings

Electrocardiogram of a patient with pulmonary embolism showing sinus tachycardia of approximately 150 beats per minute and right bundle branch block.
.An electrocardiogram (ECG) is routinely done on patients with chest pain to quickly diagnose myocardial infarctions (heart attacks).^ I would describe the pain is that of a heart attack.
  • Pulmonary Embolism - Randomness of Christi 15 January 2010 13:10 UTC www.twistermc.com [Source type: General]

^ Some people have inherited abnormalities in blood clotting that make them more likely to have pulmonary embolism, as well as other clotting disorders, such as stroke and myocardial infarction (heart attack).
  • Pulmonary Embolism - Symptoms, Treatment and Prevention 15 January 2010 13:10 UTC www.healthscout.com [Source type: FILTERED WITH BAYES]

^ Details were taken from the notes of any patient who was not recruited and who described chest pain as sharp or pleuritic.
  • Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study -- Hogg et al. 23 (2): 123 -- Emergency Medicine Journal 15 January 2010 13:10 UTC emj.bmj.com [Source type: Academic]

.An ECG may show signs of right heart strain or acute cor pulmonale in cases of large PEs - the classic signs are a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III ("S1Q3T3").^ Figure 1 Electrocardiogram shows pattern of right ventricular strain (S wave in lead I, Q wave in lead III, and T-wave inversion in lead III).
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

^ Other frequent findings include signs of right heart strain.
  • Emergency Medicine 15 January 2010 13:10 UTC www.emedmag.com [Source type: Academic]

^ An electrocardiogrammay show signs of right heart strain or acute cor pulmonalein cases of large PEs - the classic signs are a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III ("S1Q3T3", as described by McGinn & White 1935).
  • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

[19] .This is occasionally (up to 20%) present, but may also occur in other acute lung conditions and has therefore limited diagnostic value.^ This is occasionally (up to 20%) present, but may also occur in other acute lung conditions and has therefore limited diagnostic value; The most commonly seen sign in the ECG is sinus tachycardia.
  • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

^ These may help with the diagnosis or may show up other conditions.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ Prognosis depends on the amount of lung that is affected and on the co-existence of other debilitating conditions.
  • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

.The most commonly seen signs in the ECG is sinus tachycardia, right axis deviation and right bundle branch block.^ Tachypnea and tachycardia were the most frequent signs.

^ ECG may be normal, or show any of these changes: sinus tachycardia, atrial fibrillation, non-specific ST or T wave abnormalities, right ventricular strain pattern V1-3, right axis deviation, RBBB, or deep S-waves in I with Q waves in III and inverted T waves in III ('S1,Q3,T3' pattern).
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

^ This is occasionally (up to 20%) present, but may also occur in other acute lung conditions and has therefore limited diagnostic value; The most commonly seen sign in the ECG is sinus tachycardia.
  • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

[20] Sinus tachycardia was however still only found in 8 - 69% of people with PE.[21]

Echocardiography findings

.In massive and submassive PE, dysfunction of the right side of the heart can be seen on echocardiography, an indication that the pulmonary artery is severely obstructed and the heart is unable to match the pressure.^ It also has the advantage of being able to measure the pressure in the right side of your heart.
  • Pulmonary embolism 15 January 2010 13:10 UTC www.cnn.com [Source type: General]
  • Pulmonary embolism - Valley Health System 15 January 2010 13:10 UTC www.valleyhealth.com [Source type: General]
  • Pulmonary embolism 15 January 2010 13:10 UTC edition.cnn.com [Source type: General]
  • OhioHealth - Pulmonary embolism 15 January 2010 13:10 UTC www.ohiohealth.com [Source type: General]

^ Thrombus in right and left main pulmonary artery were seen in 2(8%) patients.
  • Role of CT angiography in pulmonary embolism and its comparative evaluation with conventional pulmonary angiography Sood S, Negi A, Dhiman DS, Sood RG, Negi PC, Sharma S - Indian J Radiol Imaging 15 January 2010 13:10 UTC www.ijri.org [Source type: Academic]

^ To the right side of the heart enters the pulmonary (lung) circulation system, and blocks an artery in the lung.
  • CardioSmart: Pulmonary Embolism 15 January 2010 13:10 UTC www.cardiosmart.org [Source type: Academic]

.Some studies (see below) suggest that this finding may be an indication for thrombolysis.^ Although most cases have no clinical evidence of deep venous thrombosisin the legs, findings that indicate this may aid in the diagnosis.
  • Pulmonary embolism Pulmonology 15 January 2010 13:10 UTC www.lumrix.net [Source type: Academic]

^ He finds some masses near the heart, but the study is hard to read because Jimmy was moving around too much.
  • Polite Dissent » Search Results » pulmonary embolism 15 January 2010 13:10 UTC politedissent.com [Source type: FILTERED WITH BAYES]

^ Although fat droplets (by oil red O stain) in bronchoalveolar lavage fluid may be suggestive of fat embolism, this finding does not appear to be sensitive or specific.
  • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

.Not every patient with a (suspected) pulmonary embolism requires an echocardiogram, but elevations in cardiac troponins or brain natriuretic peptide may indicate heart strain and warrant an echocardiogram.^ A small pulmonary embolism may cause: .
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ The evaluation of suspected pulmonary embolism.
  • Unexplained Dyspnea May Indicate Pulmonary Embolism | December 2004 | RT for Decision Makers in Respiratory Care 15 January 2010 13:10 UTC www.rtmagazine.com [Source type: Academic]

^ Troponin and brain natriuretic peptide levels may also be elevated.
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

[22]
.The specific appearance of the right ventricle on echocardiography is referred to as the McConnell sign.^ Echocardiography documents pulmonary hypertension and enlargement of the right ventricle.
  • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

^ McConnell MV, Solomon SD, Rayan ME et al: Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism.
  • ISPUB - Postoperative Acute Pulmonary Embolism: A Case Report 15 January 2010 13:10 UTC www.ispub.com [Source type: Academic]

