NationMaster - Encyclopedia: Pulmonary embolism

Pulmonary embolism (PE) is a blockage of the pulmonary artery (or one of its branches), usually when a venous thrombus (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. This process is termed thromboembolism. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... The pulmonary arteries carry blood from the heart to the lungs. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... For Trombe wall (used in solar homes), see Trombe wall. ... An embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... The pulmonary arteries carry blood from the heart to the lungs. ...

Symptoms may include difficulty breathing, pain in the chest during breathing, and in more severe cases collapse, circulatory instability and sudden death. Treatment, usually, is with anticoagulant medication, such as heparin and warfarin, and rarely (in severe cases) with thrombolysis or surgery. In other, rarer forms of pulmonary embolism, material other than a blood clot is responsible; this may include fat or bone (usually in association with significant trauma), air (often when diving), clumped tumor cells, and amniotic fluid (affecting mothers during childbirth). Dyspnea (R06. ... Look up Pain in Wiktionary, the free dictionary. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Collapse is a sudden and often unannounced loss of postural tone (going weak), often but not necessarily accompanied by loss of consciousness. ... This article is about the medical condition. ... A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Some common lipids. ... This article is about the skeletal organs. ... Look up air in Wiktionary, the free dictionary. ... It has been suggested that this article or section be merged with Professional diving. ... See the article about cancer for the main article about malignant tumors. ... The amniotic sac is a tough but thin transparent pair of membranes which holds a developing embryo (and later fetus) until shortly before birth. ... For other uses, see Mother (disambiguation). ... Parturition redirects here. ...

Signs, symptoms and risk factors

Clinical presentation

Symptoms of PE are sudden-onset dyspnea (shortness of breath), tachypnea (rapid breathing), chest pain of "pleuritic" nature (worsened by breathing), cough, hemoptysis (coughing up blood), and may aid in the diagnosis. More severe cases can include signs such as pleural rub, cyanosis (blue discoloration, usually of the lips and fingers), collapse, and circulatory instability. About 15% of all cases of sudden death are attributable to PE. Dyspnea (R06. ... Tachypnea is a medical term for breathing which is more rapid than normal. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Hemoptysis (US English) or haemoptysis (International English) is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e. ... Cyanosis refers to the bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. ... Collapse is a sudden and often unannounced loss of postural tone (going weak), often but not necessarily accompanied by loss of consciousness. ... This article is about the medical condition. ... A cardiac arrest is the cessation of normal circulation of the blood due to failure of the ventricles of the heart to contract effectively during systole. ...

Risk factors

The most common sources of embolism are proximal leg deep venous thrombosis (DVTs) or pelvic vein thromboses. Any risk factor for DVT also increases the risk that the venous clot will dislodge and migrate to the lung circulation, which happens in up to 15% of all DVTs. The conditions are generally regarded as a continuum termed venous thromboembolism (VTE). In sciences dealing with the anatomy of animals, precise anatomical terms of location are necessary for a variety of reasons. ... It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ...

The development of thrombosis is classically due to a 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. Virchows triad encompasses three broad categories of factors that are thought to contribute to venous thrombosis: Alterations in normal blood flow Injuries to the vascular endothelium Alterations in the constitution of blood (hypercoagulability) While the triad is now frequently applied to describe thrombosis arising within the arterial circulation, many...

In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Economy class syndrome was coined in the late 1990s when it turned out that people who has traveled long distances by aeroplane were at an increased risk for thrombosis, especially deep venous thrombosis and its main complication, pulmonary embolism. ... This article is about human pregnancy in biological females. ... Estriol. ... Hormonal contraception refers to birth control methods that act on the hormonal system. ... Factor V Leiden (sometimes Factor VLeiden) is the name given to a variant of human factor V that causes a hypercoagulability disorder. ... Thrombin (activated Factor II) is a coagulation protein that has many effects in the coagulation cascade. ... How to recognize Protein C deficiency ... Protein S deficiency is a disorder associated with increased risk of thrombosis. ... Image:Antithrombin. ... Hyperhomocysteinemia is a medical condition characterized by an abnormally large level of homocysteine in the blood. ... Plasmin is an important degrading enzyme (EC 3. ... Fibrinolysis is the process where a fibrin clot, the product of coagulation, is broken down. ... This article, image, template or category should belong in one or more categories. ... Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired life-threatening disease of the blood characterised by hemolytic anemia, thrombosis and red urine due to breakdown of red blood cells. ...

