SAQ 230 – Vascular – pulmonary embolism assessment and thrombolysis

Question 1. pulmonary embolism assessment and thrombolysis.

a. Examination features

• Heart rate above 100/min.
• Tachypnoea.
• Fever.
• Unilateral leg swelling.
• Signs of right-heart strain, such as raised JVP, loud P2, RV heave, or gallop rhythm.
• Pleural rub.

b. ECG findings

• Sinus tachycardia.
• Right-axis deviation.
• S1Q3T3 pattern.
• Right-ventricular strain with T-wave inversion in V1-V4.
• Right bundle-branch block.
• Right-atrial enlargement or dominant R wave in V1.

c. Chest-x-ray findings

• Cardiomegaly.
• Elevated hemidiaphragm.
• Small pleural effusion.
• Wedge-shaped pulmonary infiltrate or Hampton hump.
• Westermark sign.
• Prominent pulmonary artery or Fleischner sign.
• Loss of lung volume.

d. CTPA advantages

• Demonstrates clot burden.
• May identify an alternative diagnosis.
• Assessment of right-ventricular dilatation assists risk stratification.

e. Thrombolysis indications

• Cardiac arrest with suspected pulmonary embolism.
• Confirmed pulmonary embolism with cardiogenic shock or treatment-resistant hypotension.
• Confirmed pulmonary embolism with treatment-resistant hypoxia.
• Massive pulmonary embolism involving more than 70% of the pulmonary vasculature.