Ask the Clinical Instructor: A Q&A column for those new to the cath lab

One of the patients that we had come in with chest pain actually had normal coronary arteries. The physician decided to rule out PE to help explain the chest pain. What can you tell me about that? Great question. Amazingly, there are a large number of deaths due to PE (pulmonary embolism) which are very unneccesary. I was unaware of this myself until I did some research. Early detection can lead to rapid treatment and save lives. Currently about two-thirds of patients die within an hour of their PE symptoms, which can add up to about 50,000 to 200,000 people per year. A pulmonary embolism is a clot in the lungs which can make it very difficult to breathe. Patients may feel short of breath, inspiration may be painful, they may be diaphoretic and tachycardic. Some of the risk factors are obesity, sedentary lifestyle, oral contraceptives, chronic obstructive pulmonary disease, peripheral vascular disease, smoking and diabetes. Previous DVT (deep vein thrombosis) will also predispose patients to future DVT and PE. Some of the detection methods include D-dimer tests, which determine blood coagulability. It can be an unreliable test in itself because people who have had recent surgery, trauma or pregnancy can all have significant D-dimer tests. A V/Q lung scan is another testing method whereby a patient inhales a pharmaceutical agent and a radioisotope is injected to determine defecencies in ventilation. Pulmonary angiography is utilized if the patient can tolerate contrast. CT scans remain the gold standard for detecting PE. Treatment of PE includes rapid anticoagulation. Weight-based heparin, coumadin and thrombolytics are among the choices. The best method of anticoagulation is patient- and symptom-dependent.

1. Forgione AM. Managing patients with suspected pulmonary embolism. Journal of the American Association of Physician Assistants July 2006. Accessed August 15, 2006 at http://jaapa.com/issues/j20060701/articles/pulmonary0706.htm