Diagnosis

The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes of chest pain and shortness of breath. Dyspnea (Latin dyspnoea, Greek dyspnoia from dyspnoos - short of breath) or shortness of breath (SOB) is perceived difficulty breathing or pain on breathing. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not...

Risk prediction

The decision to do medical imaging is usually based on clinical grounds, i.e. the medical history, symptoms and findings on physical examination. The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ...

The most commonly used method to predict clinical probability, the Wells score, is clinical prediction rule, whose use is complicated by multiple versions being available. In 1995, Wells et al initially developed a prediction rule (based on a literature search) to predict the likelihood of PE, based on clinical criteria.^[1] The prediction rule was revised in 1998^[2] This prediction rule was further revised when simplified during a validation by Wells et al in 2000.^[3] In the 2000 publication, Wells proposed two different scoring systems using cutoffs of 2 or 4 with the same prediction rule.^[3] In 2001, Wells published results using the more conservative cutoff of 2 to create three categories.^[4] An additional version, the "modified extended version", using the more recent cutoff of 2 but including findings from Wells's initial studies^[1]^[2] were proposed.^[5] Most recently, a further study reverted to Wells's earlier use of a cutoff of 4 points^[3] to create only two categories.^[6] A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome. ... Year 1995 (MCMXCV) was a common year starting on Sunday. ...

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.^[7]

Traditional interpretation^[3]^[4]^[9] DTV Is a software program used for watching online television A.K.A. Videocasts It can also stand for deep vein thrombosis ...

D-dimer is a blood test performed in the medical laboratory to diagnose thrombosis. ...

Blood tests

In low/moderate suspicion of PE, a normal D-dimer level (shown in a blood test) is enough to exclude the possibility of thrombotic PE.^[11] D-dimer is a blood test performed in the medical laboratory to diagnose thrombosis. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ...

When a PE is being suspected, a number of blood tests are done, in order to exclude important secondary causes of PE. This includes a full blood count, clotting status (PT, APTT, TT), and some screening tests (erythrocyte sedimentation rate, renal function, liver enzymes, electrolytes). If one of these is abnormal, further investigations might be warranted. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... This article is about the clotting of blood. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) is a commonly performed test for the system of coagulation, especially its intrinsic pathway. ... The Throbin Clotting Time (TCT), also known as the Thrombin Time (TT), is a coagulation assay which is usually performed in order to detect for the thereputic level of the anticoagulant Heparin. ... The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... An electrolyte is any substance containing free ions that behaves as an electrically conductive medium. ...

Medical imaging

The gold standard for diagnosing pulmonary embolism (PE) is pulmonary angiography. Pulmonary angiography is used less often due to wider acceptance of CT scans, which are non-invasive. In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ... Pulmonary angiography (or pulmonary arteriography) is a cardiological medical procedure. ...

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 patients, and the possibility of identifying other lung disorders from the differential diagnosis in case there is no pulmonary embolism. 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.^[12] A study with a mixture of 4 slice and 16 slice scanners reported a sensitivity of 83% and a specificity of 96%. This study noted that additional testing is necessary when the clinical probability is inconsistent with the imaging results.^[13] CTPA is non-inferior to VQ scanning, and identifies more emboli (without necessarily improving the outcome) compared to VQ scanning.^[14] CT Pulmonary Angiogram or CTPA is a medical diagnostic test used to diagnose a pulmonary embolus or PE. It is short for Computed Tomography Pulmonary Angiogram. ... negron305 Cat scan redirects here. ... Radiocontrast agents (or simply contrast agents) are compounds used to improve the visibility of internal bodily structures in an X-ray image. ... This article does not cite any references or sources. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...

