Professional Documents
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EMBOLI PARU
Dr. dr. Azhari Gani SpPD-KKV, FINASIM, FCIC
Nisio MD, Nick VE, Buller HR. Deep vein thrombosis and pulmonary embolism. The lancet.2016:1-14
Clinical and environmental risk factors
Hypercoagulability
Older age
Active cancer
Antiphospholipid syndrome
Oestrogen therapy
Pregnancy or puerperium
Personal or family history of venous thromboembolism
Obesity
Autoimmune and chronic inflammatory diseases (eg, inflammatory bowel disease)
Heparin-induced thrombocytopenia
Vascular damage
Surgery
Trauma or fracture
Central venous catheter or pacemaker
Venous stasis or immobilisation
Hospitalisation for acute medical illness
Nursing-home residence
Long-hour travel for more than 4 h
Paresis or paralysis
Heritable risk factors
Factor V Leiden
Prothrombin 20210G A mutation
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
Non-0 blood group
Wilbur J, Shian B. Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism. Am Fam Physician.2012;86:913-9.
Pulmonary embolism
Presents with acute chest pain.
Breathlessness with shock.
Cough & hemopysis.
May be fatal.
Non-Specific!!
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
Radiographic Signs Hamptons Hump
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
Pulmonary Embolism
Clinical Decision Rules
Konstantinides S, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D. 2014 ESC Guidelines on the diagnosis and management of acute
pulmonary embolism. European Heart Journal.2014:1-48.
Peter Augustinos, MD; Kenneth Ouriel, MD. Invasive Approaches to Treatment of Venous Thromboembolism. Circulation. 2004;110:27-34.
Catheter Embolectomy & Fragmentation