What is a blockage of a pulmonary artery by foreign matter?
The obstruction may be fat, air, tumor tissue, or a thrombus that usually arises from a peripheral vein (most frequently arising from the deep veins of the legs)
A blood clot that forms and remains in a vein is called what?
A blood clot that becomes dislodged and travels to another part of the body is called what?
Embolus may originate from one large thrombus or occur as a series of small thrombi and may or may not interfere with what?
the right side of the heart's ability to perfuse the lungs adequately
If Blockage of the pulmonary vascular system is significant blood flow restricted leading to what?
Can a pulmonary embolism cause bronchoconstriction or bronchospasm?
Exact mechanism not known. Maybe release of histamine, prostoglandin or other cellular mediators
The most common cause of pulmonary blood clots for Pulmonary Embolism originate�or break away from�?
deep vein thrombus (DVT)
What are other possible causes of thrombosis or embolism?
What does Virchow's triad include?
with Thrombosis being in the middle
Blood clot formation is due to three things, what are they?
Blood � the increased tendency of blood to form clots
Vessel Wall � injury to the endothelial cells that line the vessels
Blood Flow � slowing or stagnation of blood flow through the veins
Blood � the increased tendency of blood to form clots is referred to as what, and what usually will caused this?
Deficiencies of anticoagulants
Increases in clotting factors in the blood
How does Vessel Wall pertain to the formation of a thrombus?
injury to the endothelial cells that line the vessels
What produce chemicals that inhibit the clotting of platelets inside the vessels?
Breakdown or absence of the cells allows clots to form in its place.
epithelial cells; from endothelium
How does Blood Flow pertain to the formation of a thrombus?
slowing or stagnation of blood flow through the veins
If blood flow slows (venous stasis) it allows platelets more time in contact with endothelium making it more likely that clots may form
How is Venous stasis a risk factor for Pulmonary Embolism?
Inactivity (most common)
Prolonged bed rest
Congestive heart failure
How do Surgical Procedures pertain to Pulmonary Embolism? (name examples)
It is a risk factor
- these last three are most important because they limit mobility for extended amount of time
Certain obstetric or gynecologic procedures
How does Trauma pertain to pulmonary embolism? (name examples)
Extensive injury to soft tissue
Postoperative or postpartum states
Extensive hip or abdominal operation
Phlegmasia alba dolens puerperarum
How do Hypercoagulation disorders pertain to pulmonary embolism? (name examples)
What are Other risk factors for Pulmonary Embolism?
Pacemakers or venous catheters
Pregnancy and childbirth
Family history of venous thromboembolism
What are common symptoms of a Pulmonary Embolism?
Sudden shortness of breath
Lightheadedness or fainting
Cool or clammy skin to the touch
What does the folllowing describe?
Chest pain that resembles a heart attack
signs and symptoms of Pulmonary Embolism
How are chest x-rays used for recognition of a pulmonary embolism?
often normal but used to rule out conditions with same symptoms
What has become the first line test for diagnosis because offers 3-D view and accurately identifies abnormalities
For a pulmonary embolism, what are common findings with an Electrocardiogram (ECG)?
commonly see nonspecific ST-T wave changes but may see A-Fib and A-Flutter as well
What will only be reliable if condition of Pulmonary Embolism is extreme?
Ventilation/Perfusion Scan (V/Q scan)
What provides clear image of blood flow and very accurate but not used due to time requirements and invasiveness?
What are additional test used to detect blood clots in veins? (DDEMMB)
D-dimer Blood Test (fibrinogen test) � simple test used to test for protein fibrinogen which is essential in clotting. Values higher than 500 ng/mL are considered positive
Duplex Venous Ultrasonography � noninvasive and very accurate for more superficial clots but not DVT�s
Extremity Venography � more complex (uses catheters and dyes) and invasive than duplex venous ultrasonography
Magnetic Resonance Imaging (MRI) � useful when CT is not an option such as pregnancy and allergies to dyes used for contrast
Magnetic Resonance Angiography (MRA) � used to differentiate between blood and clots
Blood Tests � used to determine if there any inherited abnormalities (i.e. family history of clots, more than one episode of clots, clots forming for no know reason)
What are clinical manifestations resulting from the pathophysiologic mechanisms caused (or activated) by Pulmonary Embolism?
What vital signs accompany Pulmonary Embolism?
Increased RR - stimulated by the pulmonary baroreceptors
Increased heart rate (pulse)
What might you see upon physical examination of a person with a Pulmonary Embolism?
Cough and hemoptysis
Peripheral edema and venous distention
Distended neck veins
Swollen and tender liver
Chest pain/decreased chest expansion
Syncope, light-headedness, and confusion
D-dimer Blood Test (fibrinogen test) � simple test used to test for protein fibrinogen which is essential in clotting. Values higher than what are considered positive?
What abnormal heart sounds might you hear with Pulmonary Embolism? (part of physical exam)
Abnormal heart sounds
Increased second heart sound (S2) due to increased pressure in the pulmonary artery � valve closes more forcefully
Increased splitting of the second heart sound (S2) sometimes noted due to either (1) pulmonary hypertension or (2) incomplete right bundle branch block (delay of signal sent to right slowing contraction)
Third heart sound (or ventricular gallop) � exact cause unknown
What is a consequence of increased pulmonary blood pressure due to strain or hypertrophy causes a sustained lift on the left lower portion of the sternum? (part of physical exam)
Right ventricular heave or lift
A right ventricular lift can be detected in patients with a pulmonary embolism if significant pulmonary hypertension is present. When will it be felt?
Felt during systole
What are the Chest Assessment Findings with Pulmonary Edema?
Pleural friction rub (especially when pulmonary infarction involves the pleura)
What type of blood gas will be seen with mild to moderate stages of Pulmonary Embolism?
pH increased, PaCO2 decreased, HCO3 N or decreased (slightly), PaO2 decreased
What type of blood gas will be seen with severe stages of a Pulmonary Embolism?