Acute and chronic pulmonary embolism Quiz

You are called to evaluate a 46 years-old male on the general surgery service following a total colectomy for ulcerative colitis four days prior. He is otherwise healthy and his postoperative course has been unremarkable. On exam, his respiratory rate is 32 breaths per minute, his heart rate sinus tachycardia at 127 beats per minute, and his blood pressure is 99/58. A CTA of the chest has confirmed bilateral, subsegmental pulmonary emboli. You are asked for recommendations and suggest:

All of the following are associated with chronic pulmonary thromboembolic disease EXCEPT:

The gold standard for diagnosis of pulmonary embolism is

Indications for performing pulmonary artery thromboendarterectomy are:

You are called emergently to evaluate a critically ill 28 years old male. He has Crohn’s disease and is one week out from a laparotomy for lysis of adhesions. Earlier in the day he was noted to have unilateral lower extremity edema and a venous ultrasound confirmed a DVT. On exam, his respiratory rate is 35 breaths per minute, his heart rate sinus tachycardia at 158 beats per minute, and his blood pressure is 69/palpable. He is being intubated because of inability to oxygenate. He is on a heparin gtt. The next best step in management is:

You are called by the labor and delivery service and asked to consult on a patient with large, bilateral pulmonary embolisms (PE). The patient is a morbidly obese 32-year-old female who is now postoperative day 3 from Cesarean section. Earlier in the day, she developed acute shortness of breath and a CTA of the chest confirmed large bilateral PEs. On exam, her respiratory rate is 28 breaths per minute, her heart rate sinus tachycardia at 125 beats per minute, and her blood pressure is 105/62. An echocardiogram shows new onset moderate to severe tricuspid regurgitation. Your recommendation(s) is/are:

A 69-year-old woman with a past medical history of coronary artery was recently diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) and is being seen in your clinic for pulmonary thromboendarterectomy (PTE) evaluation. On work-up she was found to have a mean pulmonary artery pressure (mPAP) of 41 mmHg and pulmonary vascular resistance (PVR) of 1,100 dynes x s x cm^-5. An echocardiogram demonstrated a left ventricular ejection fraction of 45-50%. On consultation with the patient, which of the following would you explain is most likely to increase her risk for in-hospital and 1-year mortality?

A 44-year old woman who works as an ICU nurse was recently hospitalized after suffering a submassive pulmonary embolism. She is concerned about developing chronic thromboembolic pulmonary hypertension and asks what symptoms she should look for. What do you tell her?