Download - Pulmonary Embolism
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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.
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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.
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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
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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 .
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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)
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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.
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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
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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 ---
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Embolus in Pulmonary Trunk
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Pulmonary Embolism
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Pulmonary Embolism
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