Pulmonary embolism classification: Difference between revisions
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==Chronic PE== | ==Chronic PE== | ||
Chronic pulmonary embolism is a consequence of incomplete resolution of pulmonary embolism. | Chronic pulmonary embolism is a consequence of incomplete resolution of pulmonary embolism. It can be characterized: | ||
It | |||
*Based on '''time''' of appearance of symptoms: | *Based on '''time''' of appearance of symptoms: | ||
**Develop '''slowly''' progressive [[dyspnea]] over a period of years due to [[pulmonary hypertension]]. | **Develop '''slowly''' progressive [[dyspnea]] over a period of years due to [[pulmonary hypertension]]. | ||
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==Massive PE== | ==Massive PE== | ||
In the past, | In the past, '''massive pulmonary embolism''' has been defined on the basis of angiographic burden of emboli by using the [[Miller Index]]<ref name="pmid5557502">{{cite journal| author=Miller GA, Sutton GC, Kerr IH, Gibson RV, Honey M| title=Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. | journal=Br Heart J | year= 1971 | volume= 33 | issue= 4 | pages= 616 | pmid=5557502 | doi= | pmc= | url= }} </ref>. This is a retrospective diagnosis based upon the pulmonary angiogram that does not inform prospective decisions. | ||
Recently the [[American Heart Association]]<ref name="pmid21422387">{{cite journal| author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 | pmid=21422387 | doi=10.1161/CIR.0b013e318214914f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref> has proposed the following definition for massive PE: ''Acute pulmonary embolism with sustained [[hypotension]] (systolic blood pressure <90 mm Hg for at least 15 minutes or requiring inotropic support, not due to a cause other than PE, such as [[arrhythmia]], [[hypovolemia]], [[sepsis]], or left ventricular [LV] dysfunction), pulselessness, or persistent profound [[bradycardia]] (heart rate <40 bpm with signs or symptoms of shock).'' | Recently the [[American Heart Association]]<ref name="pmid21422387">{{cite journal| author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 | pmid=21422387 | doi=10.1161/CIR.0b013e318214914f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref> has proposed the following definition for massive PE: ''Acute pulmonary embolism with sustained [[hypotension]] (systolic blood pressure <90 mm Hg for at least 15 minutes or requiring inotropic support, not due to a cause other than PE, such as [[arrhythmia]], [[hypovolemia]], [[sepsis]], or left ventricular [LV] dysfunction), pulselessness, or persistent profound [[bradycardia]] (heart rate <40 bpm with signs or symptoms of shock).'' | ||
Revision as of 20:20, 14 December 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Synonyms and keywords: PE
Overview
Pulmonary embolism is classified in two different ways based upon:
- Time of appearance of symptoms & size of embolus : Acute vs Chronic
- Severity of the disease : Massive vs Submassive vs Low-risk
Acute PE
Pulmonary embolism is called acute, if the embolism is
- Based on time of appearance of symptoms:
- Develop symptoms and signs immediately after obstruction of pulmonary vessels.
- Based on characteristic of the embolus:
- Situated centrally within the vascular lumen
- Occludes a vessel
- It also causes distention of the involved vessel.
Acute PE can be further classified as massive pulmonary embolism, submassive pulmonary embolism or low-risk pulmonary embolism.
Chronic PE
Chronic pulmonary embolism is a consequence of incomplete resolution of pulmonary embolism. It can be characterized:
- Based on time of appearance of symptoms:
- Develop slowly progressive dyspnea over a period of years due to pulmonary hypertension.
- Based on characteristic of the embolus[1]:
- Embolus is eccentric and Contiguous with the vessel wall
- Embolus reducing the arterial diameter by ≥50%
- Evidence of recanalization within the thrombus
- Presence of an arterial web
Massive PE
In the past, massive pulmonary embolism has been defined on the basis of angiographic burden of emboli by using the Miller Index[2]. This is a retrospective diagnosis based upon the pulmonary angiogram that does not inform prospective decisions.
Recently the American Heart Association[3] has proposed the following definition for massive PE: Acute pulmonary embolism with sustained hypotension (systolic blood pressure <90 mm Hg for at least 15 minutes or requiring inotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or left ventricular [LV] dysfunction), pulselessness, or persistent profound bradycardia (heart rate <40 bpm with signs or symptoms of shock).
Submassive PE
The American Heart Association[3] has proposed the following definition for submassive PE: "Acute PE without systemic hypotension (systolic blood pressure ≥90 mm Hg) but with either RV dysfunction or myocardial necrosis."
Low-risk PE
The American Heart Association[3] has proposed the following definition for Low-risk PE: "Acute PE and the absence of the clinical markers of adverse prognosis that define massive or submassive PE."
Saddle PE
A saddle PE is one that lodges at the bifurcation of the main pulmonary artery into the right and left pulmonary arteries. Most of the saddle PE are submassive.
References
- ↑ Castañer E, Gallardo X, Ballesteros E, Andreu M, Pallardó Y, Mata JM; et al. (2009). "CT diagnosis of chronic pulmonary thromboembolism". Radiographics. 29 (1): 31–50, discussion 50-3. doi:10.1148/rg.291085061. PMID 19168835.
- ↑ Miller GA, Sutton GC, Kerr IH, Gibson RV, Honey M (1971). "Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism". Br Heart J. 33 (4): 616. PMID 5557502.
- ↑ 3.0 3.1 3.2 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.