Pulmonary embolism pathophysiology: Difference between revisions
Jump to navigation
Jump to search
m (Robot: Automated text replacement (-mgibson@perfuse.org +charlesmichaelgibson@gmail.com, -kfeeney@perfuse.org +kfeeney@elon.edu)) |
No edit summary |
||
| Line 6: | Line 6: | ||
Pulmonary embolism occurs when there is an acute obstruction of the pulmonary artery or one of its branches. It is commonly caused by a venous thrombus that has dislodged from its site of formation and embolized to the arterial blood supply of one of the lungs. The process of clot formation and embolization is termed [[thromboembolism]]. | Pulmonary embolism occurs when there is an acute obstruction of the pulmonary artery or one of its branches. It is commonly caused by a venous thrombus that has dislodged from its site of formation and embolized to the arterial blood supply of one of the lungs. The process of clot formation and embolization is termed [[thromboembolism]]. | ||
==Clot Formation== | == Pathophysiology == | ||
=== Clot Formation === | |||
* Most pulmonary emboli commonly originate in the [[iliofemoral vein]], deep within the vasculature of the lower extremity. | * Most pulmonary emboli commonly originate in the [[iliofemoral vein]], deep within the vasculature of the lower extremity. | ||
* Less commonly, a pulmonary embolism may also arise in the upper extremity veins, renal veins, or pelvic veins. | * Less commonly, a pulmonary embolism may also arise in the upper extremity veins, renal veins, or pelvic veins. | ||
| Line 15: | Line 16: | ||
** The size of the embolus and the degree to which it occludes the vascular tree and its subsequent branches. | ** The size of the embolus and the degree to which it occludes the vascular tree and its subsequent branches. | ||
==Embolization== | === Embolization === | ||
* After formation, a thrombus will travel from the site of origin and circulate through the [[inferior vena cava]] into the right ventricle and on into the pulmonary vasculature where it will lodge.<ref name="McGill">McGill University. (2004, June 24). Pulmonary Embolism. Retrieved May 7, 2012, from McGill Virtual Stethoscope Pathophysiology.</ref> | * After formation, a thrombus will travel from the site of origin and circulate through the [[inferior vena cava]] into the right ventricle and on into the pulmonary vasculature where it will lodge.<ref name="McGill">McGill University. (2004, June 24). Pulmonary Embolism. Retrieved May 7, 2012, from McGill Virtual Stethoscope Pathophysiology.</ref> | ||
* Depending upon the patient, there can be one or many pulmonary emboli present. The size of the clot(s) and their physiologic impact will depend largely on the individual patient and subsequent anatomy of the vasculature. <ref name="McGill">McGill University. (2004, June 24). Pulmonary Embolism. Retrieved May 7, 2012, from McGill Virtual Stethoscope Pathophysiology.</ref> | * Depending upon the patient, there can be one or many pulmonary emboli present. The size of the clot(s) and their physiologic impact will depend largely on the individual patient and subsequent anatomy of the vasculature. <ref name="McGill">McGill University. (2004, June 24). Pulmonary Embolism. Retrieved May 7, 2012, from McGill Virtual Stethoscope Pathophysiology.</ref> | ||
==Hemodynamic Consequences== | === Hemodynamic Consequences === | ||
*Hemodynamic complications arise as a result of the obstruction of flow within the pulmonary arteries. | *Hemodynamic complications arise as a result of the obstruction of flow within the pulmonary arteries. | ||
*In circumstances where more than two-thirds of the [[pulmonary artery]] is occluded, the right ventricle needs to find ways to preserve pulmonary perfusion. Some of the adaptative mechanism of the right ventricle are as follows: | *In circumstances where more than two-thirds of the [[pulmonary artery]] is occluded, the right ventricle needs to find ways to preserve pulmonary perfusion. Some of the adaptative mechanism of the right ventricle are as follows: | ||
| Line 38: | Line 39: | ||
**[[Ventilation/perfusion ratio]] (V/Q ratio) | **[[Ventilation/perfusion ratio]] (V/Q ratio) | ||
==Mechanism== | === Mechanism === | ||
The diagram below summarizes the sequence of pathophysiologic events in pulmonary embolism:<ref name="pmid19041539">{{cite journal |author=Fengler BT, Brady WJ |title=Fibrinolytic therapy in pulmonary embolism: an evidence-based treatment algorithm |journal=Am J Emerg Med |volume=27 |issue=1 |pages=84–95 |year=2009 |month=January |pmid=19041539 |doi=10.1016/j.ajem.2007.10.021 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-6757(07)00699-7 |accessdate=2011-12-21}}</ref> | The diagram below summarizes the sequence of pathophysiologic events in pulmonary embolism:<ref name="pmid19041539">{{cite journal |author=Fengler BT, Brady WJ |title=Fibrinolytic therapy in pulmonary embolism: an evidence-based treatment algorithm |journal=Am J Emerg Med |volume=27 |issue=1 |pages=84–95 |year=2009 |month=January |pmid=19041539 |doi=10.1016/j.ajem.2007.10.021 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-6757(07)00699-7 |accessdate=2011-12-21}}</ref> | ||
Revision as of 18:32, 4 February 2013
|
Pulmonary Embolism Microchapters |
|
Diagnosis |
|---|
|
Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores |
|
Treatment |
|
Follow-Up |
|
Special Scenario |
|
Trials |
|
Case Studies |
|
Pulmonary embolism pathophysiology On the Web |
|
Directions to Hospitals Treating Pulmonary embolism pathophysiology |
|
Risk calculators and risk factors for Pulmonary embolism pathophysiology |
Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [1], The APEX Trial Investigators; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Pulmonary embolism occurs when there is an acute obstruction of the pulmonary artery or one of its branches. It is commonly caused by a venous thrombus that has dislodged from its site of formation and embolized to the arterial blood supply of one of the lungs. The process of clot formation and embolization is termed thromboembolism.
