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Pulmonary embolism 

Pulmonary embolism
Chapter:
Pulmonary embolism
Author(s):

Adam Torbicki

, Marcin Kurzyna

, and Stavros Konstantinides

DOI:
10.1093/med/9780199687039.003.0066_update_003

Update:

2 new references

Simplified approach which allows withholding of treatment despite clinical suspicion of PE (YEARS clinical algorithm) by adjusting D-dimer threshold according to clinical presentation of the patient and decreasing the need of CT angiography has been presented.

The concept of multidisciplinary Pulmonary Embolism Response Teams (PERT) for assisting in rapid clinical decision-making in complex pulmonary embolism cases has been introduced.

Updated on 22 February 2018. The previous version of this content can be found here.
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date: 22 October 2019

Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results from other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.

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