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The acute block of the pulmonary arteries by blood clots that most of the time arising from the lower extremities. Sudden shortness of breath and edema in one or both legs, require prompt medical evaluation, mortality rate is 5 to 15%

1.Acute and Chronic (PE):
Acute PE results from the sudden occlusion of pulmonary arteries by thrombi, leading to potentially life-threatening hemodynamic compromise. Chronic PE refers to the sequelae of unresolved or recurrent emboli, causing pulmonary vascular remodeling and chronic thromboembolic pulmonary hypertension (CTEPH).

2.Risk Factors: Risk
Factors for PE include Virchow’s triad of hypercoagulability, stasis, and endothelial injury, along with specific conditions such as recent surgery, trauma, malignancy, immobility, pregnancy, and genetic predispositions like Factor V Leiden mutation. Airplane flights, car driving longer than two hours without using stockings or stop for a walking

3.Symptoms of Acute PE:
Acute PE presents with symptoms ranging from mild dyspnea and pleuritic chest pain to hemodynamic instability, syncope, and sudden death. Other signs may include tachycardia, tachypnea, and signs of deep venous thrombosis (DVT).

4.Symptoms of Chronic PE: Chronic PE can manifest as exertional dyspnea, fatigue, signs of right heart strain, low saturation including elevated jugular venous pressure, hepatomegaly, and lower extremity edema.

5. Diagnosis: Diagnosis relies on a combination of clinical assessment, D-dimer testing, imaging studies (CT pulmonary angiography being the gold standard), and risk stratification tools like the Wells score or Geneva score.

6.Treatment: Acute PE is primarily managed with anticoagulation to prevent clot propagation and recurrence. Severe cases may require systemic thrombolysis, catheter-directed therapies, or surgical embolectomy. Chronic PE, especially CTEPH, may necessitate surgical or percutaneous pulmonary thromboendarterectomy or medical therapy like riociguat recently approved, reduce the pulmonary hypertension with dilatation of the pulmonary arteries.

7.Prognosis: The prognosis of PE depends on various factors, including the extent of thrombotic burden, hemodynamic stability, and comorbidities. Prompt diagnosis and appropriate management significantly improve outcomes.

8. Risk of Acute PE:
Individuals with risk factors are predisposed to acute PE, which can lead to significant morbidity and mortality if untreated.

9. PE and Pulmonary Hypertension: Chronic thrombotic obstruction in PE can lead to pulmonary hypertension due to increased pulmonary vascular resistance, right ventricular dysfunction, and ultimately, right heart failure.

10.PE and Heart Failure: Acute PE can precipitate acute right heart failure, particularly in cases of massive embolism or underlying cardiac dysfunction.

11.PE After COVID-19:
COVID-19 is associated with a hypercoagulable state, increasing the risk of PE, particularly in severe cases, possibly due to a combination of endothelial dysfunction, stasis, and systemic inflammation.

12.PE and DVT:
PE often arises from DVT in the lower extremities, with the two entities comprising venous thromboembolism (VTE). Management strategies for PE and DVT share many similarities.

RaulAyalaMD
@MyDoctorOnCall.com