Pulmonary embolism

Q: What should be suspected with such clinical/echocardiographic findings? show answer

A: Differential diagnosis of such findings would include pulmonary embolism, acute right ventricular infarct and acute chest syndrome.

Q: What is the comprehensive clinical classification of pulmonary hypertension? show answer

A: 1. Pulmonary arterial hypertension (PAH). 2. Pulmonary hypertension due to left heart disease. 3. Pulmonary hypertension due to lung diseases and/or hypoxia. 4. Chronic thromboembolic pulmonary hypertension and other pulmonary artery obstructions. 5. Pulmonary hypertension with unclear and/or multi-factorial mechanisms.

Q: What should be done next? show answer

A: 1. Haemodynamic and respiratory support 2. CT pulmonary angiography should be done as soon as possible (D-dimer measurement is not recommended in high clinical probability) 3. Initiate anticoagulation 4. Consider reperfusion treatment

Q: What are the differences between massive and sub-massive pulmonary embolism? show answer

A: 1. Massive PE: Acute pulmonary embolism with sustained hypotension (systolic blood pressure <90 mmHg for at least 15 minutes or requiring inotropic support, not due to a cause other than PE. 2. Sub-massive PE: Acute pulmonary embolism without systemic hypotension (systolic blood pressure >90 mmHg) but with either RV dysfunction or myocardial necrosis.

Q: What are the most important risk factors for pulmonary embolism? show answer

A: According to the 2019 European Society of Cardiology (ESC) guidelines: the strongest risk factors for venous thromboembolism are (OR>10): 1. Fracture of lower limb. 2. Hospitalization for heart failure or atrial fibrillation/flutter (within previous 3 months). 3. Hip or knee replacement. 4. Major trauma. 5. Myocardial infarction (within previous 3 months). 6. Previous VTE. 7. Spinal cord injury.