Pulmonary Embolism

Pulmonary Embolism

Swan-Ganz catheter in pulmonary hypertension:  sign of decreased cardiac outout is reduced mixed venous O2.  (Fick principle)

metamphetamine cause of Pulmonary HTN

Pulmonary Embolism


Classic: Stasis, Hypercoagulability and 
endothelial damage (Virchow’s triad)
• Now thought of as acquired or congenital
• Congenital: Thrombophilia (Factor V Leiden, 

Thrombin gene mutations, protein C&S 

deficiency, AT III deficiency)
• Acquired: Immobility of Lower Extremities, 

Surgery (esp. orthopedic of LE), trauma, stroke, 

heart failure, medical illness, critical illness, 

pregnancy, exogenous estrogens, malignancy, 

inflammatory disorders, nephrotic syndrome, 

APLA, smoking, age.

Clinical Signs

• 

Pulmonary: Increased 

respiratory rate, 

Hypoxemia, Crackles, 

Pleural friction rub

• Cardiac: Tachycardia,

hypotension, Right sided 

S4, Elevated jugular 

venous pressure, Increased 

P2.

• Extremities: Leg swelling,

redness. 

Well’s Criteria for PE

• Clinical Signs and Symptoms of DVT? Yes +3
• PE Is #1 Diagnosis, or Equally Likely Yes +3
• Heart Rate > 100? Yes +1.5
• Immobilization at least 3 days, or Surgery in the Previous 4 weeks Yes +1.5
• Previous, objectively diagnosed PE or DVT? Yes +1.5
• Hemoptysis? Yes +1
• Malignancy w/ Treatment within 6 mo, or palliative? Yes +1
• Score interp: <2 points 3.4% chance of PE
• 2-6 points 27.8% chance of PE
• >6 point 78% chance of PE

Diagnostic Tests for PE

• D-dimer and dead-space measurement
• Assessment of lower extremities for DVT
• Ventilation / Perfusion Scanning  (gives probability answer)
• CT angiography of pulmonary arteries = most commonly done test (yes or no answer)
• MRI thorax for PE
• Pulmonary Angiography - no advantage over CT angio

Treatment of PE

• 

Anticoagulation with heparin 

or Low Molecular Weight 

Heparin or Fondaparinux 

then coumadin
• Removal of aggravating

cause when possible

• Thrombolysis for

hemodynamically unstable 

patients

• IVC filters in cases of LE

DVT in patients who cannot 

be anti-coagulated