Acute Pulmonary Embolism Overview课件.ppt

Acute Pulmonary Embolism: Diagnosis and Management Robert Sidlow, MD November 8, 2010 Why care? PE is the most common preventable cause of death in hospitalized patients ~600,000 deaths/year 80% of pulmonary emboli occur without prior warning signs or symptoms 2/3 of deaths due to pulmonary emboli occur within 30 minutes of embolization Death due to massive PE is often immediate Diagnosis can be difficult Early treatment is highly effective YOU WILL TAKE CARE OF PATIENTS WITH PE!  Natural History of VTE 40-50% of pts with DVT develop PE, often “silent” PE presents 3-7 days after DVT Fatal within 1 hour after onset of respiratory symptoms in 10% Shock/persistent hypotension in 5-10% (up to 50% of patients with RV dysfunction) Most fatalities occur in untreated pts Perfusion defects completely resolve in 75% of all patients (who survive) Diagnosis: Clinical Presentation Dyspnea, tachypnea, or pleuritic chest pain most common Pleuritic pain = distal emboli ?pulmonary infarction and pleural irritation Isolated dyspnea of rapid onset= central PE with hemodynamic sequlea Retrosternal angina like sxs= RV ischemia Syncope=rare presentation, but indicates severely reduced hemodynamic reserve Sxs can develop over weeks In pts with pre-existing CHF or COPD, worsening dyspnea may indicate PE Diagnosis: Chest X-Ray Usually abnormal, but non-specific Study of 2,322 patients with PE: Cardiac enlargement (27%) Normal (24%) Pleural effusion (23%) Elevated hemidiaphragm (20%) Pulmonary artery enlargement (19%) Atelectasis (18%) Parenchymal pulmonary infiltrates (17%) Chest Radiographs in Acute Pulmonary Embolism: Results From the International Cooperative Pulmonary Embolism Registry. Chest July 2000 118:3338; 10.1378/chest.118.1.33 Diagnosis: ECG Usually non-specific ST/T waves changes and tachycardia RV strain patterns suggest severe PE Inverted T waves V1-V4 QR in V1 Incomplete RBBB S1Q3T3 S1Q3T3 and T wave changes Diagnosis:Other tests Most patients with PE have a no