^ Sensitivity ( left ) and specificity ( right ) plots for turbidimetric D-dimer tests in the diagnosis of PE. The reference number for each study is listed between the plots.
  • Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis -- Brown et al. 49 (11): 1846 -- Clinical Chemistry 15 January 2010 13:10 UTC www.clinchem.org [Source type: Academic]

.This is the finding of akinesia of the mid-free wall but normal motion of the apex.^ A distinct echocardiographic pattern of RV dysfunction, with akinesia of RV free wall but normal motion at apex, has been shown to occur in acute PE and has been coined McConnel's sign.
  • Echocardiography 15 January 2010 13:10 UTC www2.umdnj.edu [Source type: Academic]

^ A 24 hour improvement in RV wall motion in patients receiving thrombolytics has been demonstrated but several trials have revealed conflicting findings regarding mortality benefit.
  • Echocardiography 15 January 2010 13:10 UTC www2.umdnj.edu [Source type: Academic]

.This phenomenon has a 77% sensitivity and a 94% specificity for the diagnosis of acute pulmonary embolism.^ The electrocardiogram in acute pulmonary embolism.
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]
  • Turkish Respiratory Journal 15 January 2010 13:10 UTC www.turkishrespiratoryjournal.com [Source type: Academic]

^ Accuracy of the clinical diagnosis of pulmonary embolism.
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]

^ Magnetic resonance angiography for the diagnosis of acute pulmonary embolism.
  • Wiley::Pulmonary Embolism, 2nd Edition 15 January 2010 13:10 UTC ca.wiley.com [Source type: Academic]
  • Wiley::Pulmonary Embolism, 2nd Edition 15 January 2010 13:10 UTC www.wiley.com [Source type: Academic]

[23]

Combining tests into algorithms

Recent recommendations for a diagnostic algorithm have been published by the PIOPED investigators; however, these recommendations do not reflect research using 64 slice MDCT.[12] These investigators recommended:
.
  • Low clinical probability.^ Thus, the diagnosis of PE should be rigorously pursued even when the lung scan is of low or intermediate probability if the clinical setting strongly suggests the diagnosis.
    • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

    ^ Five patients were excluded from the study due to low clinical probability and normal D-dimer levels.

    ^ PE was diagnosed in 68% of the patients with high clinical probability and in only 9% of those who were assigned a low clinical probability.
    • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]

    .If negative D-dimer, PE is excluded.^ Study of 756 patients found it is safe to withhold anticoagulation and defer additional evaluation in patients with a low or intermediate clinical probability of PE and a negative D-dimer.
    • Pulmonary Embolism 15 January 2010 13:10 UTC www.thoracic.org [Source type: Academic]

    ^ In a recent study by Dunn et al ., the sensitivity of the D-dimer assay was 97% and the negative predictive value for suspected PE was 99.6% [ 4 ].
    • Imaging of pulmonary embolism 15 January 2010 13:10 UTC www.c2i2.org [Source type: Academic]

    ^ The quantitative plasma D-Dimer (ELISA method) has a sensitivity of 96% allowing the exclusion of PE for values < 500 ng/l with a high negative predictive value.
    • DIAGNOSIS AND MANAGEMENTOF PULMONARY EMBOLISM 15 January 2010 13:10 UTC jcsmr.anu.edu.au [Source type: Academic]

    .If positive D-dimer, obtain MDCT and based treatment on results.
  • Moderate clinical probability.^ If the results are positive, treatment is indicated.
    • THE MERCK MANUAL OF GERIATRICS, Ch. 77, Pulmonary Embolism 15 January 2010 13:10 UTC www.merck.com [Source type: Academic]

    ^ Clinical probability and D-dimer .
    • Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study -- Hogg et al. 23 (2): 123 -- Emergency Medicine Journal 15 January 2010 13:10 UTC emj.bmj.com [Source type: Academic]

    ^ Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography.
    • Pulmonary Embolism 15 January 2010 13:10 UTC www.thoracic.org [Source type: Academic]

    .If negative D-dimer, PE is excluded.^ Study of 756 patients found it is safe to withhold anticoagulation and defer additional evaluation in patients with a low or intermediate clinical probability of PE and a negative D-dimer.
    • Pulmonary Embolism 15 January 2010 13:10 UTC www.thoracic.org [Source type: Academic]

    ^ In a recent study by Dunn et al ., the sensitivity of the D-dimer assay was 97% and the negative predictive value for suspected PE was 99.6% [ 4 ].
    • Imaging of pulmonary embolism 15 January 2010 13:10 UTC www.c2i2.org [Source type: Academic]

    ^ The quantitative plasma D-Dimer (ELISA method) has a sensitivity of 96% allowing the exclusion of PE for values < 500 ng/l with a high negative predictive value.
    • DIAGNOSIS AND MANAGEMENTOF PULMONARY EMBOLISM 15 January 2010 13:10 UTC jcsmr.anu.edu.au [Source type: Academic]

    .However, the authors were not concerned that a negative MDCT with negative D-dimer in this setting has an 5% probability of being false.^ For instance, there were 42% false-positives among patients with low clinical suspicion and a positive scan, and 40% false negatives among patients with high clinical probability but negative scan.
    • Pulmonary Embolism 15 January 2010 13:10 UTC www.thoracic.org [Source type: Academic]

    ^ Study of 756 patients found it is safe to withhold anticoagulation and defer additional evaluation in patients with a low or intermediate clinical probability of PE and a negative D-dimer.
    • Pulmonary Embolism 15 January 2010 13:10 UTC www.thoracic.org [Source type: Academic]

    ^ This required a pretest probability of around 13% to allow a negative D-dimer to confer a post-test probability that would effectively rule out the disease.
    • Emergency Medicine 15 January 2010 13:10 UTC www.emedmag.com [Source type: Academic]

