User:Sam Halada/Pulmonary Embolism

Epidemiology[edit]
There are roughly 10 million cases of pulmonary embolisms per year. In the United states, pulmonary embolisms are the primary cause of at least 10,000 to 12,000 deaths per year and a contributing cause in at least 30,000 to 40,000 deaths per year. True incidence involving pulmonary embolisms is unknown because they often go undiagnosed or unnoticed until autopsy. From 1993 to 2012, there have been an increased number of admissions in hospitals due to pulmonary embolisms, jumping from 23 cases per 100,000 people to 65 cases per 100,000 people. Despite this increase, there has been a decrease in mortality during that same time period due to medical advances that have occurred.

Venous thromboembolism (VTE), a common risk factor, is present at much higher rates in those over the age of 70 (three times higher compared to those aged 45 to 69). This is likely due to there being a general lower level of activity among the elderly, resulting in higher rates of immobility and obesity. VTE has a large, and continuously rising, case fatality rate. This rate is roughly 10% after 30 days, 15% after three months and up to 20% after one year. Pulmonary embolisms alone (when resulting in hospitalizations) have a case fatality rate of about 5% to 10% so VTE can play a large factor in the severity of the embolisms. When looking at all cases.'''.. the rate of fatality (ADD TO EXISTING SECTION HERE)'''

Risk factors[edit]
'''INSERT AFTER “... Regarded as a continuum termed venous thromboembolism (VTE).”'''

VTE is much more common in immunocompromised individuals as well as individuals with comorbidities including:


 * Those that undergo orthopedic surgery at or below the hip without prophylaxis.
 * This is due to immobility during or after the surgery, as well as venous damage during the surgery.
 * Pancreatic and colon cancer patients (other forms of cancer also can be factors, but these are the most common)
 * This is due to the release of procoagulants.
 * Risk of VTE is at its greatest during diagnosis and treatment, but lowers in remission.
 * Patients with high-grade tumors
 * Pregnant Individuals
 * As the body puts itself into what is known as a "hypercoagulable state" the risk of a hemorrhage during childbirth is decreased and is regulated by increased expression of factors VII, VIII, X, Von Willebrand, and fibrinogen.
 * Those on estrogen contraceptives

'''INSERT AFTER “... Cancer (due to secretion of pro-coagulants)”'''

Although most pulmonary embolisms are the result of proximal leg deep vein thrombosis (DVTs), there are still many other risk factors that can also result in a pulmonary embolism.


 * Risk Factors Include:
 * Varicose veins caused by vascular damage
 * Pulmonary hypertension
 * Diabetes
 * Traumatic hip fractures that immobilize the patient
 * Joint fixation (primarily in the legs)

Diagnosis[edit]
INSERT AFTER “...further testing is not typically needed.”

In situations with more high risk individuals, further testing is needed. A CT pulmonary angiogram (CTPA) is the preferred method for diagnosis of a pulmonary embolism due to its easy administration and accuracy. Although a CTPA is preferred, there are also other tests that can be done. For example, a proximal lower limb compression ultrasound (CUS) can be used. This is a test which is primarily used as a confirmatory test, meaning it confirms a previous analysis showing the presence or suspected presence of a pulmonary embolism. According to a cross-sectional study, CUS tests have a sensitivity of 41% and specificity of 96%.

 Notes from sources: 
 * Various other risk factors attributed to pulmonary embolisms
 * Varicose veins caused by vascular damage
 * Pulmonary hypertension
 * Diabetes
 * Traumatic hip fractures that immobilize the patient
 * Joint fixation, primarily in the legs, but can happen elsewhere
 * Those that undergo orthopedic surgery at or below the hip are at an elevated risk for VTE without prophylaxis. This is due to immobility during or after the surgery, as well as venous damage during the surgery
 * Pancreatic and colon cancer are have the highest rates of VTE due to the release of procoagulants, however cancer in general is a risk factor. Risk of VTE is at its greatest during diagnosis and treatment, but lowers in remission.
 * Patients with high-grade tumors are also at an increased risk of VTE
 * Pregnancy increases the risk of VTE because the body puts itself into what is known as a "hypercoagulable state". This decreases the risk of a hemorrhage during childbirth and is regulated by increased expression of factors VII, VIII, X, von Willebrand, and fibrinogen.
 * The risk of VTE increases by a factor of 3 to 4 while on estrogen contraceptives
 * Diagnosis
 * Proximal lower limb compression ultrasound (CUS)
 * Primarily used as a confirmatory test, meaning it confirms a previous analysis showing the presence of a pulmonary embolism. According to a cross-sectional study, CUS tests has a sensitivity of 41% and specificity of 96%. A 79% sensitivity and 84% specificity was observed in CUS tests involving a whole leg. CTPA is the preferred method for diagnosis of a pulmonary embolism due to its easy administration and accuracy.
 * Epidemiology
 * There are roughly 10 million cases of pulmonary embolisms per year. True incidence involving pulmonary embolisms is unknown because they often go undiagnosed or unnoticed until autopsy.
 * From 1993 to 2012, there has been an increase in the number of admissions for pulmonary embolisms from 23 per 100,000 to 65 per 100,000. Despite this, there has been a decrease in mortality during that same time period due to medical advances.
 * VTE is present at much higher rates in those over the age of 70 (three times higher compared to those aged 45 to 69). This is likely due to there being a a general lesser level of activity among the elderly, resulting in higher rates of immobility and obesity.
 * VTE has a very large case fatality rate, with there being an average mortality rate of roughly 10% after 30 days and 15% within 3 months. This rate increases to 20% by one year.
 * Pulmonary embolisms themselves cause between 5 and 10% of in-hospital deaths.
 * Those with a greater body mass index (BMI) generally are at higher risk of pulmonary embolisms