![]() ![]() Elevated B-type natriuretic peptide or N-terminal B-type natriuretic peptide. ![]() Table 2: Risk Stratification and Treatment of PE The presence of RV strain by both biomarkers and imaging indicates a high-risk, submassive PE and portends worse prognosis, which may merit more aggressive treatment. Normotensive patients are further risk stratified using clinical scores such as the Pulmonary Embolism Severity Index (PESI) 9 and its simplified version, sPESI, 10 biomarkers, and imaging modalities that detect RV strain. 8 Patients with massive (high-risk) PE require immediate intervention including thrombolytics and thrombectomy, with or without mechanical hemodynamic support. Further, patients with a single sub-segmental PE but no DVT, active cancer, or symptoms may not require anticoagulation. Patients with low-risk PE are generally treated with anticoagulation and may not merit admission to the hospital. Short-term mortality in PE is driven by hemodynamic derangements and RV failure. Once a PE is diagnosed, the patient should be risk stratified (Table 2). Westermark sign: Prominent pulmonary artery with decreased peripheral vasculature Hampton hump: wedge opacity in the setting of pulmonary infarct McConnell's sign: RV free wall akinesis sparing the apex Table 1: Signs and Symptoms Associated With PE Symptoms Using this rule, PE can be ruled out without further imaging if there is absence of any of the following: 7įor patients with intermediate or high pretest probability or a positive D-dimer, a contrast-enhanced chest computed tomography (CT) angiography is indicated. The PE rule-out criteria can also be used in cases of low pretest probability. 5,6 In cases of low and intermediate pretest probability, testing D-dimer is helpful because a negative result may be used to rule out PE. Once PE is suspected, a determination of pretest probability using either the Wells or Geneva scores may be used. PE presenting symptoms are variable, thus making the diagnosis challenging (Table 1). This team includes, but is not limited to, cardiac surgery, cardiology, hematology, critical care, vascular medicine, vascular surgery, and radiology specialists who discuss complex cases and expedite treatment decisions. A consensus document was recently issued by the Pulmonary Embolism Response Team (PERT) Consortium, which endorses a PERT approach to high- and intermediate-risk cases by a multidisciplinary team. ![]() Treatment varies depending on the severity of the disease and the center's expertise and resources. 1-3 This is likely an underestimation because PE can result in unexplained sudden cardiac death. However, PE is considered to be the third most common cause of cardiovascular death, with 60,000-100,000 deaths per year. The incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thromboembolism (DVT), in the United States is unclear because there is no national surveillance system. ![]()
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