    Presumably, the 5% error rate will fall as 64 slice MDCT is more commonly used. .If positive D-dimer, obtain MDCT and based treatment on results.
  • High clinical probability.^ If the results are positive, treatment is indicated.
    • THE MERCK MANUAL OF GERIATRICS, Ch. 77, Pulmonary Embolism 15 January 2010 13:10 UTC www.merck.com [Source type: Academic]

    ^ Clinical probability and D-dimer .
    • Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study -- Hogg et al. 23 (2): 123 -- Emergency Medicine Journal 15 January 2010 13:10 UTC emj.bmj.com [Source type: Academic]

    ^ Clinical presentation, Assessment of clinical probability, D-dimer, Compression ultrasonography and computed, tomographic venography, Ventilation–perfusion, Scintigraphy, Computed tomography, Pulmonary angiography, Echocardiography, Diagnostic strategies, Suspected high-risk pulmonary embolism, Suspected non-high-risk pulmonary embolism .
    • ESC> Guidelines & Surveys> Clinical Practice Guidelines> Acute Pulmonary Embolism (Diagnosis and Management of) 15 January 2010 13:10 UTC www.escardio.org [Source type: Academic]

    Proceed to MDCT. If positive, treat, if negative, additional tests are needed to exclude PE.

Pulmonary Embolism Rule-out Criteria

.The Pulmonary Embolism Rule-out Criteria, or PERC rule, helps assess patients in whom pulmonary embolism is suspected, but unlikely.^ The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram.
  • Role of CT angiography in pulmonary embolism and its comparative evaluation with conventional pulmonary angiography Sood S, Negi A, Dhiman DS, Sood RG, Negi PC, Sharma S - Indian J Radiol Imaging 15 January 2010 13:10 UTC www.ijri.org [Source type: Academic]

^ A normal result essentially rules out a pulmonary embolism.
  • Embolism - Definition, Description, Causes and symptoms, Diagnosis, Treatment, Prognosis, Prevention 15 January 2010 13:10 UTC health.stateuniversity.com [Source type: Academic]

^ The evaluation of suspected pulmonary embolism.
  • Unexplained Dyspnea May Indicate Pulmonary Embolism | December 2004 | RT for Decision Makers in Respiratory Care 15 January 2010 13:10 UTC www.rtmagazine.com [Source type: Academic]

.Unlike the Wells Score and Geneva score, which are clinical prediction rules intended to risk stratify patients with suspected PE, the PERC rule is designed to rule-out risk of PE in patients when the physician has already stratified them into a low-risk category.^ However, combinations of clinical features in the form of clinical prediction rules can be useful for stratifying patients into risk categories.
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

^ The Wells clinical prediction rule for DVT (see print Table 2 ) is used to stratify patients according to risk status.
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

^ Pretest probability of PE by Wells’ clinical prediction rules 19 (%) .
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

.Patients in this low risk category without any of these criteria may undergo no further diagnostic testing for PE: Hypoxia - Sa02 <95%, unilateral leg swelling, hemoptysis, prior DVT or PE, recent surgery or trauma, age >50, hormone use, tachycardia.^ These tests may include the following: .

^ The risk of deep vein thrombosis after surgery is reduced 50% with the use of these stockings.
  • Embolism - Definition, Description, Causes and symptoms, Diagnosis, Treatment, Prognosis, Prevention 15 January 2010 13:10 UTC health.stateuniversity.com [Source type: Academic]

^ Further tests may be unnecessary in this situation.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

.The rationale behind this decision is that further testing (specifically CT angiogram of the chest) may cause more harm (from radiation exposure and contrast dye) than the risk of PE.[24] The PERC rule has a sensitivity of 97.4% and specificity of 21.9% with a false negative rate of 1.0% (16/1666).^ Further testing may include: 2 .
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Further tests may be unnecessary in this situation.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ Further testing may include: 1 .

[25]

Treatment

.In most cases, anticoagulant therapy is the mainstay of treatment.^ Hemodynamically stabile pulmonary embolism has a much lower mortality rate, especially in recent years, because of treatment with anticoagulant therapy.
  • Pulmonary Embolism: eMedicine Emergency Medicine 15 January 2010 13:10 UTC emedicine.medscape.com [Source type: Academic]

^ In most cases, treatment consists of anti- coagulant medications (also called blood thinners).
  • pulmonary embolism, pulmonary emboli 15 January 2010 13:10 UTC my.clevelandclinic.org [Source type: FILTERED WITH BAYES]

^ Anti-clotting treatment is continued until three months after the pulmonary embolus, in most cases.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

.Acutely, supportive treatments, such as oxygen or analgesia, are often required.^ Acutely, supportive treatments, such as oxygen or analgesia, are often required.
  • Pulmonary Embolism Support Group - DailyStrength 15 January 2010 13:10 UTC www.dailystrength.org [Source type: General]

^ This often requires hospital treatment.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

^ Mechanical ventilation is often required to maximize oxygen delivery to the patient with circulatory collapse.
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

Anticoagulation

.In most cases, anticoagulant therapy is the mainstay of treatment.^ Although most cases of acute PE resolve with therapy, a substantial residual thromboembolic burden occasionally persists or develops over time.
  • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

^ CONCLUSIONS Although PEA is the mainstay treatment for CTEPH and should be considered as the first-line therapy, it is not sufficient to address the needs of all patients.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

^ But they may be most effective when combined with anticoagulant therapy.

