Cardiac arrest by pulmonary embolism

  • Tips to remember:
    • PE is considered the most feared complication of DVT.
    • A pulmonary artery, or several depending on how proximal is the embolus located, is occluded. This increases pressure upward to the heart, which needs to pump harder to keep the flow.
    • Hypoxic lungs, intending to adapt, produce substances that constrict pulmonary vessels (lungs “believe” there’s no pressure, so they try to increase pressure) but this only adds increased pressures even more to an already failing right ventricle.
    • A vicious cycle starts and the heart can’t longer compensate. Then it finally stops. There’s no fibrillation, so its an unshockable stop. Sometimes there will be prior symptoms like heavy dyspnea and syncope, but sometimes there is sudden cardiac death, specially when PE is MASSIVE (embolus occludes the pulmonary trunk).
    • Reversible cause of cardiac arrest means you can get ROSC but you need to resolve the primary cause: You need to treat PE.
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PE is considered a complication of DVT, perhaps the most severed and catastrophic. One in a pulmonary artery, the pressure changes affect the biomechanics of the heart, increasing the strenght needed to pump. Once the heart is unable to comply with these demands, it finally stops. The arrest is unshockable, so chest compressions are needed. The worst of all is that you need to resolve the PE to have your heart pumping again. Click to enlarge and download in high resolution.

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-The Plague Doctor

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