Pulmonary embolism pathophysiology: Difference between revisions

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* 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.
* The nature of the clinical manifestation of a pulmonary embolism depends on a number of factors:<ref name="Hellas">Kostadima, E., & Zakynthinos, E. (2007). Pulmonary Embolism: Pathophysiology, Diagnosis, Treatment. Hellenic Journal of Cardiology, 94-107.</ref>
** 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 [[vasoconstriction|reflex vasoconstriction]].
** The size of the embolus and the degree to which it occludes the vascular tree and its subsequent branches.
* The development of thrombosis is classically due to a group of causes referred to as [[Virchow's triad]]. Virchow's triad includes alterations in [[blood flow]], factors in the vessel wall, and factors affecting the properties of the [[blood]]. It is common for more than one risk factor to be present.  Shown below is an image depicting [[Virchow's triad]].
* The development of thrombosis is classically due to a group of causes referred to as [[Virchow's triad]]. Virchow's triad includes alterations in [[blood flow]], factors in the vessel wall, and factors affecting the properties of the [[blood]]. It is common for more than one risk factor to be present.  Shown below is an image depicting [[Virchow's triad]].



Revision as of 18:46, 7 July 2014

Pulmonary Embolism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary Embolism from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

Assessment of Clinical Probability and Risk Scores

Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Arterial Blood Gas Analysis

D-dimer

Biomarkers

Electrocardiogram

Chest X Ray

Ventilation/Perfusion Scan

Echocardiography

Compression Ultrasonography

CT

MRI

Treatment

Treatment approach

Medical Therapy

IVC Filter

Pulmonary Embolectomy

Pulmonary Thromboendarterectomy

Discharge Care and Long Term Treatment

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Follow-Up

Support group

Special Scenario

Pregnancy

Cancer

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Case #1

Pulmonary embolism pathophysiology On the Web

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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:

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 development of thrombosis is classically due to a group of causes referred to as Virchow's triad. Virchow's triad includes alterations in blood flow, factors in the vessel wall, and factors affecting the properties of the blood. It is common for more than one risk factor to be present. Shown below is an image depicting Virchow's triad.

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.[1]
  • 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. [1]

Hemodynamic Consequences

Mechanism

The diagram below summarizes the sequence of pathophysiologic events in pulmonary embolism:[3]

References

  1. 1.0 1.1 1.2 1.3 1.4 McGill University. (2004, June 24). Pulmonary Embolism. Retrieved May 7, 2012, from McGill Virtual Stethoscope Pathophysiology.
  2. Benotti JR, Dalen JE (1984). "The natural history of pulmonary embolism". Clin Chest Med. 5 (3): 403–10. PMID 6488744.
  3. 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)

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