.Heparin, low molecular weight heparins (such as enoxaparin and dalteparin), or fondaparinux is administered initially, while warfarin, acenocoumarol, or phenprocoumon therapy is commenced (this may take several days, usually while the patient is in hospital).^ Heparin comes in two forms: traditional and low molecular weight.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Warfarin maintenance therapy may be initiated after 1-3 days of effective heparinization.
  • Pulmonary Embolism: Treatment & Medication - eMedicine Emergency Medicine 15 January 2010 13:10 UTC emedicine.medscape.com [Source type: Academic]

^ Less commonly, the patient does not take warfarin but takes a daily injection of low molecular weight heparin or fondaparinux for the entire treatment period.
  • Pulmonary embolism 15 January 2010 13:10 UTC www.uptodate.com [Source type: Academic]

.It however may be possible to treat low risk patients as outpatients.^ For low risk situations, defined as minor surgery in patients less than 40 years of age without additional risk factors, early physical activity, if possible, is recommended.
  • Pulmonary Embolism - a knol by Taylor 15 January 2010 13:10 UTC knol.google.com [Source type: Academic]

^ However, spiral CT may not be suitable for patients with poor kidney function and patients who are unable to have a CT for other reasons (eg, an allergy to contrast dye).
  • Pulmonary embolism 15 January 2010 13:10 UTC www.uptodate.com [Source type: Academic]

^ Catatonia in the setting of a mood disorder, an organic process, or a psychotic disorder presents significant risk to the patient’s well-being, as well as an additional barrier to treating the underlying disorder.
  • Pulmonary Embolism as a Complication of Major Depressive Disorder with Catatonic Features: A Case Report | Psychiatry MMC 15 January 2010 13:10 UTC www.psychiatrymmc.com [Source type: Academic]

[26] An ongoing study is looking into the safety of this practice.[27] .Warfarin therapy often requires frequent dose adjustment and monitoring of the INR.^ Hazard of LDUH might not be appreciated and the administration of a continuous infusion in the hospital setting is often not entirely valued due to the need of monitoring and dosage adjustment that could be inadequate to administered doses (5).
  • Management of Pulmonary Embolism 15 January 2010 13:10 UTC www.priory.com [Source type: Academic]

^ Frequent blood tests (usually every 6 hours) are required to monitor the clotting effects of this medication.
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Anticoagulant effect of warfarin adjusted by varying dose to keep INR within target range.
  • Pulmonary Embolism: Treatment & Medication - eMedicine Emergency Medicine 15 January 2010 13:10 UTC emedicine.medscape.com [Source type: Academic]

In PE, INRs between 2.0 and 3.0 are generally considered ideal. .If another episode of PE occurs under warfarin treatment, the INR window may be increased to e.g.^ None of the deaths were directly attributable to PE. There were seven episodes of recurrent VTE (5%; 95% CI, 2%–11%); four of these occurred in the first month.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ If under treatment for another illness, such as cancer, anticoagulants will need to be taken for as long as risk factors for PE are present.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

^ It is used when anticoagulants are not an option, when clots form despite anticoagulant use, or when there is an increased risk of death or a severely restricted lifestyle if another pulmonary embolism occurs.

.2.5-3.5 (unless there are contraindications) or anticoagulation may be changed to a different anticoagulant e.g.^ Dosing Interactions Contraindications Precautions Antiplatelet agents or anticoagulants may increase risk of bleeding .
  • Pulmonary Embolism: Treatment & Medication - eMedicine Emergency Medicine 15 January 2010 13:10 UTC emedicine.medscape.com [Source type: Academic]

^ CONTRAINDICATIONS FOR PEA Aside from inoperable CTEPH established on the basis discussed above , what are the other contraindications to PEA in CTEPH? There are limited data to evaluate where comorbidity may constitute a contraindication to surgery.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

^ When DVT or PE is diagnosed, anticoagulation should be instituted immediately unless contraindications are present.
  • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

.low molecular weight heparin.^ Heparin comes in two forms: traditional and low molecular weight.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Low-molecular-weight heparin is also effective for people in this situation.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Low-molecular-weight heparin (LMWH) is preferred to unfractionated heparin.
  • THE MERCK MANUAL OF GERIATRICS, Ch. 77, Pulmonary Embolism 15 January 2010 13:10 UTC www.merck.com [Source type: Academic]

.In patients with an underlying malignancy, therapy with a course of low molecular weight heparin may be favored over warfarin based on the results of the CLOT trial.^ Heparin comes in two forms: traditional and low molecular weight.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Heparin or warfarin (Coumadin) therapy.
  • Pulmonary embolism 15 January 2010 13:10 UTC www.cnn.com [Source type: General]
  • Pulmonary embolism - Valley Health System 15 January 2010 13:10 UTC www.valleyhealth.com [Source type: General]
  • Pulmonary embolism 15 January 2010 13:10 UTC edition.cnn.com [Source type: General]
  • OhioHealth - Pulmonary embolism 15 January 2010 13:10 UTC www.ohiohealth.com [Source type: General]

^ Warfarin maintenance therapy may be initiated after 1-3 days of effective heparinization.
  • Pulmonary Embolism: Treatment & Medication - eMedicine Emergency Medicine 15 January 2010 13:10 UTC emedicine.medscape.com [Source type: Academic]

[28] .Similarly, pregnant women are often maintained on low molecular weight heparin to avoid the known teratogenic effects of warfarin, especially in the early stages of pregnancy.^ Heparin comes in two forms: traditional and low molecular weight.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Low-molecular-weight heparin is also effective for people in this situation.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Pregnant women usually are treated with heparin only, because warfarin is dangerous for the pregnancy.
  • LUNG DISORDERS - Pulmonary Embolism (PE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]

.People are usually admitted to hospital in the early stages of treatment, and tend to remain under inpatient care until INR has reached therapeutic levels.^ Early discharge from hospital inpatient ward .
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ If the INR remains at a therapeutic level (> 2), argatroban does not need to be restarted.
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

^ Pulmonary embolism is one of the most common causes of death in hospitalized people who must remain in bed for a long time.
  • Pulmonary Embolism Symptoms ~ APS Foundation of America, Inc 15 January 2010 13:10 UTC www.apsfa.org [Source type: General]
  • Pulmonary Embolism (PE, PTE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]
  • Postoperative Pulmonary Embolism or Deep Vein Thrombosis (DVT) 15 January 2010 13:10 UTC nhqc.com [Source type: Academic]

