Diagnosis Treatment

Abstract

Pulmonary embolism is common, treatable and often overlooked. Genetic factors such as factor V Leiden and acquired factors such as immobility, pregnancy, surgery and malignancy increase the risk. The clinical features are nonspecific, but dyspnoea and tachypnoea are almost universal. Traditional tests such as electrocardiography, blood gases and chest X ray lack sensitivity and specificity and recently ventilation perfusion scanning and leg ultrasound have been shown to be unhelpful in many cases. Central venous pressure measurement and echocardiography, especially of the right ventricle, are helpful in a collapsed patient. D-Dimer testing is useful in excluding pulmonary embolism provided it is part of a diagnostic pathway that includes clinical risk. Spiral CT scanning is sensitive and specific for proximal pulmonary embolism. Immediate treatment with low molecular weight heparin is indicated, except for the hypotensive patient, when thrombolysis with alteplase should be considered. Warfarin should be started and continued for six months or longer if justified by genetic or acquired factors.