Pathophysiology
Clot Formation
- Most pulmonary emboli commonly originate in the iliofemoral vein, deep within the vasculature of the lower extremity.
- Less commonly, a pulmonary embolism may also arise in the upper extremity veins, renal veins, or pelvic veins.
- The nature of the clinical manifestation of a pulmonary embolism depends on a number of factors:[1]
- The presence of any preexisting cardiopulmonary conditions.
- The role of chemical vasoconstriction as it is insinuated by platelets releasing serotonin and thromboxane which adhere to the embolus.
- The presence of pulmonary artery dilatation and subsequent reflex vasoconstriction.
- The size of the embolus and the degree to which it occludes the vascular tree and its subsequent branches.
Embolization
- After formation, a thrombus will travel from the site of origin and circulate through the inferior vena cava into the right ventricle and on into the pulmonary vasculature where it will lodge.[2]
- Depending upon the patient, there can be one or many pulmonary emboli present. The size of the clot(s) and their physiologic impact will depend largely on the individual patient and subsequent anatomy of the vasculature. [2]
Hemodynamic Consequences
- Hemodynamic complications arise as a result of the obstruction of flow within the pulmonary arteries.
- In circumstances where more than two-thirds of the pulmonary artery is occluded, the right ventricle needs to find ways to preserve pulmonary perfusion. Some of the adaptative mechanism of the right ventricle are as follows:
- Generate a systolic blood pressure in excess of 50 mmHg.
- Maintain an average pulmonary artery pressure of approximately 40 mmHg.
- Without these adapations, a pulmonary embolism will lead to right heart failure.[3]
- Additional complications include the following:[2]
- Increased resistence in the pulmonary vessels.
- Pulmonary hypertension
- Right ventricular strain
- Congestive heart failure
- Vasoconstriction
- In patients with underlying cardiopulmonary disease, the cardiac output suffers substantial deterioration in overall output as compared to otherwise healthy individuals.
- In patients with coexisting coronary artery disease, right ventricular failure is more common following a pulmonary embolism as compared to those without coexisting CAD.
- In 10% of all pulmonary embolism cases, the pulmonary embolism develops into a pulmonary infarction. This is an exceedingly rare complication.[2]
- Long term complications:[2]
Mechanism
The diagram below summarizes the sequence of pathophysiologic events in pulmonary embolism:[4]
References
- ↑ Kostadima, E., & Zakynthinos, E. (2007). Pulmonary Embolism: Pathophysiology, Diagnosis, Treatment. Hellenic Journal of Cardiology, 94-107.
- ↑ 2.0 2.1 2.2 2.3 2.4 McGill University. (2004, June 24). Pulmonary Embolism. Retrieved May 7, 2012, from McGill Virtual Stethoscope Pathophysiology.
- ↑ Benotti JR, Dalen JE (1984). "The natural history of pulmonary embolism". Clin Chest Med. 5 (3): 403–10. PMID 6488744.
- ↑ Fengler BT, Brady WJ (2009). "Fibrinolytic therapy in pulmonary embolism: an evidence-based treatment algorithm". Am J Emerg Med. 27 (1): 84–95. doi:10.1016/j.ajem.2007.10.021. PMID 19041539. Retrieved 2011-12-21. Unknown parameter
|month=ignored (help)