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 – occurrence of fluid in the gap between the lung and pleura.
Cardiovascular system (I00-I99)
- Acute right ventricular failure (RHV) due to RV ischemia (reduced blood flow to the right ventricle (heart)).
- Chronic cor pulmonale – right heart strain due to excessive pressure load.
- Chronic thromboembolic pulmonary hypertension (CTEPH) due to recurrent pulmonary embolism (chronic thromboembolism):The 2-year prevalence for chronic thromboembolic pulmonary hypertension (CTEPH) is approximately 1-4%.Symptoms: Exertional dyspnea (shortness of breath on exertion), chest pain, fatigue, edema (water retention), or syncope (brief loss of consciousness); Diagnosis: echocardiography, followed by a ventilation perfusion scintigram; if necessary. also a right heart catheterization; therapy: surgical excision of the thrombotic material, i.e. pulmonary endarterectomy using the heart-lung machine; a new treatment option is pulmonary balloon angioplasty (pulmonary artery balloon angioplasty, BPA).
- Pulmonary infarction – demarcation of a section of the lung no longer supplied with blood.
- Recurrent pulmonary embolism
- Atrial fibrillation (VHF) (approximately 10% of patients with pulmonary embolism presented with VHF; this had little or no effect on prognosis after acute pulmonary embolism)
Further
- Acute phase: lethality (mortality related to the total number of people suffering from the disease) about 7-11 percent!
- Pulmonary embolism mortality rate (number of deaths in a given period, relative to the number of the population in question) between the ages of 15 and 55 years:
- Women: 13 per 1,000 deaths (because of sex difference: hormone- and pregnancy-associated thrombosis risk).
- Men: 2-7 per 1,000 deaths.
Prognostic factors
- Hypotension (low blood pressure) after acute pulmonary embolism leads to an increase in mortality (death rate) to more than 15%; patients with values ≤ 120 mmHg had a 20-fold increased likelihood of dying during hospitalization. According to one study, cut-off values of systolic 119.5 or diastolic 66.5 mmHg are predictors of hospital mortality. These thresholds more accurately predicted in-hospital mortality risk than did cardiac troponin I levels.
- Right ventricular dysfunction: right ventricular dysfunction (RVD) is detected by a blood pressure index (BPI) ≤ 1.7 with a sensitivity of 92.8% (percentage of diseased patients in whom the disease is detected by use of the procedure, ie, a positive finding occurs) and a specificity (probability that actually healthy individuals who do not have the disease in question are also detected as healthy by the test) of 100%. Pulmonary embolism with right heart involvement is more likely to be fatal (9.5% of patients died, compared with 1.4% without RVD).
“Pulmonary Embolism Severity Index” (sPESI)
| Predictors | Points |
| Age > 80 years | 1 |
| Chronic heart failure (cardiac insufficiency) or pulmonary disease | 1 |
| History of cancer | 1 |
| Arterial oxygen saturation <90%. | 1 |
| Systolic blood pressure <100 mmHg | 1 |
| Heart rate ≥ 110 beats/min | 1 |
Interpretation
- 0 points: 30-day mortality studies is approximately 1% → patient can be discharged early within the next four days (or even within 24 hours) if he is hemodynamically stable and there are no reasons not to do so.
- ≥ 1 points: Determination of right ventricular function by CT angiography (CTPE) or transthoracic echocardiography (TTE) and cardiac biomarkers (BNP, NT-proBNP, troponin I and T).
- Right ventricular dysfunction + positive biomarker test → patient’s risk should be considered intermediate-high (otherwise intermediate-low) → systemic thrombolytic therapy (dissolution of a thrombus (blood clot) using drugs) should be considered.
Note: Pregnant women are not included in the sPESI; however, their premature discharge should be well considered!
Chronic thromboembolic pulmonary hypertension (CTEPH)
CTEPH score according to Klok et al.
| Predictors (predictive factors) | Points |
| Unprovoked pulmonary embolism | +6 |
| > 2 weeks delayed embolism diagnosis | +3 |
| Hypothyroidism (underactive thyroid gland) | +3 |
| Right ventricular dysfunction at diagnosis | +2 |
| Diabetes mellitus | -3 |
| Thrombolytic therapy (dissolution of a thrombus (blood clot) with the help of drugs) | -3 |
Interpretation:
- > 7 points: 10% risk of CTEPH.
- 7 points (threshold): diagnostics required to exclude CTEPH.
- <7 points: 0.38% risk of CTEPH.
Other predictors of CTEPH:
- Previous thromboembolic disease
- Large thrombus burden (CT-A) in acute LE
- Right ventricular dysfunction on echocardiography in acute LE
- Malignant and chronic inflammatory comorbidities.
- Thrombophilia (tendency to thrombosis).
- Clinical symptoms (dyspnea (shortness of breath); limited exercise tolerance).
