Thromboembolic obstruction of pulmonary arteries.
Causes
- • DVT propagation
- • Right heart thrombus
- • Fat/amniotic/air embolism (rare)
Risk factors
- • Recent surgery/immobility
- • Malignancy
- • OCP/HRT/pregnancy
- • Prior VTE, thrombophilia
- • Long-haul travel
Clinical features
- • Sudden dyspnoea, pleuritic chest pain, haemoptysis
- • Syncope (massive PE)
Investigations
- • Wells + D-dimer for low-risk
- • CTPA (gold standard)
- • V/Q if renal impairment/pregnancy
- • Troponin, BNP, echo (RV strain)
Diagnosis
- • Confirmed by imaging; PESI/sPESI for risk stratification
Management
- • Massive (unstable): systemic tPA 100 mg IV over 2 h
- • Submassive: consider catheter-directed thrombolysis
- • Anticoagulation: LMWH bridge → DOAC (apixaban 10 mg BD × 7 d then 5 mg BD; rivaroxaban 15 mg BD × 21 d then 20 mg OD)
- • IVC filter if OAC contraindicated
Drug therapy
- • Duration: 3 months if provoked; ≥6 months / indefinite if unprovoked or high-risk
Complications
- • Chronic thromboembolic PH (CTEPH)
- • RV failure
- • Death
Clinical pearls
- • Y-descent absent in cardiac tamponade; PE has ↑pulmonary pressures
- • PERC rule excludes PE in low-risk patients
References
- • ESC 2019 PE Guidelines
Related in WardRound
Educational — verify locally.
