Pulmonary Embolism

What is Pulmonary Embolism?

A pulmonary embolism (PE) is a blot clot in an artery of the lungs which stops blood from flowing to the lung. A clot commonly travels from the legs, but can also come from other veins in the body.

What are the symptoms of Pulmonary Embolism?

Symptoms of a pulmonary embolism can be nonspecific. The most common signs are shortness of breath, low oxygen level,  high heart rate, and chest pain. PE should be suspected in patients with sudden difficulty breathing with no other explanation.

What are the risk factors of Pulmonary Embolism?

Risk factors for PE include:

  • Clotting disorders such as Protein C or S deficiency
  • Antithrombin III deficiency
  • Recent airplane travel
  • Surgery
  • Cancer.

How can Pulmonary Embolism be diagnosed?

  • Well’s Criteria is one of the commonly used criteria which assigns points to different symptoms to determine the likelihood that someone is having a PE. A higher score means that a PE is more likely. If the Well’s criteria was low, another criteria called the PERC criteria is used to rule out a PE. If the PERC criteria is zero, PE is ruled out and other diagnoses are considered. If the Well’s criteria showed moderate risk or the PERC criteria was more than zero a blood product called a D- Dimer is obtained.  If this value is higher, a cat scan angiography is obtained which is the gold standard for diagnosing a PE.
  •  White blood count can also be measured. A high white count can be a sign of a PE.
  • An arterial blood glass will be measured to determine the oxygen levels in the blood. A low blood oxygen level is a positive sign for PE.
  • A chest Xray may be abnormal in a PE, however, it is not specific. An abnormal chest XRay will warrant further workup, but this is not used to rule in or out a PE.
  • A ventilation-perfusion can be used to assess for a PE. This test measures blood and Oxygen flow to the lungs. It is used to assess whether the probability of a PE is high or low. If the test indicates the probability is high, CT angiography (mentioned above) is the best test to definitively diagnose a PE.  
  • EKG: the most common finding is Tachycardia (high heart rate). Other findings include nonspecific ST-segment changes, afib, and others.
  • Echo: This test is used to rule out other diagnoses that can be confused with a PE such as pericardial effusion. In some cases, it can detect a PE, but it is not very sensitive to this.
  • Duplex Ultrasound can be used to test for the presence of deep vein thrombosis, a clot in the leg. The presence of a clot in the leg along with symptoms of a PE such as shortness of breath, chest pain, or low oxygen levels can prove the presence of a PE.

What is the treatment for Pulmonary Embolism?

Management of PE is either anticoagulation ( blood thinners) or thrombolysis (clot busters). Any patient that is suspected of a PE will be placed on a blood thinner such as heparin or warfarin. A patient who is having a PE along with low blood pressure who has a low bleeding risk should be given a clot buster. Patients who have had a PE should be placed on long term blood thinners to prevent another PE.

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