Ventilation/perfusion scan (or V/Q scan or lung scintigraphy), which shows that some areas of the lung are being ventilated but not perfused with blood (due to obstruction by a clot). This type of examination is used less often because of the more widespread availability of CT technology, however, it may be useful in patients who have an allergy to iodinated contrast or in pregnancy due to lower radiation exposure than CT.^[15] A ventilation/perfusion scan, also called a V/Q scan, is a medical test to measure the circulation of air and blood within a patients lungs. ... Nuclear medicine is the branch of medicine that uses unsealed radioactive substances in diagnosis and therapy. ... In respiratory physiology, ventilation is the rate at which gas enters or leaves the lung. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ... iodinated contrast is an intervenous radiographic die containing iodine, which enhances vascular structures and organs. ... This article is about human pregnancy in biological females. ...

Tests that are frequently done that are not sensitive for PE, but can be diagnostic. The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ...

Frontal chest X-ray. ... Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... A break or fracture in one or more of the bones making up the human rib cage. ... A radiologic sign is an objective indication of some medical fact or quality that is detected by a physician during examination of a radiograph (i. ... In chest radiography, the Westermark Sign, is a sign that represents a focus of oligemia (vasoconstriction) seen distal to a pulmonary embolus (PE). ... Hamptons hump, also Hampton hump, is a radiologic sign seen on chest X-rays indicating pulmonary infarction and classically due to pulmonary embolism. ... Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize internal organs, their size, structure and their pathological lesions. ... It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... Medical ultrasonography is an ultrasound-based imaging diagnostic technique used to visualize internal organs, their size, structure and their pathological lesions. ... This article is about human pregnancy in biological females. ...

Electrocardiogram findings

An electrocardiogram (ECG) is routinely done on patients with chest pain to quickly diagnose myocardial infarctions (heart attacks). An ECG may show signs of right heart strain or acute cor pulmonale in cases of large PEs - the classic signs are a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III ("S1Q3T3").^[17] This is occasionally (up to 20%) present, but may also occur in other acute lung conditions and has therefore limited diagnostic value; the most commonly seen sign in the ECG is sinus tachycardia. â€œQRSâ€ redirects here. ... Heart attack redirects here. ... â€œQRSâ€ redirects here. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ...

Echocardiography findings

In massive and submassive PE, dysfunction of the right side of the heart can be seen on echocardiography, an indication that the pulmonary artery is severely obstructed and the heart is unable to match the pressure. Some studies (see below) suggest that this finding may be an indication for thrombolysis. Not every patient 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.^[18] An echocardiogram. ... The pulmonary arteries carry blood from the heart to the lungs. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ... Brain natriuretic peptide (also known as B-type natriuretic peptide or GC-B) is a 32-amino-acid polypeptide secreted by the ventricles of the heart in response to excessive stretching of myocytes (heart muscles cells) in the ventricles. ...

The specific appearance of the right ventricle on echocardiography is referred to as the McConnell sign. This is the finding of akinesia of the mid-free wall but normal motion of the apex. This phenomenon has a 77% sensitivity and a 94% specificity for the diagnosis of acute pulmonary embolism.^[19]

Combining tests into algorithms

Recent recommendations for a diagnostic algorithm have been published by the PIOPED investigators; however, these recommendations do not reflect research using 64 slice MDCT.^[10] These investigators recommended:

Treatment

In most cases, anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments, such as oxygen or analgesia, are often required. Oxygen first aid kit showing a demand valve and a constant flow mask Oxygen therapy is the administration of oxygen as a therapeutic modality. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...

Massive PE causing hemodynamic instability (marked decreased oxygen saturation, tachycardia and/or hypotension) is an indication for thrombolysis, the enzymatic destruction of the clot with medication. Some advocate its use also if right ventricular dysfunction can be demonstrated on echocardiography.^[20] Oxygen saturation is a relative measure of the amount of oxygen that is dissolved or carried in a given medium. ... This article or section does not cite any references or sources. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... An echocardiogram. ...