Increasingly, low-risk cases are managed on an outpatient basis in a fashion already common in the treatment of DVT.[29]
.Warfarin therapy is usually continued for 3–6 months, or "lifelong" if there have been previous DVTs or PEs, or none of the usual risk factors is present.^ Anticoagulation should continue for 3 months after the PE. 6 .
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

^ If DVT is diagnosed, PE is assumed to be present.
  • Arch Intern Med -- Suspected Pulmonary Embolism in Pregnancy: Clinical Presentation, Results of Lung Scanning, and Subsequent Maternal and Pediatric Outcomes, May 27, 2002, Chan et al. 162 (10): 1170 15 January 2010 13:10 UTC archinte.ama-assn.org [Source type: Academic]

^ Anticoagulation is continued for 3-6 months, depending on the cause of the PE and continuing risk factors.
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

.An abnormal D-dimer level at the end of treatment might signal the need for continued treatment among patients with a first unprovoked pulmonary embolus.^ People with a pulmonary embolus may have abnormally low oxygen levels.
  • Pulmonary Embolism - Symptoms, Treatment and Prevention 15 January 2010 13:10 UTC www.healthscout.com [Source type: FILTERED WITH BAYES]

^ The most common radiographic abnormalities were atelectasis and pulmonary parenchymal consolidation, either or both of which occurred in 69% of the patients with PE and in 58% of those without ( 23 ).
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]

^ In this and other studies, the combination of a normal ELISA D-dimer level and a low clinical probability has been shown to be accurate in ruling out pulmonary embolism [ 5,6 ], with a 3-month risk of subsequent thromboembolism in patients who were not anticoagulated in these studies between 0 and 1.5%.
  • Imaging of pulmonary embolism 15 January 2010 13:10 UTC www.c2i2.org [Source type: Academic]

[30]

Thrombolysis

.Massive PE causing hemodynamic instability (shock and/or hypotension, defined as a systolic blood pressure <90 mmHg or a pressure drop of 40 mmHg for>15 min if not caused by new-onset arrhythmia, hypovolemia or sepsis) is an indication for thrombolysis, the enzymatic destruction of the clot with medication.^ The pressure keeps blood from pooling and clotting.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]
  • LUNG DISORDERS - Pulmonary Embolism (PE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]

^ Massive PE : where the patient is shocked or hypotensive, this is defined as a systolic blood pressure < 90 mmHg or a pressure drop of 40 mmHg for > 15 min not caused by new-onset arrhythmia , hypovolaemia or sepsis .
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

^ Massive PE causing hemodynamic instability (marked decreased oxygen saturation, tachycardia and/or hypotension) is an indication for thrombolysis, the enzymatic destruction of the clot with medication.
  • Pulmonary Embolism Support Group - DailyStrength 15 January 2010 13:10 UTC www.dailystrength.org [Source type: General]

.It is the best available medical treatment in this situation and is supported by clinical guidelines.^ More information is also required to define how best to place medical treatment alongside other treatment modalities.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

^ Continued research and clinical trials investigating possible applications of new medical treatments are required.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

^ Surgical treatments/interventions for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

[31][32][33]
.The use of thrombolysis in non-massive PEs is still debated.^ Use of thrombolysis is debated.
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

^ Massive PE causing hemodynamic instability (marked decreased oxygen saturation, tachycardia and/or hypotension) is an indication for thrombolysis, the enzymatic destruction of the clot with medication.
  • Pulmonary Embolism Support Group - DailyStrength 15 January 2010 13:10 UTC www.dailystrength.org [Source type: General]

^ The prognosis of non-massive PE depends mainly on the existence of other factors such as age, COPD, IHD or cancer.
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

.The aim of the therapy is to dissolve the clot, but there is an attendant risk of bleeding or stroke.^ Many physicians order the use of stockings before surgery and until there is no longer an elevated risk of developing blood clots.
  • Embolism - Definition, Description, Causes and symptoms, Diagnosis, Treatment, Prognosis, Prevention 15 January 2010 13:10 UTC health.stateuniversity.com [Source type: Academic]

^ While clots usually dissolve on their own, there are medications that can dissolve clots quickly.
  • Pulmonary embolism 15 January 2010 13:10 UTC www.cnn.com [Source type: General]
  • Pulmonary embolism - Valley Health System 15 January 2010 13:10 UTC www.valleyhealth.com [Source type: General]
  • Pulmonary embolism 15 January 2010 13:10 UTC edition.cnn.com [Source type: General]

^ There were a couple of other medical problems this episode as well, most dealing with bleeding and clotting — flip sides of the same coin: 1.
  • Polite Dissent » Search Results » pulmonary embolism 15 January 2010 13:10 UTC politedissent.com [Source type: FILTERED WITH BAYES]

[34] .The main indication for thrombolysis is in submassive PE where right ventricular dysfunction can be demonstrated on echocardiography, and the presence of visible thrombus in the atrium.^ Some advocate its use also if right ventricular dysfunction can be demonstrated on echocardiography.
  • Pulmonary Embolism Support Group - DailyStrength 15 January 2010 13:10 UTC www.dailystrength.org [Source type: General]

^ Massive PE causing hemodynamic instability (marked decreased oxygen saturation, tachycardia and/or hypotension) is an indication for thrombolysis, the enzymatic destruction of the clot with medication.
  • Pulmonary Embolism Support Group - DailyStrength 15 January 2010 13:10 UTC www.dailystrength.org [Source type: General]

^ Echocardiography Transthoracic and transesophageal echocardiography have been used to document the presence of air in the right ventricle and may show evidence of acute right ventricular dilation and pulmonary artery hypertension consistent with air embolism [ 3,32 ].
  • Air embolism 15 January 2010 13:10 UTC cmbi.bjmu.edu.cn [Source type: Academic]

[35]

