4days)Q* PregnancyQ and PuerperiumQ* High dose estrogen therapyQ* Surgery (trauma (especially of pelvis, hip or lower limb)Q* Malignancy (especially pelvis, abdominal, metastatic)* Heart failure/Recent MIQ* Nephrotic syndromeQ* Inflammatory bowel diseaseQ* PolycythemiaQ* PNHQ or Lupus anticoagulant* Behcet's syndromeQ* HomocystinuriaQ* Paralysis of lower limb* Varicose veins, InfectionClinical features:Symptoms: Dyspnea chest pain, hemoptysis and coughSigns: Tachypnea (MC)Q. fever, unilateral leg swelling, wheeze, pleural friction rubAny patient with high likelihood of pulmonary embolism on clinical evaluation straightaway undergoes imaging tests, while a patient with low clinical likelihood should first undergo D-dimer test.Factors for Clinical Assessment of Pulmonary Embolism* Clinical signs and symptoms of DVTQ* An alternative diagnosis is less likely than pulmonary embolism* Heart rate >100/minQ* HemoptysisQ* Immobilization or previous surgery in 4 weeksQ* Previous DVT/PEQ* MalignancyQ (on treatment, treatment in past 6 months) ECG Changes in Pulmonary Embolism(Sinus tachycardia: MC and non-specific finding on ECGQ)Features of Acute Right Heart StrainHighly predictive of PE* Acute right axis deviation* P pulmonale* Right bundle branch block* Inverted T waves* ST segment change* S1Q3T3Q: Seen in < 12% patients- S wave in lead I- Q wave in lead III- Inverted T wave in lead III- S wave in lead I, II. and III (S1S2S3)Diagnosis:D-dimer: Excellent screening test for the diagnosis of PEQ.Best investigation in clinical suspicion of PE: Multidetector CTQ.Eung scanning is now a 2nd line diagnostic test for PE.Pulmonary angiography: Gold standard for diagnosis of PEQ (but expensive and cumbersome)Treatment:Anticoagulation is the foundation for successful treatment of DVT and PE. Immediately effective anticoagulation is initiated with a parenteral drug, unfractionated heparin (UFH)Q.The only FDA-approved indication for PE fibrinolysis is massive PEQ.Pulmonary embolectomy: The risk of intracranial hemorrhage with fibrinolysis has prompted a renaissance of surgical embolectomy.">