Anticoagulation

In most cases, anticoagulant therapy is the mainstay of treatment. Heparin, low molecular weight heparins (such as enoxaparin and dalteparin), or fondaparinux is administered initially, while warfarin therapy is commenced (this may take several days, usually while the patient is in hospital). Warfarin therapy often requires frequent dose adjustment and monitoring of the INR. In PE, INRs between 2.0 and 3.0 are generally considered ideal. If another episode of PE occurs under warfarin treatment, the INR window may be increased to e.g. 2.5-3.5 (unless there are contraindications) or anticoagulation may be changed to a different anticoagulant e.g. low molecular weight heparin. In patients with an underlying malignancy, therapy with a course of low molecular weight heparin may be favored over warfarin based on the results of the CLOT trial.^[21] Similarly, pregnant women are often maintained on low molecular weight heparin to avoid the known teratogenic effects of warfarin. An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis. ... Enoxaparin is a low molecular weight heparin manufactured by Sanofi-Aventis. ... Dalteparin is a low molecular weight heparin. ... Fondaparinux (Arixtra) is an anticoagulant medication. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis. ... In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis. ... Teratogenesis is a medical term from the Greek, literally meaning monster making. ...

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.^[22] D-dimer is a blood test performed in the medical laboratory to diagnose thrombosis. ...

Image File history File links Size of this preview: 800 Ã— 500 pixel Image in higher resolution (1021 Ã— 638 pixel, file size: 46 KB, MIME type: image/jpeg) Taken by user:BozMo URL at http://catesfamily. ... Image File history File links Size of this preview: 800 Ã— 500 pixel Image in higher resolution (1021 Ã— 638 pixel, file size: 46 KB, MIME type: image/jpeg) Taken by user:BozMo URL at http://catesfamily. ... The British decimal Twenty Pence (20p) coin was issued in June 1982 to fill in the obvious gap between the Ten Pence and Fifty Pence coins; it rapidly gained acceptance and very large numbers now circulate [1]. The coin is minted from an alloy of 84% copper and 16% nickel...

Inferior vena cava filter

If anticoagulant therapy is contraindicated and/or ineffective an inferior vena cava filter may be implanted.^[23] An inferior vena cava filter, also IVC filter a type of vascular filter, is a medical device that is implanted into the inferior vena cava to prevent pulmonary emboli (PEs). ... In medicine, a contraindication is a condition or factor that increases the risk involved in using a particular drug, carrying out a medical procedure or engaging in a particular activity. ... An inferior vena cava filter, also IVC filter a type of vascular filter, is a medical device that is implanted into the inferior vena cava to prevent pulmonary emboli (PEs). ...

Thrombolysis

Thrombolysis can be given for severe PEs when surgery is not immediately available or possible (e.g. periarrest or during cardiac arrest). The only trial that addressed this issue had 8 patients; the four receiving thrombolysis survived, while the four who received only heparin died.^[24] The use of thrombolysis in moderate PEs is still debatable. The aim of the therapy is to dissolve the clot, but there is an attendant risk of bleeding or stroke.^[25] Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ...

Surgical management of PE

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 selected patients.^[26] In thoracic surgery, a pulmonary thrombectomy, is an emergency procedure that removes clotted blood (thrombus) from the pulmonary arteries. ...

Chronic pulmonary embolism leading to pulmonary hypertension (known as chronic thromboembolic hypertension) is treated with a surgical procedure known as a pulmonary thromboendarterectomy. In medicine, pulmonary hypertension (PH) is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion. ... In thoracic surgery, a pulmonary thromboendarterectomy, PTE, is an operation that removes organized clotted blood (thrombus) from the pulmonary arteries. ...

Prognosis

Mortality from untreated PE is said to be 26%. This figure comes from a trial published in 1960 by Barrit and Jordan,^[27] which compared anticoagulation against placebo for the management of PE. Barritt and Jordan performed their study in the Bristol Royal Infirmary in 1957. This study is the only placebo controlled trial ever to examine the place of anticoagulants in the treatment of PE, the results of which were so convincing that the trial has never been repeated as to do so would be considered unethical. That said, the reported mortality rate of 26% in the placebo group is probably an overstatement, given that the technology of the day may have detected only severe PEs. Year 1960 (MCMLX) was a leap year starting on Friday (link will display full calendar) of the Gregorian calendar. ... The Bristol Royal Infirmary is a large teaching hospital, situated in the centre of Bristol, England. ...