Surgical management

Used inferior vena cava filter.
.Surgical management of acute pulmonary embolism (pulmonary thrombectomy) is uncommon and has largely been abandoned because of poor long-term outcomes.^ The electrocardiogram in acute pulmonary embolism.
  • Accuracy of Clinical Assessment in the Diagnosis of Pulmonary Embolism -- MINIATI et al. 159 (3): 864 -- American Journal of Respiratory and Critical Care Medicine 15 January 2010 13:10 UTC ajrccm.atsjournals.org [Source type: Academic]
  • Turkish Respiratory Journal 15 January 2010 13:10 UTC www.turkishrespiratoryjournal.com [Source type: Academic]

^ Pulmonary embolism - initial management .
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

^ MJA: Management of pulmonary embolism in the home .
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

.However, recently, it has gone through a resurgence with the revision of the surgical technique and is thought to benefit selected patients.^ However, this should not preclude elderly patients with PE being treated through ambulatory care, as 87% of patients aged ≥ 70 years completed the program successfully.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ It is indispensable to revise and re-evaluate whether patient- adjusted dose could brink some benefits into massive PE therapy.
  • Management of Pulmonary Embolism 15 January 2010 13:10 UTC www.priory.com [Source type: Academic]

^ However, it is essential to ensure that the patients are appropriately selected and to demonstrate that these patients can be safely managed in the outpatient or home setting.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

[36]
.Chronic pulmonary embolism leading to pulmonary hypertension (known as chronic thromboembolic hypertension) is treated with a surgical procedure known as a pulmonary thromboendarterectomy.^ Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

^ This frequently leads to pulmonary embolism if untreated.
  • Embolism - Definition, Description, Causes and symptoms, Diagnosis, Treatment, Prognosis, Prevention 15 January 2010 13:10 UTC health.stateuniversity.com [Source type: Academic]

^ DVTs and pulmonary embolism are also known as 'VTE' or 'venous thromboembolism'.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

Inferior vena cava filter

.If anticoagulant therapy is contraindicated and/or ineffective, or to prevent new emboli from entering the pulmonary artery and combining with an existing blockage, an inferior vena cava filter may be implanted.^ Vena cava filters are not recommended as the first treatment for pulmonary embolism.

^ Studies have shown that vena cava filters help prevent pulmonary embolism.

^ But they may be most effective when combined with anticoagulant therapy.

[37]

Prognosis

.Mortality from untreated PE is said to be 26%.^ Complications and prognosis Mortality from PE is 30% if untreated, reduced to 2-8% by adequate anticoagulation and thrombolysis.
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

.This figure comes from a trial published in 1960 by Barrit and Jordan,[38] which compared anticoagulation against placebo for the management of PE. Barritt and Jordan performed their study in the Bristol Royal Infirmary in 1957. This study is the only placebo controlled trial ever to examine the place of anticoagulants in the treatment of PE, the results of which were so convincing that the trial has never been repeated as to do so would be considered unethical.^ From this study, the VQ scan results in pregnant women with suspected PE clearly differ from those performed in nonpregnant patients with suspected PE. The prevalence of high-probability VQ scans in pregnant women is very low (1.8%) compared with that reported in nonpregnant patients (about 10%); the prevalence of normal VQ scans is much higher (73.5%) in pregnant women than in nonpregnant subjects (about one third).
  • Arch Intern Med -- Suspected Pulmonary Embolism in Pregnancy: Clinical Presentation, Results of Lung Scanning, and Subsequent Maternal and Pediatric Outcomes, May 27, 2002, Chan et al. 162 (10): 1170 15 January 2010 13:10 UTC archinte.ama-assn.org [Source type: Academic]

^ Streptokinase was compared to the heparin in the treatment of PE, with the final endpoint represented by the pulmonary perfusion, controlled by the angiography.
  • Management of Pulmonary Embolism 15 January 2010 13:10 UTC www.priory.com [Source type: Academic]

^ The final solution (Amber), will have to wait until next week, but come on — “resin?” House would have figured it out then and there.
  • Polite Dissent » Search Results » pulmonary embolism 15 January 2010 13:10 UTC politedissent.com [Source type: FILTERED WITH BAYES]

.That said, the reported mortality rate of 26% in the placebo group is probably an overstatement, given that the technology of the day may have detected only severe PEs.^ Mortality rates as high as 25% at seven days have been reported.
  • Emergency Medicine 15 January 2010 13:10 UTC www.emedmag.com [Source type: Academic]

^ On Day 49, she was taken to a community hospital emergency room for severe dehydration and was given intravenous fluids over several hours.
  • Pulmonary Embolism as a Complication of Major Depressive Disorder with Catatonic Features: A Case Report | Psychiatry MMC 15 January 2010 13:10 UTC www.psychiatrymmc.com [Source type: Academic]

^ Anticoagulation remains the standard of treatment for PE and has clearly been shown to reduce mortality and the rate of recurrent PE. 3 Anticoagulation does not directly contribute to clot lysis.
  • Is Thrombolytic Therapy Effective For Pulmonary Embolism? - March 15, 2002 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

.Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic embolisation to the lung can lead to pulmonary hypertension.^ Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in your lungs is too high.
  • Pulmonary embolism 15 January 2010 13:10 UTC www.cnn.com [Source type: General]
  • Pulmonary embolism - Valley Health System 15 January 2010 13:10 UTC www.valleyhealth.com [Source type: General]
  • Pulmonary embolism 15 January 2010 13:10 UTC edition.cnn.com [Source type: General]

^ Chronic thromboembolic pulmonary hypertension.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

^ Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

.After a massive PE, the embolus must be resolved somehow if the patient is to survive.^ Most patients with PE who receive adequate anticoagulation survive.
  • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

^ Untreated, approximately one third of patients who survive an initial PE die of a future embolic episode.
  • Pulmonary Embolism Information 15 January 2010 13:10 UTC www.mac-paper.com [Source type: FILTERED WITH BAYES]

^ It is indispensable to revise and re-evaluate whether patient- adjusted dose could brink some benefits into massive PE therapy.
  • Management of Pulmonary Embolism 15 January 2010 13:10 UTC www.priory.com [Source type: Academic]

