Pulmonary embolism PE is a blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body through the bloodstream embolism.
PE usually results from a blood clot in the leg that travels to the lung. Efforts to prevent PE include beginning to move as soon as possible after surgery, lower leg exercises during periods of sitting, and the use of blood thinners after some types of surgery. Pulmonary emboli affect aboutpeople each untere Extremität Varix Behandlung in einem frühen Stadium in Europe.
Symptoms of pulmonary embolism are typically sudden in onset and may include one or many of the following: On physical examination, the lungs are usually normal. Occasionally, a pleural friction rub may be audible over the affected area of the lung mostly in PE with infarct.
A pleural effusion is sometimes present that is exudative, detectable by decreased percussion note, massive Lungenembolie, audible breath sounds, and vocal resonance. As smaller pulmonary emboli tend to lodge in more peripheral areas without collateral circulation they are more likely to cause lung infarction and small effusions both of which are painfulbut not hypoxia, dyspnea or hemodynamic instability such as tachycardia. Larger PEs, which tend to lodge centrally, typically cause dyspnea, hypoxia, low blood pressurefast heart rate and faintingbut are often painless because there is no lung infarction due to collateral massive Lungenembolie. The classic presentation for PE with pleuritic pain, dyspnea and tachycardia is likely caused by a large fragmented embolism causing both large and small PEs.
Thus, small PEs are often missed because they cause pleuritic pain alone without any other findings and large PEs often massive Lungenembolie because they are painless and mimic other conditions often causing ECG changes and small rises in troponin and BNP levels, massive Lungenembolie.
PEs are sometimes described as massive, submassive and nonmassive depending on the clinical signs and symptoms. Although the exact definitions of these are unclear, massive Lungenembolie, an accepted definition of massive PE is one in which there is hemodynamic instability such as sustained low blood pressure, slowed heart rateor pulselessness. The conditions are generally regarded as a continuum termed venous thromboembolism VTE. The development of thrombosis is classically due to massive Lungenembolie group of causes named Virchow's triad alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood.
Often, more than one risk factor is present, massive Lungenembolie. After a first PE, the search for secondary causes is usually brief. Only when a second PE occurs, and especially when this happens while still under anticoagulant therapy, a further search for underlying conditions is undertaken.
This will include testing "thrombophilia screen" for Factor V Leiden mutationantiphospholipid antibodies, protein C and S and antithrombin levels, and later prothrombin mutation, MTHFR massive Lungenembolie, Factor VIII concentration and rarer inherited coagulation abnormalities, massive Lungenembolie. In order to diagnose a pulmonary embolism, a review of clinical criteria to determine the need for Blutungen aufgrund von Ösophagusvarizen is recommended.
If there are concerns this is followed by testing to determine a massive Lungenembolie of being able to confirm a diagnosis by imaging, followed by imaging if other tests have shown that there is a likelihood of a PE diagnosis.
The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation shortness of breathmassive Lungenembolie, chest pain cannot be definitively differentiated from other causes of chest pain and shortness of breath.
The decision to perform medical imaging is based on clinical reasoning, massive Lungenembolie, that is, the medical historysymptoms and findings on physical examinationfollowed by an assessment of clinical probability, massive Lungenembolie.
The most commonly used massive Lungenembolie to predict clinical probability, the Wells score, is a clinical prediction rulewhose use is complicated by multiple versions being available. InPhilip Steven Wellsinitially developed a prediction rule based on a literature search to predict the likelihood of PE, based on clinical criteria.
There are additional prediction rules for PE, such as the Geneva rule. More importantly, the use of any rule is associated with reduction in recurrent thromboembolism. Traditional interpretation  massive Lungenembolie .
Massive Lungenembolie interpretation  , massive Lungenembolie. The pulmonary embolism rule-out criteria PERC helps assess people in whom pulmonary embolism is suspected, but unlikely. Unlike the Wells score and Geneva scoremassive Lungenembolie, which are clinical prediction rules intended to risk stratify people with suspected PE, the PERC rule is designed to rule out risk of PE Memo für Krampfadern people when the physician has already stratified them into a low-risk category.
People in this low risk category without any of these criteria may undergo no further diagnostic testing for PE: The rationale behind this decision is that further testing specifically CT angiogram of the chest may cause more harm from radiation exposure and contrast dye than the risk of PE.
In other words, a positive D-dimer is not synonymous with PE, but a negative D-dimer is, with a good degree of certainty, an indication of absence of a PE. When a PE is being suspected, massive Lungenembolie, several blood tests are done in order to exclude important secondary causes of PE, massive Lungenembolie. This includes a full blood countclotting status PTaPTTTTmassive Lungenembolie, and some screening tests erythrocyte sedimentation raterenal functionliver enzymesmassive Lungenembolie, electrolytes.
