Fashida Favour
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PULMONARY EMBOLISM (PE) 🫁
Pulmonary embolism is the obstruction of pulmonary arteries by a thrombus, most commonly originating from deep vein thrombosis (DVT).
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1️⃣ Pathophysiology
➊ Thrombus forms in deep veins (usually legs)
➋ Clot travels through venous circulation
➌ Embolus lodges in pulmonary artery
➍ Causes ventilation–perfusion (V/Q) mismatch → hypoxemia
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2️⃣ Risk Factors (Virchow’s Triad)
➊ Venous Stasis
•Prolonged immobility
•Surgery
•Pregnancy
➋ Endothelial Injury
•Trauma
•Surgical procedures
➌ Hypercoagulability
•Oral contraceptives
•Malignancy
•Inherited thrombophilia
⸻
3️⃣ Clinical Features
➊ Sudden dyspnea
➋ Pleuritic chest pain
➌ Tachypnea and tachycardia
➍ Hypoxemia with respiratory alkalosis (↑ pH, ↓ PaCO₂)
⚠️ Massive PE may present with:
•Syncope
•Hypotension
•Hemodynamic instability
⸻
4️⃣ Diagnosis
➊ D-dimer
•Highly sensitive test
•Useful to rule out PE in low-risk patients
➋ CT Pulmonary Angiography
•Gold standard diagnostic test
➌ Ventilation–Perfusion (V/Q) Scan
•Used if CT is contraindicated (e.g., pregnancy, renal failure)
➍ ECG Findings
•Sinus tachycardia (most common)
•S₁Q₃T₃ pattern (rare but classic)
⸻
5️⃣ Management
➊ Anticoagulation (First-line treatment)
•Heparin → DOACs (Apixaban, Rivaroxaban)
➋ Thrombolysis
•tPA for massive PE with hemodynamic instability
➌ Inferior Vena Cava (IVC) Filter
•Used when anticoagulation is contraindicated
⸻
6️⃣ High-Yield Clinical Pearls
➊ Always suspect PE in sudden dyspnea with a normal chest X-ray
➋ Sinus tachycardia is the most common ECG finding
➌ PE is a major cause of sudden death in hospitalized patients
⸻
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#PulmonaryEmbolism
#medicine
#DVT
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💡DEEP VEIN THROMBOSIS (DVT)
Formation of a blood clot in a deep vein, most commonly in the legs.
Major concern: clot may travel to the lungs → Pulmonary Embolism (PE).
⸻
1️⃣ Risk Factors (Virchow’s Triad)
➊ Venous stasis
•Prolonged immobility (long flights, hospitalization, casts)
➋ Hypercoagulability
•Pregnancy
•Oral contraceptives
•Cancer
•Inherited thrombophilia
➌ Endothelial injury
•Surgery
•Trauma
•Central venous catheters
⸻
2️⃣ Clinical Features
➊ Unilateral leg swelling
➋ Calf pain or tenderness
➌ Warmth and redness of the leg
➍ Sometimes asymptomatic
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3️⃣ Complications
➊ Pulmonary embolism (PE)
•Sudden dyspnea, chest pain, hemoptysis
➋ Post-thrombotic syndrome
•Chronic leg pain and swelling
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4️⃣ Diagnosis
➊ D-dimer → screening in low-risk patients
➋ Doppler ultrasound → first-line test
➌ CT or MR venography if diagnosis unclear
⸻
5️⃣ Treatment
➊ Anticoagulation (first line)
•Heparin → DOACs (apixaban, rivaroxaban)
•Or warfarin
➋ Thrombolysis / thrombectomy
•For severe or extensive thrombosis
➌ Compression stockings
•Prevent post-thrombotic syndrome
⸻
6️⃣ Prevention
➊ Early mobilization after surgery
➋ Leg exercises during long travel
➌ Prophylactic anticoagulation in high-risk patients
⸻
📌 Exam Pearl:
Always suspect DVT in a patient with unilateral leg swelling and risk factors → early diagnosis prevents life-threatening pulmonary embolism.
⸻
📚 Master your medical exams with our innovative medical notes at:
🌐 mediconotes.com
⸻
#MedicoNotes
#DVT
#PulmonaryEmbolism
#MedicalStudents
#usmle

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