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1. UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
PULMONARY
TROMBOEMBOLIA
STUDENTS
William Cruz
Kevin Herrera
Jorge Pacheco
Angie Chamba
Sonia Quijilema
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

2. Pulmonary Tromboembolia
Definition
Pulmonary embolism is a medical condition in which the sudden occlusion of the
pulmonary artery is caused by a thrombus that emerges from the deep venous system at the
lower limbs level. Venous thromboembolism encompasses deep vein thrombosis and
pulmonary embolism It is one of the three major cardiovascular diseases along with
myocardial infarction and stroke. Pulmonary thromboembolism is the leading cause of
preventable death in hospitalized patients. It is crucial that current physicians manage to
clear and treatment of this pathology, and that they implement prophylactic schemes
routinely in hospitalized patients in which they are indicated in order to reduce mortality to
a minimum.

3. Etiology
In most cases (approximately 95% of them) the thrombus or clot forms in the veins of the
lower limbs and migrates to the pulmonary artery. Less frequently it can be air (gaseous
piston) or fat (fatty embolus). This occlusion mainly affects the lungs and the heart:
 A zone of the lungs does not receive venous blood (poor in oxygen) and therefore
can not oxygenate it and this will negatively affect the oxygen that will later reach
the rest of the patient's organs and tissues.
 The heart will continue to pump blood to the lungs but as a result of such occlusion,
you will encounter an obstacle and the pressure will increase inside the pulmonary
artery, weakening the right ventricle of the heart (the heart chamber that sends
oxygen-free blood to the lungs).
The most common clinical manifestations or symptoms are dyspnea (shortness of breath),
chest pain and dizziness or fainting, although fever and coughing up blood may also occur
when accompanied by a pulmonary infarction (a lung area is necrotic or dies as a result of
lack of irrigation). When the thrombus is very large and obstructs the main pulmonary
artery it can even cause death.
Signs and symptoms
Symptoms include:
 Short of breath
 Fast breathing
 Chest pain or discomfort that usually gets worse when you cough or breathe deeply
 Incrise of cardiac frecuency
 Cough blood
 Very low blood pressure, dizziness or fainting
Occasionally, people with pulmonary embolism show no symptoms until they have serious
complications, such as pulmonary hypertension (high blood pressure in the arteries of the
lungs).

4. Diagnosis
Deep vein thrombosis occurs as pain and localized edema along the deep venous system of
the lower or upper extremities. The main complications of DVT are PE and post-thrombotic
syndrome. Superficial thrombophlebitis should also be included in this pathological
spectrum, since concomitant DVT is present in up to 25% of cases. A D-dimer test with
appropriate sensitivity (ELISA or advanced turbidimetric method) in a patient with low
clinical probability discards DVT with tranquility. Patients with moderate or high clinical
probability should undergo venous duplex Doppler ultrasound of the entire limb to exclude
or confirm the diagnosis. In central locations such as the subclavian or pelvic region,
additional images such as computed tomography or magnetic resonance imaging may be
required.
Of all the proximal DVTs of the lower extremities, 50% embolize the lung, often
asymptomatically. The symptoms that are most frequently associated with PE are dyspnea,
pleuritic chest pain, hemoptysis, syncope and cough. Upon physical examination, patients
may present tachypnea, tachycardia and hypotension. On chest radiography (usually
normal), elevated hemidiaphragm can be seen due to loss of lung volume, segmental
opacities, pleural effusion or linear atelectasis. The electrocardiogram (altered less than
10% of the time) may show sinus tachycardia, S1Q3T3, right QRS deviation, transient
BCRD, T wave inversion, and ST-segment depression in right-sided perchondials. In
arterial blood gases, which can be normal in up to 40% of PE, hypoxemia, hypocapnia and
increased alveolar-arterial oxygen difference may occur.
When facing a patient with suspected PE, the risk factors and clinical elements must be
analyzed to arrive at a clinical probability bet. It is always recommended to implement in
Emergency Services some scoring system for the diagnostic probability of PE prior to the
exams (D-dimer or angioTAC). The most used is the Simplified Wells Score (Table 1),
which has a similar performance to more complex ones (Original Wells or Revised
Geneva) 1. Separates patients into two risk groups: low and high. As in DVT, if the clinical
probability is low for PE and the D-dimer is normal, no further study or treatment is
required, since the negative predictive value (NPV) is 99%. There is current evidence that
suggests that the D-dimer cut-off point should be adjusted by age in patients over 50

5. years2. If the cut-off point is 500 mcg / L, it must be multiplied by age by 10 (ie at 60 years
the normal value is 600 mcg / L and at 75, 750 mcg / L).
Treatment
Treatment in the acute or initial phase aims to stabilize the patient, relieve their symptoms,
resolve the vascular obstruction and prevent new episodes. In most cases it is achieved with
parenteral anticoagulation (administered by endovenous or subcutaneous puncture, not oral)
during the first 5-10 days. The most used medication in these cases is heparin. In a minority
of patients, usually the most critical or in those who can not receive anticoagulants, other
treatments are required such as fibrinolysis to accelerate the dissolution of the clot or
placement of a filter in the vena cava to prevent new thrombi from migrating to the lung .
After the first days and once at home, the patient must take oral anticoagulants (Sintrom,
Xarelto, Eliquis, Pradaxa and Lixiana) for a minimum period of 3 months. This period
should be prolonged in some patients who have a higher risk of suffering from another PE,
such as those who have several predisposing risk factors or those who have already had a
second PE. In these cases anticoagulation can be even for life.
Prevention
The prevention of the formation of new blood clots can prevent pulmonary embolism.
Prevention can include:
 Continue to take anticoagulants: It is also important to have regular check-ups with
your doctor, to verify that the dose of your medications is working to prevent the
formation of blood clots, but at the same time not causing bleeding
 Changes in the healthy lifestyle for the heart: as a heart-healthy diet, exercise and, if
you smoke, stop smoking
 Wear compression stockings to prevent deep vein thrombosis
 Move legs when sitting for a long time (as on long trips)
 Move as soon as possible after surgery or be bedridden.

6. Bibliography
 Chalikias GK, Tziakas DN, Stakos DA, Konstantidines SV. Management of acute
pulmonary embolism: A contemporary, risktailored approach. Hellenic J Cardiol
2010; 51: 437-450.
 Jenab Y, et al. Effect of delay in hospital presentation on clinical imaging findings
in acute pulmonary thromboembolism. The Journal of Emergency Medicine 2014;
46 (4); 465-471
 Konstantidines SV, et al. 2014 ESC Guidelines on the diagnosis and management of
acute pulmonary embolism. European Heart Journal 2014; 35: 3033-3080.