If one of these is abnormal, further investigations might be warranted. In typical people who are not known to be at high risk of PE, imaging is helpful to confirm or exclude a diagnosis of PE after simpler first-line tests are used. CT pulmonary angiography is the recommended first line diagnostic imaging test in most people. Historically, massive Lungenembolie, the gold standard for diagnosis was pulmonary angiographymassive Lungenembolie, but this has fallen into disuse with the increased availability of non-invasive techniques.
CT pulmonary angiography CTPA is a pulmonary angiogram obtained using computed tomography CT with radiocontrast rather than right heart catheterization. Its advantages are clinical equivalence, its non-invasive nature, its greater availability to people, and the possibility of identifying other lung disorders from the differential diagnosis in case there is no pulmonary embolism.
On CT scanpulmonary emboli can be classified according to level along the arterial tree. CT pulmonary angiography showing a "saddle embolus" at the bifurcation of the main pulmonary artery and thrombus burden in the lobar arteries on both sides. Assessing the accuracy of CT pulmonary angiography is hindered by the rapid changes in the number of rows of detectors available in multidetector CT MDCT machines, massive Lungenembolie.
However, this study's results may be biased due to possible incorporation bias, since the CT scan was the final diagnostic tool in people with pulmonary embolism. The authors noted that a negative single slice CT scan is insufficient to rule out massive Lungenembolie embolism on its own.
This study noted that additional testing is necessary when the clinical probability is inconsistent with the imaging results, massive Lungenembolie. It is particularly useful in people who have an allergy to iodinated contrastimpaired renal function, or are pregnant due to its lower radiation exposure as compared to CT. Tests that are frequently done that are not sensitive for PE, but can be diagnostic. The primary use of the ECG is to rule out other causes of chest pain. While certain ECG changes may occur with PE, massive Lungenembolie, none are specific enough to confirm massive Lungenembolie sensitive enough to rule out the diagnosis.
The most commonly seen signs in the ECG are sinus tachycardiaright axis deviation, and right bundle branch block. In massive massive Lungenembolie submassive PE, dysfunction of the right side of the heart may be seen massive Lungenembolie echocardiographyan indication that the pulmonary artery is severely obstructed and the right ventriclea low-pressure pump, is unable to match the pressure, massive Lungenembolie.
Some studies see below suggest that this finding may be an indication for thrombolysis. Not every person with a suspected pulmonary embolism requires an echocardiogram, but elevations in cardiac troponins or brain natriuretic peptide may indicate heart strain and warrant an echocardiogram, massive Lungenembolie,  and be important in prognosis.
The specific appearance of the right ventricle massive Lungenembolie echocardiography is referred to as the McConnell's sign. This is the finding of akinesia of the mid-free wall but a normal motion of the apex. Ultrasound of the heart showing signs of PE .
Pulmonary embolism may be preventable in those with risk factors. People admitted to hospital may receive preventative medication, including unfractionated heparinlow molecular weight heparin LMWHmassive Lungenembolie, or fondaparinuxand anti-thrombosis stockings to reduce the risk of a DVT in the leg that could dislodge and migrate to the lungs.
Massive Lungenembolie the completion of massive Lungenembolie in those with prior PE, long-term aspirin is useful to prevent recurrence. Anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments, massive Lungenembolie, such as oxygen or analgesiamay be required, massive Lungenembolie. People are often admitted to hospital in the early stages of treatment, and tend to remain under inpatient care until the INR has reached therapeutic levels.
Increasingly, massive Lungenembolie, however, low-risk cases are managed at home in a massive Lungenembolie already common in the treatment of DVT. Usually, anticoagulant therapy is the mainstay of treatment. Unfractionated heparin UFHlow molecular weight heparin LMWHmassive Lungenembolie, or fondaparinux is administered initially, while warfarinacenocoumarolor phenprocoumon therapy is commenced this may take several days, usually while the patient is in the hospital. LMWH may reduce bleeding among people with pulmonary embolism as compared to UFH according to a systematic review of randomized controlled trials by the Cochrane Collaboration.
There was no difference in overall mortality between participants massive Lungenembolie with LMWH and those treated with unfractionated heparin, massive Lungenembolie. Warfarin therapy often requires a frequent dose adjustment and monitoring of the international normalized ratio INR.
In patients with an underlying malignancy, therapy with a course of LMWH is favored over warfarin; it Thrombophlebitis Veterinary continued for six months, at which point a decision should be reached whether ongoing treatment is required. Similarly, massive Lungenembolie, pregnant women are often maintained on low molecular weight heparin until at least six weeks after delivery to avoid the known teratogenic effects of warfarin, especially in the early stages of pregnancy, massive Lungenembolie.
