Obligatory medical device diagnostics. Electrocardiogram (ECG; recording of the electrical activities of the myocardium)* – as an emergency baseline diagnostic[excessive P wave (P pulmonale), a right deviation of position type, right heart strain sign (new onset right bundle branch block), S-I Q-III type, T negatives in V1-V4 (5), ST depressions; atrial arrhythmias] Blood pressure measurement … Pulmonary Embolism: Diagnostic Tests
In principle, the following measures are available for the acute therapy of pulmonary embolism: Anticoagulation (anticoagulation; NOAK: apixaban, dabigatran, edoxaban, and rivaroxaban) or intravenous thrombolysis (dissolving the thrombus) as an emergency measure in case of hemodynamic deterioration (ESC guideline: class 1 recommendation). Recanalizing procedures (reopening of displaced vessels): thrombectomy (surgical removal of a blood clot … Pulmonary Embolism: Surgical Therapy
To prevent pulmonary embolism, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Inadequate fluid intake – leads to desiccosis (dehydration), thus increasing thrombophilia (tendency to clot/thrombosis) Consumption of stimulants Tobacco (smoking) Physical activity Frequent prolonged sitting or immobility (bedriddenness). Prolonged sitting in front of the TV – ≥ 5 h/d … Pulmonary Embolism: Prevention
The following symptoms and complaints may indicate pulmonary embolism: The symptom pattern depends on the size of the thrombus! If a massive pulmonary embolism occurs (i.e., obstruction of more than 50% of the pulmonary circulation; in approximately 5-10 of all cases of pulmonary embolism), then the full clinical picture of pulmonary embolism described below is … Pulmonary Embolism: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Approximately 80-90% of thrombi in the pulmonary arteries originate from deep vein thrombosis (TBVT) and 10-20% from thrombosis of the iliac, axillary, jugular veins or from the right heart. If a thrombus (blood clot) detaches from its association, it closes via the heart into a pulmonary artery and then relocates a … Pulmonary Embolism: Causes
General measures Immobilization – not for severity level 1 Early discharge and outpatient therapy in “carefully selected” low-risk patients may be considered if subsequent anticoagulation is warranted on an outpatient basis (Class IIa recommendation). After the acute phase: Nicotine restriction (refraining from tobacco use). Review of permanent medication due topossible effect on the existing disease. … Pulmonary Embolism: Therapy
The following are the most important diseases or complications that may be contributed to by pulmonary embolism: Respiratory system (J0-J99) Infarct pneumonia – pneumonia that manifests in the portion of the lung that is no longer perfused. Lung abscess – formation of an encapsulated collection of pus. Pleurisy (inflammation of the pleura) Pleural effusion – … Pulmonary Embolism: Complications
Staging of pulmonary embolism (LE) according to Grosser. Severity I moderately severe LE Severity II severe LE Severity III massive LE Severity IV fulminant LE Clinical symptoms Discrete (sudden, short-term onset of dyspnea (shortness of breath), hyperventilation, anxiety, and dizziness), clinically silent in 80% Acute dyspnea, tachypnea (respiratory rate: > 20/min), tachycardia (heart beats: > … Pulmonary Embolism: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes [central cyanosis (bluish discoloration of skin and central mucous membranes, e.g., tongue)] (20 %) Signs of right heart failure (right-sided heart failure)? Neck vein congestion? … Pulmonary Embolism: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count [for basic diagnosis; if unfractionated heparin (UFH) is used, regular check of platelet count]. CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Blood gas analysis (BGA) D-dimer (end product of proteolysis of fibrin) – Indications: in suspected pulmonary embolismNote: The specificity (probability that actually … Pulmonary Embolism: Test and Diagnosis
Therapeutic targets Dissolution of the thrombus (thrombolysis/dissolution of the thrombus). Secondary prophylaxis (measures intended to prevent further progression of a disease that has already occurred; see below). Therapy recommendations 2019 ESC Guidelines:Anticoagulation treatment should be given as soon as pulmonary embolism is suspected, if there is a moderate or high clinical probability, without waiting for … Pulmonary Embolism: Drug Therapy
Medical history (history of illness) represents an important component in the diagnosis of pulmonary embolism. Family history Is there a history of frequent cardiovascular disease in your family? Social history What is your profession? Do you sit a lot? Have you just taken a long-haul flight? Current medical history/systemic history (somatic and psychological complaints). Have … Pulmonary Embolism: Medical History