Is called a Pulmonary Venous Thromboembolism or PE

Can be very common and very serious

Approximately 200,000 deaths are attributed to a PE.

Many cases are only identified upon autopsy or after death

Several different “substances” can cause an emboli
   ·    Air
   ·    Thrombus – most common
   ·    Septic emboli
   ·    Foreign bodies
   ·    Tumor cells
   ·    Amniotic fluid

Thrombi can arise from anywhere in the venous circulation

Most often arise in a vein from the calf

The emboli can break off and travel to the heart and into the lungs that can cause the embolism.

DVT or Deep Venous Thrombosis is essential and a Pulmonary Embolism may be waiting to happen.

Risk factors are the following:
   ·    Pooling or slowing of venous blood flow
   ·    Injury to vessel wall
   ·    Hypercoagulability
   ·    Following a surgery
   ·    Bed rest
   ·    Obesity
   ·    Following a stroke
   ·    Inherited conditions

Complications of having a PE are:
   ·    Obstuction
   ·    Heart Failure
   ·    Hypoxemia
   ·    Decrease cardiac output
   ·    Death

Symptoms
   -    Wheezing
   -    Difficult breathing
   -    Pain with breathing
   -    Coughing blood
   -    Chest pain
   -    Rapid breathing
   -    Wheezing
   -    Palpitations
   -    Leg pain

EKG may often be abnormal

Arterial blood gas shows Respiratory Alkalosis

D-dimer can be elevated

D-dimer is a breakdown product of fibrin

Chest X-ray is quite important

A perfusion scan is done by injecting particles into the venous system.   Will show a blockage in the lung where blood flow is being obstructed.

Almost 3 out of 4 who have a PE will also have a DVT on evaluation

The standard for diagnosis is a Pulmonary Arteriography – it is regarded as an invasive procedure that is safe

MRI can help determine a DVT

Ultrasound of leg to show DVT

Prevention is the key of success in many cases

Risk factors can often be identified and concerns can be addressed

For example, compression stockings can improve risk for DVT and improves venous return

Treatment
·         Heparin
·         Warfarin typically 6 months

Low-molecular-weight heparins (LMW)
·         Dalteparin  (Fragmin)  a LMW
·         Enoxaparin  (Lovenox)  a LMW
·         Nadroparin  (Fraxiparin)  a LMW
·         Tinzaparin  (Innohep)  a LMW

·         Unfractionated heparin

Thrombolytic Therapy
·         Streptokinase
·         Urokinase
·         Recombinant tissue plasmingoen activator (rt-PA) [Alteplase]

Interruption of the vena cava
A filter may be placed as a net to catch thrombus

Prognosis is that almost 50,000 death are seen annually
With a mortality rate from an untreated PE to be around 25%
The underlying disease and area of lungs affected are the keys to good prognosis