Risk factors
* Hypercoagulable states
- Protein C, Protein S deficiency
- Anti-thrombin III deficiency
- Lupus anticoagulant ( Anti- phospholipid )
* Recent surgery
* Pregnancy
* Prolonged bed rest / Immobility / Travel
* Malignancy
* Oral contraceptive use, Drug abuse
* Certain venous aneurysms, DVT
Tips for using D-Dimer wisely :
- Use a high sensitivity assay
- Test low risk patients
- Test when you expect it will be negative (to rule out PE)
- Don't test D-dimer if you plan to order a CT regardless
- D-dimer should not be used to rule out Pulmonary Embolism in pregnancy
* EKG findings :
- Sinus tachycardia : 44 %
- Non specific STT changes : 50 %
- RV strain pattern (Tinv over V1-4) : 34 %
flipped T waves in anterior and inferior leads,
an uncommon finding which has been shown to be highly specific for PE
- RAE : 9 %
- Right axis deviation : 16 %
- Right ventricular dilatation : dominant R in V1
- S1Q3T3 pattern : 20 %
- New incomplete RBBB : 18 %
Chest pain + New T inv over V1-3
1. Ant wall ischemia, ACS ?
2. PE : RV strain pattern
Also :
Massive acute PE can mimicking STEMI
Acute PE can leads to STE in aVR
* CXR :
- Common findings include :
Atelectasis or pulmonary parenchymal abnormalities (18 to 69 %)
- Pleural effusion (47 %)
- Cardiomegaly (50 %)
- Normal (12 to 22 %)
- Hampton hump
Shallow, wedge-shaped opacity in the periphery of the lung,
with its base against the pleural surface.
- Westermark's sign
A sharp cut-off of pulmonary vessels
with distal hypoperfusion in a segmental distribution within the lung.
( Regional oligaemia )
- Fleischner sign : Enlarged pulmonary artery
- Palla's sign : Right descending pulmonary artery enlargement
- Knuckle sign : Abrupt tapering of an occluded vessel distally
- Ice melting sign
- Ventilation phase : gaseous radionuclide such as xenon ortechnetium DTPA
- Perfusion phase : intravenous injection of radioactive Tc99m-MAA
Ventilation phase ok, Perfusion phase with defect.
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