PULMONARY EMBOLISM

AHMAD FAEEZ ALEEFFUDDIN BIN MOHAMAD BIDIN

MENTOR:ENCIK SAMSUDDIN

WHAT IS PULMONARY EMBOLISM

Obstruction of the pulmonary artery or one of its

branches by a thrombus that originates
somewhere in the venous system or in the right
side of the heart

CAUSES OF PULMONARY EMBOLISM

Trauma
Embolism
Surgery
Heart failure
Hypercoagulability(increased clotting potential of
the blood)
pregnancy
Atrial fibrilation
Older than 50 years

PATHOPHYSIOLOGY
When a thrombus completely or partially
obstructs a pulmonary artery or its branches,the
alveolar dead space is increased.
The area, although continuing to be
ventilated,receives little or no blood flow.thus ,gas
exchange is impaired or absent in this area.
In adittion,various substances are released from
the clot and surrounding area,causing regional
blood vessels and bronchioles to constrict.

This cause an increase in pulmonary vascular

resitance.this reaction compounds(the ventilationsperfusion imbalance)
The haemodynamics consequences are increased
pulmonary vascular resistance from the regional
vasoconstriction and reduced size of the pulmonary
vascular bed.
This result in an increase in pulmonary arterial
pressure and,in turn ,an increase in right ventricular
work to maintain pulmonary blood flow.

When the work requirements of the right ventricle

exceed its capacity,right ventricular failure
occurs,leading to a decrease in cardiac output followed
by a decrease in systemic blood presusure and the
developementof shock.

RISK FACTORS
Venous stasis
Prolonged immobilization
Varicose veins
Spinal cord injury
Hypercoagulability(due to release of tissue
thromboplastin after injury/surgery)
Tumor
Increased platelet count
(polysalathemia,splenectomy)

CLINICAL MANIFESTATIONS
Dyspnea
Chest pain
Anxiety
Fever
Tachycardia
Hemoptysis
syncope

ASSESSMENT AND DIAGNOSTIC

FINDINGS
Pulmonary angiography(pulmonary vessels do
not fill symetrically with defect and obstruction
seen)
Chest x-ray
ECG(sinus tachycardia)
ABG(respiratory alkalosis)
Venous ultrasonography

MEDICAL MANAGEMENT
General measures to improve respiratory and
vascular status
Anti-coagulation therapy
Thrombolytic therapy
Surgical intervention

GENERAL MANAGEMENT
Oxygen therapy is administered to correct the
hypoxemia,relieve the pulmonary vascular
vasoconstriction and reduce the pulmonary
hypertension
Using elastic compression stockings or
intermittent pneumatic leg compression devices
reduces venous stasis
Elevating the leg above the level of the heart also
increases venous flow.

ANTICOAGULATION THERAPY
Heparin and warfarin sodium
Primary method for managing acute deep vein
thrombosis and pulmonary embolism
Heparin is used to prevent recurrence of emboli
but has no effect on emboli that are already
present
I/v bolus of 5000 to 10000 units follwed by a
continuous infusion initiated at a dose of 18 U/kg
per hour,not to exceed 1600 U/hour

THROMBOLYTIC THERAPY
Urokinase,streptokinase,alteplase
Paticularly in patients who are severely
compromised (eg,those who are hypotensive and
have significiant hypoxemia despite oxygen
supplementation
Resolves the thrombi or emboli more quickly

SURGICAL MANAGEMENT
Pulmonary embolectomy requires a thoractomy
wih cardiopulmonary bypass technique.
Transvenous catheter embolectomy is a technique
in which a vacuum cupped catheter is introduced
transvenously into the affected pulmonary
artery.Suction is aplied to the end of the embolus
and the embolus is aspirated into the cup.

REFERENCE

Sobieszczyk P (2012). Catheter-assisted pulmonary embolectomy.

Circulation, 126(15): 19171922.
Tapson VF, Becker RC (2007). Venous thromboembolism. In EJ Topol et
al., eds., Textbook of Cardiovascular Medicine, 3rd ed., pp. 15691584.
Philadelphia: Lippincott Williams and Wilkins.
U.S. Department of Health and Human Services (2008). The Surgeon
General's call to action to prevent deep vein thrombosis and pulmonary
embolism. Available online:
http://www.surgeongeneral.gov/library/calls/deepvein/index.html.
Weitz JI (2012). Pulmonary embolism. In L Goldman, A Shafer, eds.,
Goldman's Cecil Medicine, 24th ed., pp. 596603. Philadelphia: Saunders.