Pulmonary embolism classification

Revision as of 20:20, 14 December 2011 by Kristin Feeney (talk | contribs)
Jump to navigation Jump to search

Pulmonary Embolism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary Embolism from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

Assessment of Clinical Probability and Risk Scores

Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Arterial Blood Gas Analysis

D-dimer

Biomarkers

Electrocardiogram

Chest X Ray

Ventilation/Perfusion Scan

Echocardiography

Compression Ultrasonography

CT

MRI

Treatment

Treatment approach

Medical Therapy

IVC Filter

Pulmonary Embolectomy

Pulmonary Thromboendarterectomy

Discharge Care and Long Term Treatment

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Follow-Up

Support group

Special Scenario

Pregnancy

Cancer

Trials

Landmark Trials

Case Studies

Case #1

Pulmonary embolism classification On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pulmonary embolism classification

CDC on Pulmonary embolism classification

Pulmonary embolism classification in the news

Blogs on Pulmonary embolism classification

Directions to Hospitals Treating Pulmonary embolism classification

Risk calculators and risk factors for Pulmonary embolism classification

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:

  1. Time of appearance of symptoms & size of embolus : Acute vs Chronic
  2. 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 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

  1. 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.
  2. 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. 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.

Template:WH Template:WS