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Pulmonary Embolism

Baylor Scott & White Medical Center – Temple

Understanding the different types of Pulmonary Embolisms (PE)

Pulmonary embolism is a condition where clots that originate elsewhere in the body break off and travel to the vasculature of the lungs to cause obstruction of the blood flow from the right side of the heart to the left side. PE can be minor when a small portion of the lung vasculature is involved, or it may be massive when the majority of the vasculature is involved, and there is compromise of the circulation. Acute massive PE is a leading cause of death in patients admitted to the hospital.

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Pulmonary embolism symptoms

Patients with a pulmonary embolism present with a variety of symptoms, including chest pain and shortness of breath. However, these symptoms are not specific for PE, and the diagnosis depends on the clinician having a high index of suspicion.

  • Patients with PE who have a reduced blood pressure are referred to as having a massive PE.
  • Patients who have a normal blood pressure but whose right heart is under strain are said to have sub-massive PE.
  • Patients with neither are stable PEs.

Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

About 2-4% of all patients with PE do not resolve their acute thrombus. They then enter a chronic phase where the vascular pressures in the lung are elevated putting a strain on the right ventricle and eventually causing it to fail.  Many patients with CTEPH are not aware that they had an acute PE. CTEPH is a common cause of unexplained pulmonary hypertension (elevated vascular pressure in the lungs). 

Diagnosis and treatment

The initial screening test to detect a pulmonary embolism is an echocardiogram to look for evidence of elevated lung pressures and right heart failure. Any patient with unexplained pulmonary hypertension should undergo a VQ scan. If the scan shows normal perfusion CTEPH is ruled out. If the VQ scan is positive, patients undergo a CT Angiogram and a right heart catheterization.​

The management of CTEPH is accomplished by a multi-disciplinary team. The entire team reviews every single patient to attain consensus before management. CTEPH is surgically curable.

In patients who have favorable anatomy, a procedure called pulmonary thrombo-endarterectomy (PTE) can reduce pressures and reverse the patients symptoms.

Patients who have residual hypertension after surgery and those who are not candidates for surgery are managed by our pulmonary hypertension specialists.

There are now medications and combinations of medications designed specifically for patients with CTEPH.

Pulmonary Embolism Response Team (PERT)

Time is of the essence in dealing with acute massive pulmonary embolism. The management of PE involves multiple specialists with a wide range of expertise. The PERT Is organized to allow for simultaneous communication to all of the specialists and for prompt activation of the required resources to manage these acutely ill patients.

Options include blood thinners (anticoagulation and fibrinolysis), catheter-based therapies and emergent surgery. We are happy to transfer patients from other institutions for these advanced therapies.

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