Embolic and thromboembolic diseases

This presentation provides information about Embolic and thromboembolic diseases and how to detect them

1. Embolic and thromboembolic diseases Aziza Al- Amri ..

2. What are thromboembolic diseases ? They are caused when a blood vessel is obstructed by a blood clot (embolus) that has been carried in the bloodstream from the site of its formation. 2

3. Cont. 3

4. Pulmonary embolism

5. Objectives Definition Incidence Symptoms Risk factors and causes Clinical presentation Complications Exams and Tests Treatment  Prevention Case study 5

6. What is pulmonary embolism ? 6 In Other W ords : PE  is the sudden blockage of a major  blood  vessel (artery) in the lung, usually by a blood clot .

7. What happens ? If a large  blood clot blocks the  artery in the lung, blood flow may be completely stopped, causing sudden death . A smaller clot reduces the blood flow and may cause damage to lung tissue . if the clot dissolves on its own, it may not cause any major problems . 7

8. Where does it happens ? It can happen anywhere in the lungs But since more blood flows into the bases of the lungs Pulmonary Embolism is more in the lower parts And less in the upper portion As a result of gravity 8

9. Incidence 600,000 per year get PE In the US This results in 50,000-200,000 deaths per year. B ased on the estimates on 2012 9

10. Symptoms Begins suddenly .. Sudden shortness of breath. Sharp chest pain that is worse with   cough or deep breath . A cough that brings up pink, foamy mucus. Rapid breathing can also cause more general symptoms such as : anxiety sweating a lot feeling lightheaded fainting fast heart rate or palpitations. 10

11. Causes B lood clot in the leg that breaks loose and travels to the lungs . Deep vain thrombosis . Other things can block the artery, such as tumors , air bubbles ,  amniotic fluid , or fat that is released into the blood vessels when a bone is broken. But these are rare. 11

12. Risk factors Being inactive for long periods. Recent surgery that involves the legs, hips, belly, or brain. Some diseases , such as cancer, heart failure, stroke, or a severe infection. Pregnancy  and  childbirth   (cesarean section). Taking  birth control pills or hormone therapy. Smoking. O lder than 70 Extremely  overweight ( obese ). 12

13. Presentation 13 Most Common Symptoms Dyspnea at rest or with exertion Pleuritic pain Cough >2-pillow orthopnea Calf or thigh pain Calf or thigh swelling Wheezing Rapid onset of dyspnea Most Common Signs Tachypnea Tachycardia Rales Decreased breath sounds Jugular venous distension

14. Complications Cardiac arrest and sudden death Shock Abnormal heart rhythms Death of part of the lung, called pulmonary infarction P leural effusion Pulmonary hypertension 14

15. Exams and Tests Diagnosing pulmonary embolism is difficult, because there are many other medical conditions, such as a heart attack or an anxiety attack, that can cause similar symptoms. 15

16. Exams and Tests 1. D-Dimer : is a blood test that measures a substance that is released when a blood clot breaks up. Elevated in thrombosis, malignancy, pregnancy, elderly, hospitalized patients. Normal results can rule out PE. 16

17. Exams and Tests 2.Electrocardiogram (ECG ): Only 10% of patients can have the S1 Q3 T3 so not reliable . 17

18. Exams and Tests 3.Chest Radiography: Not a sensitive or specific test for the diagnosis of PE. Atelectasis, Pleural effusion, or a pulmonary parenchymal abnormality is noted most commonly Only a small portion of patients with PE have a normal CXR. 18

19. CxR Westermark and Fleishner’s s ign Your footer comes here 19

20. CxR Hamptons Hump sign 20

21. Exams and Tests 4. CT Angiogram Your footer comes here 21

22. Exams and Tests 5.Pulmonary Angiography 22

23. Exams and Tests Pulmonary Angiography: The “gold standard” A negative pulmonary angiogram excludes clinically relevant PE. The risk of embolization in patients with a negative angiogram is extremely low   23

24. Exams and Tests More tests can be used , like what ?! 6. MRI 7. ABG “ sudden drop in O 2 level ” 8. Doppler  ultrasound “ reflected sound waves to determine whether a blood clot is present in the large veins of the legs ” 9.Echo “ detects abnormalities in the size of right ventricle ” 24

25. After determination PE .. O ther tests can help guide treatment and suggest how well the pt. will recover : B rain  natriuretic peptide: A blood test to check the level of the hormone ( level heart under stress ) protein  troponin: ( level damage to the heart’s muscle ) 25

26. Treatment  Anticoagulant medications If symptoms are severe and life-threatening, aggressive treatment is needed   T hrombolytic medications ( risk of sever bleeding ) R emove the clot ( Embolectomy ) 26

27. If surgery or medicines are not options, is there other methods to prevent pulmonary embolism ? 27

28. Yes ! Vena cava filter  : This filter can prevent blood clots in the leg or pelvic veins from traveling to the  lungs  and heart, may be permanent or removable .

29. Prevention Exercise Getting up out of bed as soon as possible after an illness or surgery Quit smoking Wear compression stockings

30. Clinical case …

31. A 25 year old white female reports to the Emergency Room because of sharp left sided chest pain and shortness of breath of one day duration. The patient was in excellent health until yesterday. She was awakened from her sleep by sharp left sided chest pain. The pain worsened with motion and deep breathing . The pain has been progressively increasing in severity and she now has severe left shoulder pain. She complains of shortness of breath and is very apprehensive about dying. She denies any cough, fever, sputum production or hemoptysis.

32. She is married and had one normal delivery three years ago. She is currently on birth control pills . She has never been hospitalized except for labor and delivery. Review of systems are negative. She denies any past history of venous problems . She reveals having a similar transitory minor episode of chest pain approximately one year ago while she was in a vacation. She works as a computer programmer. She smokes one pack of cigarettes a day for the past eight years. She considers herself a social drinker.

33. On Physical Examination BP=114/80 ; pulse 118 ; T= 37.0 She appears to be in moderate respiratory distress . She is well developed and nourished . Pertinent findings include a RR of 30 and shallow breathing. There is dullness, decreased chest expansion and decreased breath sounds in the left base . There were no rales or rubs.

34. Cont. Abdomen, pelvic and rectal exams are normal . The extremities reveal no evidence of edema, cyanosis or clubbing . Patient has negative Homan's Sign . Joint exam revealed shoulder movements complete in range. No warmth or tenderness noted. The rest of the patient's joints are normal.

35. F ollowing tests were done : ABG: FI0 2 . 21 pH 7.39 PCO 2 30 HCO 3 20 PaO 2 80 SaO 2 95 % No drop on Oxygen level

36. CXR reveals pleural effusion in the left base. The left diaphragm is elevated . Shoulder x-ray is normal . There was a small amount of fluid in the left pleural space.

37. Doppler exam revealed deep vein thrombosis of the left lung , why ?

38. This patient did have CTA performed, which confirmed presence of PE . She was subsequently started on anticoagulation

39. Thank You A ny questions?