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Review
. 2019 May;19(3):243-247.
doi: 10.7861/clinmedicine.19-3-247.

Acute pulmonary embolism

Luke Howard  1
Affiliations
Review

Acute pulmonary embolism

Luke Howard. Clin Med (Lond). 2019 May.

Erratum in

  • Erratum: Acute pulmonary embolism.
    Howard L. Howard L. Clin Med (Lond). 2019 Jul;19(4):359. doi: 10.7861/clinmedicine.19-4-359. Clin Med (Lond). 2019. PMID: 31308128 Free PMC article. No abstract available.

Abstract

Pulmonary embolism, despite being common, often remains elusive as a diagnosis, and clinical suspicion needs to remain high when seeing a patient with cardiopulmonary symptoms. Once suspected, diagnosis is usually straightforward; however, optimal treatment can be difficult. Risk stratification with clinical scores, biomarkers and imaging helps to refine the best treatment strategy, but the position of thrombolysis in intermediate risk (submassive) pulmonary embolism remains a grey area. Pulmonary embolism response teams are on the increase to provide advice in such cases. Direct oral anticoagulants have been a major advance in treatment this decade, but are not appropriate for all patients. Follow-up of patients with pulmonary embolism should be mandatory to determine duration of anticoagulation and to assess for serious long-term complications.

Keywords: Pulmonary embolism; thrombolysis.

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Figures

Fig 1.
Fig 1.
Diagnosis of pulmonary embolism (based on European Society of Cardiology guidelines and National Institute for Health and Care Excellence CG144). aCardiac arrest; systolic blood pressure <90 mmHg or drop ≥40 mmHg for 15 minutes not related to new-onset arrhythmia, hypovolaemia or sepsis. CTPA = computed tomography pulmonary angiography; PE = pulmonary embolism; VQ = ventilation perfusion.
Fig 2.
Fig 2.
Risk stratification of non-high risk pulmonary embolism (based on European Society of Cardiology 2014 guidelines). BNP = brain natriuretic peptide; CT = computed tomography; hsTnI = high sensitive Troponin-I; PESI = Pulmonary Embolism Severity Index; RV = right ventricle; sPESI = simplified Pulmonary Embolism Severity Index.
Fig 3.
Fig 3.
British Thoracic Society algorithm for selection of patients for outpatient management.4 aAlternatively, Hestia criteria may be used without subsequent need for additional social/medical criteria. BNP = brain natriuretic peptide; CT = computed tomography; PESI = Pulmonary Embolism Severity Index; RV = right ventricle; sPESI = simplified Pulmonary Embolism Severity Index.
See this image and copyright information in PMC

Comment in

  • Pulmonary embolism.
    Thompson A. Thompson A. Clin Med (Lond). 2019 Jul;19(4):357-358. doi: 10.7861/clinmedicine.19-4-357a. Clin Med (Lond). 2019. PMID: 31308127 Free PMC article. No abstract available.

References

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    1. Howard L, Barden S, Condliffe R, et al. British Thoracic Society guideline for the initial outpatient management of pulmonary embolism (PE). Thorax 2018;73(Suppl 2):ii1–29. - PubMed
    1. National Institute for Health and Care Excellence Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. Clinical guideline [CG144]. London: NICE, 2015.