文档介绍：2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism
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2014vs(2000 or 2008)
(1) Initial risk stratification
(2) Thrombolytic treatment
(3) New oral anticoagulants
(4) Chronic thromboembolic pulmonary hypertension
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Epidemiology
difficult to determine:
remain asymptomatic
diagnosis may be an incidental finding
sudden death
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Epidemiology
over 317 000 deaths were related to VTE in six countries of the European Union (with a total population of million) in 2004:
34% presented with sudden fatal PE
59% were deaths resulting from PE that remained undiagnosed during life
7%of the patients who died early were correctly diagnosed with PE before death.
(Cohen AT, Venousthromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98(4):756–764.)
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Predisposing factors
surgery
trauma
immobilization
pregnancy
oral contraceptive use
hormone replacement therapy
cancer
obesity
infection and central venous lines
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Pathophysiology
Acute PE interferes with circulation and gas exchange
Right ventricular (RV) failure is considered the primary cause of death in severe PE
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Clinical classification of pulmonary embolism severity
Replace
“massive PE
sub-massive PE
submassive PE”
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Diagnosis
Clinical presentation
non-specific
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Assessment of clinical probability
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Assessment of clinical probability
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