**Pulmonary Thromboembolism (PTE)** — also called **Pulmonary Embolism (PE)** — is a **life-threatening condition** caused by the **obstruction of the pulmonary artery or its branches** by a thrombus (blood clot), fat, air, or tumor material that usually originates in the deep veins of the legs (deep vein thrombosis — DVT).
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### 🫁 **Definition**
Pulmonary thromboembolism is the **occlusion of one or more pulmonary arteries** by thrombi that originate elsewhere (typically from the deep venous system of the lower extremities).
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### ⚙️ **Pathophysiology**
1. **Thrombus formation** in deep veins → dislodgement → embolization to lungs
2. **Blockage of pulmonary arteries** → increased pulmonary vascular resistance
3. **Right ventricular strain/failure** due to increased afterload
4. **V/Q mismatch** → hypoxemia and impaired gas exchange
5. Large embolus may cause **sudden death** due to circulatory collapse.
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### 🧬 **Causes / Risk Factors (Virchow’s Triad)**
| Factor | Examples |
| ---------------------- | -------------------------------------------------------------------------------------------------------- |
| **Venous stasis** | Prolonged immobility, surgery, heart failure, long flights |
| **Endothelial injury** | Trauma, surgery, indwelling catheters |
| **Hypercoagulability** | Cancer, pregnancy, oral contraceptives, genetic thrombophilias (Factor V Leiden, Protein C/S deficiency) |
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### ⚠️ **Clinical Features**
**Symptoms:**
* Sudden onset **dyspnea** (shortness of breath)
* **Pleuritic chest pain**
* **Cough**, sometimes with **hemoptysis**
* **Syncope** in massive PE
**Signs:**
* **Tachypnea** (rapid breathing)
* **Tachycardia**
* **Hypotension** (in massive PE)
* **Raised JVP**, right ventricular heave
* **Loud P₂** (pulmonary component of 2nd heart sound)
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### 🧪 **Diagnosis**
**1. Laboratory Tests**
* **D-dimer:** Elevated in thrombus formation (sensitive but not specific)
* **Arterial Blood Gas (ABG):** Hypoxemia, respiratory alkalosis
**2. Imaging**
* **CT Pulmonary Angiography (CTPA):** Gold standard
* **V/Q Scan:** Useful if CTPA contraindicated (e.g., renal failure)
* **Doppler ultrasound** of lower limbs — detects DVT source
* **ECG:** S₁Q₃T₃ pattern, right heart strain
* **Echocardiography:** RV dilation, pulmonary hypertension (esp. in massive PE)
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### 💊 **Management**
#### **1. Initial Stabilization**
* Oxygen therapy
* IV fluids (if hypotensive)
* Vasopressors if in shock (e.g., norepinephrine)
#### **2. Anticoagulation (Mainstay of therapy)**
* **Heparin (LMWH or UFH)** – immediate
* Transition to **Warfarin** or **DOACs (e.g., apixaban, rivaroxaban)**
#### **3. Thrombolytic Therapy**
* **Indicated in massive PE** with hemodynamic instability
* Drugs: **Alteplase (tPA)**
#### **4. Surgical / Interventional**
* **Embolectomy** – in massive PE if thrombolysis contraindicated or fails
* **IVC filter** – prevents future emboli in patients who cannot take anticoagulants
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### 🧠 **Complications**
* Pulmonary infarction
* Recurrent PE
* Chronic thromboembolic pulmonary hypertension (CTEPH)
* Right heart failure
* Death (if untreated)
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### 📊 **Prognosis**
* Mortality ~30% if untreated
* <8% with prompt diagnosis and anticoagulation
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### 🩸 **Prevention**
* Early mobilization after surgery
* Prophylactic LMWH in high-risk patients
* Compression stockings
* Avoid prolonged immobility
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