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. There is controversy over whether or not small subsegmental PEs need to be treated at all^[28] and some evidence exists that patients with subsegmental PEs may do well without treatment.^[29]^[13] In medicine, pulmonary hypertension (PH) is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion. ...

Predicting mortality

The PESI and Geneva prediction rules can estimate mortality and so may guide selection of patients who can be considered for outpatient therapy.^[30]

Evaluation for underlying causes for recurrence

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 mutation, antiphospholipid antibodies, protein C and S and antithrombin levels, and later prothrombin mutation, MTHFR mutation, Factor VIII concentration and rarer inherited coagulation abnormalities. An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... This article is about the clotting of blood. ...

References

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^ ^a ^b Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (1998). "Use of a clinical model for safe management of patients with suspected pulmonary embolism". Ann Intern Med 129 (12): 997-1005. PMID 9867786.
^ ^a ^b ^c ^d ^e Wells P, Anderson D, Rodger M, Ginsberg J, Kearon C, Gent M, Turpie A, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (2000). "Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer.". Thromb Haemost 83 (3): 416-20. PMID 10744147.
^ ^a ^b Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ (2001). "Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer". Ann Intern Med 135 (2): 98-107. PMID 11453709.
^ Sanson BJ, Lijmer JG, Mac Gillavry MR, Turkstra F, Prins MH, Büller HR (2000). "Comparison of a clinical probability estimate and two clinical models in patients with suspected pulmonary embolism. ANTELOPE-Study Group". Thromb. Haemost. 83 (2): 199-203. PMID 10739372.
^ ^a ^b van Belle A, Büller H, Huisman M, Huisman P, Kaasjager K, Kamphuisen P, Kramer M, Kruip M, Kwakkel-van Erp J, Leebeek F, Nijkeuter M, Prins M, Sohne M, Tick L (2006). "Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography". JAMA 295 (2): 172-9. doi:10.1001/jama.295.2.172. PMID 16403929.
^ Roy PM, Meyer G, Vielle B, Le Gall C, Verschuren F, Carpentier F, Leveau P, Furber A (2006). "Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism". Ann. Intern. Med. 144 (3): 157-64. PMID 16461959.
^ Neff MJ (2003). "ACEP releases clinical policy on evaluation and management of pulmonary embolism". American family physician 68 (4): 759-60. PMID 12952389.
^ Yap KS, Kalff V, Turlakow A, Kelly MJ (2007). "A prospective reassessment of the utility of the Wells score in identifying pulmonary embolism". Med. J. Aust. 187 (6): 333–6. PMID 17874979.
^ ^a ^b ^c ^d Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD (2007). "Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators". Radiology 242 (1): 15-21. doi:10.1148/radiol.2421060971. PMID 17185658.
^ Bounameaux H, de Moerloose P, Perrier A, Reber G (1994). "Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview". Thromb. Haemost. 71 (1): 1-6. PMID 8165626.
^ Schaefer-Prokop C, Prokop M (2005). "MDCT for the diagnosis of acute pulmonary embolism". European radiology 15 Suppl 4: D37-41. PMID 16479644.
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For transport in plants, see Vascular tissue. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... For other forms of hypertension, see Hypertension (disambiguation). ... In kidney, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumens - hyaline arteriolosclerosis. ... While most forms of hypertension in humans have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... Renovascular hypertension (or renal hypertension) is a form of secondary hypertension. ... Ischaemic (or ischemic) heart disease is a disease characterized by reduced blood supply to the heart. ... Prinzmetals angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. ... Heart attack redirects here. ... Dresslers syndrome is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). ... Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-depleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. ... Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ... Grays Fig. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). ... Mitral regurgitation (MR), also known as mitral insufficiency, is the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart. ... Mitral valve prolapse (MVP) is a heart valve condition marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. ... Mitral stenosis is a narrowing of the orifice of the mitral valve of the heart. ... The aortic valve is one of the valves of the heart. ... Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ... Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ... The pulmonary valve, also known as pulmonic valve, is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. ... Pulmonary valve stenosis is a medical condition in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. ... Pulmonary valve insufficiency (or incompetence, or regurgitation) is a condition where the pulmonary valve is not strong enough to prevent backflow into the right ventricle. ... The tricuspid valve is on the right side of the heart, between the right atrium and the right ventricle. ... Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. ... Tricuspid insufficiency, also termed Tricuspid regurgitation, refers to the failure of the hearts tricuspid valve to close properly during systole. ... Myocardium is the muscular tissue of the heart. ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ... Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. ... Hypertrophic cardiomyopathy, or HCM, is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause. ... This article is considered orphaned, since there are very few or no other articles that link to this one. ... Restrictive cardiomyopathy (RCM) is the least common cardiomyopathy. ... Arrhythmogenic right ventricular dysplasia (ARVD, also known as arrhythmogenic right ventricular cardiomyopathy or ARVC) is a type of nonischemic cardiomyopathy that involves primarily the right ventricle. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... A heart block is a disease in the electrical system of the heart. ... A heart block denotes a disease in the electrical system of the heart. ... First degree AV block or PR prolongation is a disease of the electrical conduction system of the heart in which the PR interval is lengthened. ... Second degree AV block is a disease of the electrical conduction system of the heart. ... Third degree AV block, also known as complete heart block, is a defect of the electrical system of the heart, in which the impulse generated in the atria (typically the SA node on top of the right atrium) does not propagate to the ventricles. ... Bundle branch block refers to a disorder of the hearts electrical conducting system. ... ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. ... Right bundle branch block (RBBB) is a cardiac conduction abnormality seen on electrocardiogram (EKG). ... Bifascicular block is a conduction abnormality in the heart where two of the three main fascicles of the His/Purkinje system are blocked. ... Trifascicular heart block is the triad of first degree heart block, right bundle branch block, and either left anterior or left posterior hemi block seen on an electrocardiogram (EKG). ... Pre-excitation syndrome is a condition where the the ventricles of the heart become depolarized too early, which leads to their premature contraction, causing arrhythmia. ... Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the Bundle of Kent. ... Lown-Ganong-Levine syndrome (LGL) is a syndrome of pre-excitation of the ventricles due to an accessory pathway providing an abnormal electrical communication from the atria to the ventricles. ... The long QT syndrome (LQTS) is a heart disease in which there is an abnormally long delay between the electrical excitation (or depolarization) and relaxation (repolarization) of the ventricles of the heart. ... The term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. ... A cardiac arrest is the cessation of normal circulation of the blood due to failure of the ventricles of the heart to contract effectively during systole. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... A supraventricular tachycardia (SVT) is a rapid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node. ... AV nodal reentrant tachycardia (AVNRT) is a type of reentrant tachycardia (fast rhythm) of the heart. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Atrial flutter is an abnormal fast heart rhythm that occurs in the atria of the heart. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... pac This page meets Wikipedias criteria for speedy deletion. ... This article does not cite any references or sources. ... An ectopic pacemaker or ectopic focus is an excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the human heart. ... Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the hearts natural pacemaker. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Cardiomegaly is a medical condition wherein the heart is enlarged. ... Although ventricular hypertrophy may occur in either the left or right or both ventricles of the heart , left ventricular hypertrophy (LVH) is more commonly encountered. ... Left ventricular hypertrophy (LVH) is the thickening of the myocardium (muscle) of the left ventricle of the heart. ... Right ventricular hypertrophy (RVH) is a form of ventricular hypertrophy affecting the right ventricle. ... Cerebrovascular disease is damage to the blood vessels in the brain, resulting in a stroke. ... For other uses, see Stroke (disambiguation). ... A transient ischemic attack (TIA, often colloquially referred to as mini stroke) is caused by the temporary disturbance of blood supply to a restricted area of the brain, resulting in brief neurologic dysfunction that usually persists for less than 24 hours. ... This article needs cleanup. ... A intracranial hemorrhage is a bleed into the substance of the cerebrum. ... Extra-axial hematoma, or extra-axial hemorrhage is a subtype of intracranial hemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself. ... Nontraumatic epidural hematoma in a young woman. