Pulmonary Embolism

Prof. M.C.Bansal MBBS;MS. FICOG. MICOG. Founder Principal & Controller, Jhalawar Medical College and Hospital Jhalawar. Ex Principal and Controller, Mahatma Gandhi Medical College & hosptal ;

Sitapura Jaipur.

Introduction

It is not an uncommon cause of MMR—responsible for 10%MMR.

Occurs as 1:7000 pregnancy. Incidence are equal in ANC and purperium

, but MMR is more in delivered women. 70% 0f women developing PE have pre

existing DVT. 50% of DVT cases may develop silent PE

due to dislodgement of small / tiny thrombus.

PE Clinical Presentation

Massive embolism i.e. obstruction of >50% of pulmonary arterial circulation is likely to be associated with right side heart failure.

Massive embolism leads to haemodynamic instability. Increased pulmonary vascular resistance and hypertension,which develops when 60-70 % pulmonary vascular tree is occluded by embolus . Right ventricular dilatation develops.

Not to forget PE may be silent

Investigations

Ventilation perfusion scintigraphy (lung scan )\

MRI Pulmonary angiography. Echo cardiography. X ray chest PA & lateral view. ECG . Diagnostic tests for Coagulation and

fibrinolysis. PO2 studies in pulmonary and aortic

circulation .

Diagnostic Tests-- Clinical examination alone is able to

confirm only 20-30% of cases of DVT Blood Tests the D-dimer International Normalised Ratio (INR). Current D-dimer assays have predictive

value for DVT, and PE INR is useful for guiding the

management of patients with known DVT who are on warfarin (Coumadin)

Xray Chest--Loss of vascular markings in the lung field where blood circulation is blocked by embolus. Atelectasis, hemidiaphragm elevation , pleural effusion.

Echocardiography ---- dilatation of right ventricle., increased pulmonary vascular resistance and pulmonary hypertension.

ECG---Right axis deviation T wave inversion in anterior chest leads. Sinus tachycardia,S1 Q3 T 3 pattern.

D-dimmer D-dimmer is a specific degradation

product of cross-linked fibrin. Because concurrent production and breakdown of clot characterize thrombosis, patients with thromboembolic disease have elevated levels of D-dimer

three major approaches for measuring D-dimer

ELISA latex agglutination blood agglutination test

recent (within 10 days) surgery or trauma,

recent myocardial infarction or stroke, acute infection, disseminated intravascular

coagulation, pregnancy or recent delivery, active collagen vascular disease, or

metastatic cancer False-positive D-dimers

occur in patients with PE

D – Dimer tests to be done ---

Embolus in Pulmonary Trunk

Pulmonary Embolism

Pulmonary Embolism