.In thrombotic PE, the blood clot may be broken down by fibrinolysis, or it may be organized and recanalized so that a new channel forms through the clot.^ Aspirin may reduce the risk of forming blood clots.
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Leg clots can form when blood flow is restricted and slows down.
  • Pulmonary Embolism Symptoms ~ APS Foundation of America, Inc 15 January 2010 13:10 UTC www.apsfa.org [Source type: General]
  • Pulmonary Embolism (PE, PTE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]

^ Blood clots can form in arteries and/or veins.
  • Main Line Health - Pulmonary Embolism 15 January 2010 13:10 UTC www.mainlinehealth.org [Source type: Academic]

.Blood flow is restored most rapidly in the first day or two after a PE.[39] Improvement slows thereafter, and some defects may remain permanently.^ Slowed blood flow .
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ The most common type of pulmonary embolism is a blood clot, usually one that forms in a leg or pelvic vein (see Venous Disorders: Deep Vein Thrombosis (DVT) ) when blood flow slows down or stops, as may occur in the leg veins when a person stays in one position for a long time.
  • Pulmonary Embolism: Pulmonary Embolism (PE): Merck Manual Home Edition 15 January 2010 13:10 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ A pulmonary embolism (PE) is a blood clot that develops in a blood vessel elsewhere in the body (most commonly from the leg), travels to an artery in the lung, and forms an occlusion (blockage) of the artery.
  • Main Line Health - Pulmonary Embolism 15 January 2010 13:10 UTC www.mainlinehealth.org [Source type: Academic]

.There is controversy over whether or not small subsegmental PEs need to be treated at all[40] and some evidence exists that patients with subsegmental PEs may do well without treatment.^ There is growing evidence that patients with sub-massive PE can be treated as outpatients or in the home.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ Physical findings such as haemodynamic status can be used to estimate severity of PE, but may be unreliable in patients with prior cardiopulmonary disease.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ Many centers now regard fibrinolysis as the primary treatment of choice for all patients with PE and even for all patients who have DVT without evidence of PE. Over the past 20 years, a large number of small studies and a small number of large studies have demonstrated consistently that fibrinolytic therapy dramatically reduces the mortality rate, morbidity, and rate of recurrence of PE regardless of the size or type of PE at the time of presentation.
  • Pulmonary Embolism Information 15 January 2010 13:10 UTC www.mac-paper.com [Source type: FILTERED WITH BAYES]

[15][41]

Predicting mortality

.The PESI and Geneva prediction rules can estimate mortality and so may guide selection of patients who can be considered for outpatient therapy.^ Physical findings such as haemodynamic status can be used to estimate severity of PE, but may be unreliable in patients with prior cardiopulmonary disease.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ However, spiral CT may not be suitable for patients with poor kidney function and patients who are unable to have a CT for other reasons (eg, an allergy to contrast dye).
  • Pulmonary embolism 15 January 2010 13:10 UTC www.uptodate.com [Source type: Academic]

^ Regarding scenario 3, although medical therapy to maintain patients' status before surgery is agreed to be advantageous, therapy that requires unnecessary delay to appropriate surgery may be deleterious.
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

[42]

Underlying causes

.After a first PE, the search for secondary causes is usually brief.^ A PE is usually caused by a deep vein thrombosis (DVT), which is the formation of one or more blood clots in the deep veins of the body, most often the legs.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

^ When a patient experiences their first episode of PE, anticoagulation therapy is usually recommended for three to six months.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]

.Only when a second PE occurs, and especially when this happens while still under anticoagulant therapy, a further search for underlying conditions is undertaken.^ Nevertheless, a 3-mo period of anticoagulant therapy is currently considered mandatory before PEA is undertaken, to minimize the risk of perioperative pulmonary embolism ( 4 ).
  • Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses -- Rubin et al. 3 (7): 601 -- Proceedings of the American Thoracic Society 15 January 2010 13:10 UTC pats.atsjournals.org [Source type: Academic]

^ One of the women with a normal scan was given anticoagulation therapy because her scan had been interpreted locally as nondiagnostic, and she refused further definitive testing.
  • Arch Intern Med -- Suspected Pulmonary Embolism in Pregnancy: Clinical Presentation, Results of Lung Scanning, and Subsequent Maternal and Pediatric Outcomes, May 27, 2002, Chan et al. 162 (10): 1170 15 January 2010 13:10 UTC archinte.ama-assn.org [Source type: Academic]

^ Pulmonary emboli can also be prevented by inserting a filter into the vena cava, but this approach is used only if anticoagulant therapy is contraindicated because of bleeding or if PE has recurred despite adequate treatment with anticoagulants (see below for definition of adequate anticoagulant therapy).
  • Pulmonary Embolism Information 15 January 2010 13:10 UTC www.mac-paper.com [Source type: FILTERED WITH BAYES]

.This will include testing ("thrombophilia screen") for Factor V Leiden mutation, antiphospholipid antibodies, protein C and S and antithrombin levels, and later prothrombin mutation, MTHFR mutation, Factor VIII concentration and rarer inherited coagulation abnormalities.^ Factor V Leiden mutation (heterozygous) .
  • DVT and Pulmonary Embolism: Part I. Diagnosis - June 15, 2004 - American Family Physician 15 January 2010 13:10 UTC www.aafp.org [Source type: Academic]

^ Polycythemia, sickle cell anemia, and inherited or acquired thrombophilia, including antithrombin III deficiency, protein C deficiency, protein S deficiency, and factor V Leiden, also increase the risk for thromboemboli.
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

^ V Leiden, antithrombin III deficiency, antiphospholipid antibodies) 7 or the contraceptive pill in women who smoke or are diabetic.
  • Pulmonary embolism--an update on thrombolytic therapy -- Thomas et al. 93 (5): 261 -- QJM 15 January 2010 13:10 UTC qjmed.oxfordjournals.org [Source type: Academic]