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Intraventricular hemorrhage (or IVH) is a bleeding of the ventricles, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral two-thirds of the spinal cord and Medulla. ... Binswangers disease is a rare form of multi-infarct dementia caused by damage to deep white brain matter. ... Moyamoya disease is an extremely rare disorder in most parts of the world except in Japan. ... Section of an artery An artery or arterial is also a class of highway. ... An arteriole is a blood vessel that extends and branchs out from an artery and leads to capillaries. ... The word capillary is used to describe any very narrow tube or channel through which a fluid can pass. ... Renal artery stenosis is the narrowing of the renal artery. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ... A plate from Grays Anatomy with yellow lines depicting the most common infrarenal location of the AAA. Abdominal aortic aneurysm, also written as AAA and often pronounced triple-A, is a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%. The normal diameter... Post surgical photo of brain aneurysm survivor. ... Raynauds phenomenon (RAY-noz), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities, named for French physician Maurice Raynaud (1834 - 1881). ... Raynauds disease (RAY-noz) is a condition that affects blood flow to the extremities which include the fingers, toes, nose and ears when exposed to temperature changes or stress. ... Buergers disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. ... Vasculitis (plural: vasculitides), a group of diseases featuring inflammation of the wall of blood vessels including veins (phlebitis), arteries (arteritis) and capillaries due to leukocyte migration and resultant damage. ... Arteritis is inflammation of the walls of arteries, usually as a result of infection or auto-immune response. ... Aortitis is the inflammation of the aorta. ... Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. ... An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. ... In medicine, hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a genetic disorder that leads to vascular malformations. ... A spider angioma (also known as a nevus araneus, spider nevus, or vascular spider) is a type of angioma found slightly below the skins surface, often containing a central red spot and reddish extensions which radiate outwards like a spiders web. ... Carotid artery dissection is an important cause of stroke in young patients. ... In medical contexts, dissection refers to a tear in the wall of a blood vessel. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Lymph originates as blood plasma lost from the circulatory system, which leaks out into the surrounding tissues. ... Lymph nodes are components of the lymphatic system. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... Phlebitis is an inflammation of a vein, usually in the legs. ... It has been suggested that this article or section be merged into deep vein thrombosis. ... This article is about Deep-vein thrombosis. ... May-Thurner syndrome is deep vein thrombosis of the iliofemoral vein due to compression of the left common iliac vein by overlying right common iliac artery. ... A venous thrombosis is a blood clot that forms within a vein. ... In medicine (gastroenterology and hepatology), Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic vein. ... Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein, leading to a reduction in drainage of the kidney. ... Paget-Schroetter disease (also Paget-von SchrÃ¶tter disease) refers to deep vein thrombosis of an upper extremity vein, including the axillary vein or subclavian vein. ... Vein gymnastics in the barefoot park Dornstetten, Germany. ... A portacaval anastomosis is a specific type of anastomosis that occurs between the veins of portal circulation and those of systemic circulation. ... Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Cross section showing the pampiniform plexus Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. ... Gastric varices are dilated submucosal veins in the stomach. ... Caput medusae means dilated veins around the umbilicus. ... Superior vena cava syndrome (SVCS) is a result of obstruction of the superior vena cava. ... Lymphadenopathy is a term meaning disease of the lymph nodes. ... Azskeptic 17:34, 10 July 2007 (UTC) Lymphedema, also spelled lymphoedema, also known as lymphatic obstruction, is a condition of localized fluid retention caused by a compromised lymphatic system. ... Lymphadenopathy is swelling of one or more lymph nodes. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Orthostatic hypotension (also known as postural hypotension, orthostatic intolerance and, colloquially, as head rush or a dizzy spell) is a sudden fall in blood pressure, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position, usually after a prolonged period of rest. ... Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...

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