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    2019 Acute PE Slide-Set For Web

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    Pragnesh Shah
    The document discusses acute pulmonary thromboembolism, including risk factors, common symptoms, and physical exam findings. It notes that dyspnea, pleuritic chest pain, and cough are common symptoms reported in 73%, 66%, and 37% of cases respectively. On physical exam, tachypnea (96%), rales (58%), accentuated heart sounds (53%), and tachycardia (44%) are frequently seen. The document also outlines initial tests for diagnosis, including D-dimer, echocardiography, and CT pulmonary angiography. D-dimer testing has high reliability for excluding PE in low risk younger patients, but low predictive value in high risk older patients.

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    2019 Acute PE Slide-Set For Web

    Uploaded by

    Pragnesh Shah
    21 views59 pages
    The document discusses acute pulmonary thromboembolism, including risk factors, common symptoms, and physical exam findings. It notes that dyspnea, pleuritic chest pain, and cough are common symptoms reported in 73%, 66%, and 37% of cases respectively. On physical exam, tachypnea (96%), rales (58%), accentuated heart sounds (53%), and tachycardia (44%) are frequently seen. The document also outlines initial tests for diagnosis, including D-dimer, echocardiography, and CT pulmonary angiography. D-dimer testing has high reliability for excluding PE in low risk younger patients, but low predictive value in high risk older patients.

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    The document discusses acute pulmonary thromboembolism, including risk factors, common symptoms, and physical exam findings. It notes that dyspnea, pleuritic chest pain, and cough are common symptoms reported in 73%, 66%, and 37% of cases respectively. On physical exam, tachypnea (96%), rales (58%), accentuated heart sounds (53%), and tachycardia (44%) are frequently seen. The document also outlines initial tests for diagnosis, including D-dimer, echocardiography, and CT pulmonary angiography. D-dimer testing has high reliability for excluding PE in low risk younger patients, but low predictive value in high risk older patients.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    21 views59 pages

    2019 Acute PE Slide-Set For Web

    Uploaded by

    Pragnesh Shah
    The document discusses acute pulmonary thromboembolism, including risk factors, common symptoms, and physical exam findings. It notes that dyspnea, pleuritic chest pain, and cough are common symptoms reported in 73%, 66%, and 37% of cases respectively. On physical exam, tachypnea (96%), rales (58%), accentuated heart sounds (53%), and tachycardia (44%) are frequently seen. The document also outlines initial tests for diagnosis, including D-dimer, echocardiography, and CT pulmonary angiography. D-dimer testing has high reliability for excluding PE in low risk younger patients, but low predictive value in high risk older patients.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 59

    Acute pulmonary thrombo-embolism

    DR PRAGNESH SHAH
    Interventional cardiologist
    • The diagnosis of pulmonary embolism should be sought actively in
    patients with respiratory symptoms unexplained by an alternative
    diagnosis. The symptoms of pulmonary embolism are nonspecific;
    therefore, a high index of suspicion is required, particularly when a
    patient has risk factors for the condition.
    Indicators of PE
    • Travel of 4 hours or more in the past month
    • Surgery within the last 3 months
    • Malignancy, especially lung cancer
    • Current or past history of thrombophlebitis
    • Trauma to the lower extremities and pelvis during the past 3 months
    • Smoking
    • Central venous instrumentation within the past 3 months
    • Stroke, paresis, or paralysis
    • Prior pulmonary embolism
    • Heart failure
    • Chronic obstructive pulmonary disease
    • A hypercoagulation workup should be performed if no obvious cause
    for embolic disease is apparent. This may include screening for
    conditions such as the following:
    • Antithrombin III deficiency
    • Protein C or protein S deficiency
    • Lupus anticoagulant
    • Homocystinuria
    • Occult neoplasm
    • Connective tissue disorders
    • The PIOPED study reported the following incidence of common
    symptoms of pulmonary embolism [35] :
    • Dyspnea (73%)
    • Pleuritic chest pain (66%)
    • Cough (37%)
    • Hemoptysis (13%)
    PHYSICAL EXAMINATION
    • In patients with recognized pulmonary embolism, the incidence of physical signs has been reported as
    follows:
    • Tachypnea (respiratory rate >16/min) - 96%
    • Rales - 58%
    • Accentuated second heart sound - 53%
    • Tachycardia (heart rate >100/min) - 44%
    • Fever (temperature >37.8°C [100.04ºF]) - 43%
    • Diaphoresis - 36%
    • S3 or S4 gallop - 34%
    • Clinical signs and symptoms suggesting thrombophlebitis - 32%
    • Lower extremity edema - 24%
    • Cardiac murmur - 23%
    • Cyanosis - 19%
    inINI
    • D DIMER
    • Echocardiography
    • CT pulmonary angiography
    • When clinical prediction rule results indicate that the patient has a
    low or moderate pretest probability of pulmonary embolism, D-dimer
    testing may be the next step. [3
    • D-dimer testing is most reliable for excluding pulmonary embolism in
    younger patients who have no associated comorbidity or history of
    venous thromboembolism and whose symptoms are of short
    duration. [4] However, it is of questionable value in patients who are
    older than 80 years, who are hospitalized, who have cancer, or who
    are pregnant, because nonspecific elevation of D-dimer
    concentrations is common in such patients.
    • D-dimer testing should not be used when the clinical probability of
    pulmonary embolism is high, because the test has low negative
    predictive value in such cases. [50]

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