Warfarin therapy is usually continued for 3—6 months, or "lifelong" if there have been previous DVTs or PEs, or none of the usual risk factors is present. An abnormal D-dimer level at the end of treatment might signal the need for continued treatment among patients with a first unprovoked pulmonary embolus.
In this situation, it is the best available treatment in those without contraindications and is supported by clinical guidelines. Catheter-directed thrombolysis CDT is a new technique found to be relatively safe and effective for massive PEs. This involves accessing the venous system by placing a catheter into a vein in the groin and guiding it through the veins by using fluoroscopic imaging until it is located next to the PE in the lung circulation.
Medication that breaks up blood clots is released through the catheter so that its highest concentration is directly next to the pulmonary embolus. CDT is performed by interventional radiologistsand in medical centers that offer CDT, it may be offered as a first-line treatment, massive Lungenembolie.
The use of thrombolysis in non-massive PEs is still debated. There are two situations when an inferior vena cava filter is considered advantageous, and those are if anticoagulant therapy is contraindicated e. Inferior vena cava filters should be removed as soon as it becomes safe to start using anticoagulation, massive Lungenembolie.
The long-term safety profile of permanently leaving a filter inside the body is not known. Surgical management of acute pulmonary embolism pulmonary thrombectomy is uncommon and has largely been abandoned because of poor long-term outcomes. However, recently, it has gone through a resurgence with the revision of the surgical technique and is thought to benefit certain people. Pulmonary emboli occur in more thanpeople in the United States each massive Lungenembolie. There are several markers used for risk stratification and these are also independent predictors massive Lungenembolie adverse outcome.
These include hypotension, cardiogenic shock, syncope, evidence of right heart dysfunction, and elevated cardiac massive Lungenembolie. Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic embolisation to the lung can lead to pulmonary hypertension.
After a massive PE, the embolus must be resolved somehow if the patient is to survive. In thrombotic PE, massive Lungenembolie, the blood clot may be broken down by fibrinolysisor it may be organized and recanalized so that a new channel forms through the clot. Blood flow is restored most rapidly in the first day or two after a PE. There is controversy over whether small subsegmental PEs need treatment at all  and some evidence exists that patients with subsegmental PEs may do well without treatment.
Once anticoagulation is stopped, the risk of a fatal pulmonary embolism is 0. This figure comes from a trial published in by Barrit and Jordan,  which compared anticoagulation against placebo for the management of PE.
Barritt and Jordan performed their study in the Bristol Royal Infirmary in
Embolectomy is the emergency surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi blood clotsand is then referred to as thrombectomy.
Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to an organ leads to necrosis. Other involved therapeutic options are anticoagulation and thrombolysis. Emboli are abnormal masses of material which can massive Lungenembolie solid, liquid or gas that are carried in the blood stream from one part of the circulation to another causing a blockage occlusion of a blood vessel that leads to lack of oxygen supply ischemia and finally infarction of tissue downstream of the embolus.
The most common type of emboli are a blood clot generated by thrombosis which has then broken massive Lungenembolie and is then transported in the blood stream see embolism. Surgical embolectomy for massive pulmonary embolism PE has become a rare procedure and is often viewed as a last resort.
Thrombolytic therapy has become the treatment of choice. Surgical or catheter embolectomy is normally performed in patients with pulmonary embolism formed from venous embolisms. Embolectomy is used for patients with persisting shock despite supportive care and who have an absolute contraindication for massive Lungenembolie therapy. Embolectomies are performed as limb-sparing techniques for arterial embolisms in acute limb ischemia. However, there are also other options, such massive Lungenembolie catheter-directed thrombolysis and anticoagulation with observation.
It can also be used for other ischemias due to embolism for example mesenteric ischemia and stroke. Typically this is done by inserting a catheter with an inflatable balloon attached to its tip into an artery, Salz umhüllt von Krampfadern the catheter tip beyond the clot, inflating the balloon, and removing the clot by withdrawing the catheter.
The catheter is called Fogarty, named after its inventor Thomas J. Possible complications of balloon embolectomy include intimal lesions, which can lead to another thrombosis, massive Lungenembolie. Catheter embolectomy is also used for aspiration embolectomy, where the thrombus is removed by suction rather than pushing with a balloon.
Surgical embolectomy is the simple surgical removal of massive Lungenembolie clot following incision into a vessel by open surgery on the artery. Outcome of embolectomy varies with size and location of the embolus. Although this is a high mortality, it may have life-saving potential in some instances, massive Lungenembolie.
From Wikipedia, the free encyclopedia. This section needs expansion, massive Lungenembolie. You can help by adding to it. Presse Medicale in French. Journal of the Association of Physicians of India, massive Lungenembolie. Seminars in Vascular Surgery. Surgical measures in acute ischemia of lower extremities, massive Lungenembolie. Pekka Aho och Pirkka Vikatmaa, massive Lungenembolie.
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