Epidemiology

Risk factors

.The most common sources of embolism are proximal leg deep venous thrombosis (DVTs) or pelvic vein thromboses.^ Prevention of deep vein thrombosis and pulmonary embolism.
  • Health Information 15 January 2010 13:10 UTC www.mountauburnhospital.org [Source type: FILTERED WITH BAYES]
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Background Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common public health problems.
  • Arch Intern Med -- Abstract: Deep Vein Thrombosis and Pulmonary Embolism in the General Population: 'The Study of Men Born in 1913', 11 AUGUST 1997, Hansson et al. 157 (15): 1665 15 January 2010 13:10 UTC archinte.ama-assn.org [Source type: Academic]

^ Yasmin side effects: Deep Vein Thrombosis and Pulmonary embolism .
  • Yasmin side effects: Deep Vein Thrombosis and Pulmonary embolism - Legal Chat Online 15 January 2010 13:10 UTC www.legalchatonline.com [Source type: General]

.Any risk factor for DVT also increases the risk that the venous clot will dislodge and migrate to the lung circulation, which happens in up to 15% of all DVTs.^ Increased levels of clotting factors in the blood.

^ Risk factors for venous thromboembolism 2 , 6 .
  • Pulmonary Embolism | Doctor | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: Academic]

^ There are several factors which increase an individuals risk of developing pulmonary embolism or DVT. Recent surgeries, long periods of immobility, heart problems, history of heart attack or stroke, previous DVT, older age, and oral contraceptives are the risk factors for developing DVT and pulmonary embolism.

.The conditions are generally regarded as a continuum termed venous thromboembolism (VTE).^ VTE = venous thromboembolism.
  • eMJA: Management of pulmonary embolism in the home 15 January 2010 13:10 UTC www.mja.com.au [Source type: Academic]

^ PE indicates pulmonary embolism; DVT, deep venous thrombosis; VTE, venous thromboembolic event; and CI, confidence interval.
  • Arch Intern Med -- Suspected Pulmonary Embolism in Pregnancy: Clinical Presentation, Results of Lung Scanning, and Subsequent Maternal and Pediatric Outcomes, May 27, 2002, Chan et al. 162 (10): 1170 15 January 2010 13:10 UTC archinte.ama-assn.org [Source type: Academic]

^ Preliminary evaluation of two new rapid immunoturbidimetric D-dimer assays in patients with clinically suspected venous thromboembolism (VTE).
  • Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis -- Brown et al. 49 (11): 1846 -- Clinical Chemistry 15 January 2010 13:10 UTC www.clinchem.org [Source type: Academic]

.The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood).^ Injury to the blood vessel wall .
  • Pulmonary Embolism, SVCMC; New York NY 15 January 2010 13:10 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Autopsies of catatonic patients revealed a seven-percent mortality by PE.[11] Virchow’s triad of venous stasis, endothelial damage, and hypercoagulabilty are the classic risk factors for DVT. The thrombosis can then dislodge and lead to an embolism ( Figure 1 ).
  • Pulmonary Embolism as a Complication of Major Depressive Disorder with Catatonic Features: A Case Report | Psychiatry MMC 15 January 2010 13:10 UTC www.psychiatrymmc.com [Source type: Academic]

^ The disease normally affects athletes whose upper-body muscle development constricts the arteries from the heart and causes potentially fatal blood clots in the lungs, he said.
  • Tulsa World: Update: Isaac Hanson undergoes surgery for pulmonary embolism 15 January 2010 13:10 UTC www.tulsaworld.com [Source type: FILTERED WITH BAYES]

.Often, more than one risk factor is present.^ People with more than one risk factor are at higher risk for blood clots.
  • Pulmonary Embolism - Medpedia 15 January 2010 13:10 UTC wiki.medpedia.com [Source type: Academic]
  • LUNG DISORDERS - Pulmonary Embolism (PE) 15 January 2010 13:10 UTC www.medic8.com [Source type: FILTERED WITH BAYES]

^ Anticoagulant prophylaxis appears more effective than mechanical prophylaxis, but the risk of both thrombosis and bleeding must be considered.
  • Cecil's Textbook of Medicine: Pulmonary Embolism: Thrombotic Pulmonary Embolism 15 January 2010 13:10 UTC www.merckmedicus.com [Source type: Academic]

^ Normal test results are actually much more meaningful than abnormal ones.

Prognosis

.Once anticoagulation is stopped, the risk of a fatal pulmonary embolism is 0.5% per year.^ Table 1 Risk factors for pulmonary embolism .
  • Massive Pulmonary Embolism -- Shaughnessy 27 (1): 39 -- Critical Care Nurse 15 January 2010 13:10 UTC ccn.aacnjournals.org [Source type: Academic]

^ A pulmonary embolism is a serious condition and can be fatal.
  • Pulmonary Embolism | Health | Patient UK 15 January 2010 13:10 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ What are the risk factors for pulmonary embolism?
  • Pulmonary Embolism 15 January 2010 13:10 UTC www.sharp.com [Source type: Academic]

[43]

References

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Simple English

A pulmonary embolism is a clot of material that blocks blood from getting to the lungs. It most often is caused by a blood clot, but it can also be caused by clumped cancer cells, fat, bone, or rarely amniotic fluid, affecting mothers during birth.

A pulmonary embolism causes sudden shortness of breath, rapid breathing, chest pain, coughing up blood and sexual dysfunction. People who suffered from pulmonary embolism are more likely to suffer from premature ejaculation. In rare cases, it can cause rapid heart beat, low blood pressure, shock, and death.

Pulmonary embolisms are separated into two categories: Acute and Chronic. Acute Pulmonary Embolisms are normally sudden, while Chronic Pulmonary Embolisms are not.

It is most often treated with anticoagulants, making it so the blood can no longer clot.


Citable sentences

Up to date as of December 19, 2010

Here are sentences from other pages on Pulmonary embolism, which are similar to those in the above article.








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