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Samwel Mikaye: Why Early Recognition of Pulmonary Embolism Matters
Samwel Mikaye/LinkedIn
Jun 18, 2026, 14:52

Samwel Mikaye: Why Early Recognition of Pulmonary Embolism Matters

Samwel Mikaye, Medical Doctor at MSK, shared a post on LinkedIn:

“Pulmonary Embolism (PE)

Definition

Pulmonary embolism is the obstruction of one or more pulmonary arteries by a thrombus, usually originating from a deep vein thrombosis (DVT) of the lower limbs or pelvis.

Risk Factors

Virchow’s Triad

1. Venous stasis

  • Prolonged immobilization
  • Surgery
  • Long-distance travel
  • Heart failure

2. Hypercoagulability

  • Pregnancy and puerperium
  • Malignancy
  • Thrombophilia
  • Oral contraceptives

3. Endothelial injury

  • Trauma
  • Surgery
  • Central venous catheters

Clinical Features

Symptoms

  • Sudden onset dyspnea
  • Pleuritic chest pain
  • Cough
  • Hemoptysis
  • Syncope (massive PE)
  • Anxiety

Signs

  • Tachypnea
  • Tachycardia
  • Hypoxia
  • Fever (low-grade)
  • Hypotension (massive PE)
  • Raised jugular venous pressure

Signs of DVT:

  • Unilateral leg swelling
  • Calf tenderness
  • Warmth and erythema

Diagnosis

Initial Tests

  • Pulse oximetry
  • ECG:
  • Sinus tachycardia (most common)
  • S1Q3T3 pattern
  • Right heart strain

Laboratory

  • D-dimer (elevated)
  • Arterial blood gas:
  • Hypoxemia
  • Respiratory alkalosis

Imaging

  • CT pulmonary angiography (CTPA) – gold standard in stable patients
  • Ventilation-perfusion (V/Q) scan if CTPA contraindicated
  • Doppler ultrasound of lower limbs for DVT
  • Echocardiography in unstable patients

Management

Initial Stabilization

  • Oxygen therapy
  • IV access and monitoring
  • Hemodynamic support if required

Anticoagulation

  • Enoxaparin
  • Heparin
  • Direct oral anticoagulants (DOACs)
  • Warfarin

Massive PE (Hemodynamic Instability)

  • Thrombolysis with Alteplase
  • Surgical or catheter-directed embolectomy if thrombolysis is contraindicated or unsuccessful

Prevention

  • Early mobilization
  • Compression stockings
  • Prophylactic anticoagulation in high-risk patients

Complications

  • Shock
  • Right ventricular failure
  • Cardiac arrest
  • Recurrent PE
  • Chronic thromboembolic pulmonary hypertension

Most PEs originate from deep vein thrombosis of the lower limbs.

Classic triad: dyspnea, pleuritic chest pain, and hemoptysis (not always present).

CT pulmonary angiography (CTPA) is the diagnostic imaging test of choice in stable patients.

D-dimer is useful for excluding PE in low-risk patients.

Massive PE may present with hypotension, shock, and syncope and requires urgent thrombolysis.”

Samwel Mikaye: Why Early Recognition of Pulmonary Embolism Matters

Other posts featuring Samwel Mikaye on Hemostasis Today.

deep vein thrombosis DVT Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine PE Pulmonary embolism Samwel Mikaye Virchow’s Triad
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