Pulmonary Embolism: Diagnosis and Treatment W. B. Davis No Disclosures www.chestpubs.org A negative D-dimer can exclude PE in low risk patients? 1. True 2. False Which of the following would you not use as sole initial therapy in PE? 1. IV unfractionated heparin 2. Rivaroxaban 3. Warfarin 4. Enoxaparin 5. Fondaparinux What is best treatment duration for PE provoked by surgery? 1. 3 months 2. 6 months 3. 12 months 4. lifetime Pulmonary Embolism • Common • Often fatal • Rapid diagnosis and treatment greatly reduce mortality PE is the great mimic of other pulmonary diseases • Sudden death • Atelectasis • Inferior MI • Pneumonia, uni- or multilobar • Acute asthma • Malignant pleural effusion • Heart failure • Large rounded mass • Radiographic paralyzed suggestive of lung hemidiaphragm cancer • Hemoptysis suggestive • Long term dyspnea of bronchiectasis, lung suggestive of COPD cancer or lung hemorrhage syndrome • Primary pulmonary hypertension Signs and Symptoms Not Helpful in Diagnosis • Dyspnea • Tachypnea • Pleuritic chest pain • Rales • Cough • Tachycardia • Hemoptysis • S 4 • Loud S P 2 • Shock