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Medical Uncertainty: Informing Decision Making for Patients With Acute Pulmonary Embolism

Lisa K. Moores, MD, FCCP
Author and Funding Information

Affiliations: Dr. Moores is Assistant Dean for Clinical Sciences, Professor of Medicine, The Uniformed Services University of the Health Sciences.

Correspondence to: Lisa K. Moores, MD, FCCP, The Uniformed Services University of the Health Sciences, Office of Student Affairs, 4301 Jones Bridge Rd, Bethesda, MD 20814; e-mail: lmoores@usuhs.mil


The views expressed in this article are those of the author and do not necessarily reflect those of the United States Army, Department of Defense, or the United States Government.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):952-953. doi:10.1378/chest.09-1092
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Extract

Pulmonary embolism is a common and potentially fatal disease.1 A number of factors have been associated with a high risk of adverse short-term outcomes. These include several patient-related demographic and historical factors, such as advanced age, male sex, chronic heart failure or chronic lung disease, and malignancy.2 Patients presenting with systemic hypotension or signs of right heart failure (determined either by echocardiography or CT angiography) also have a worse prognosis.3 In addition, patients with acute PE and elevated levels of serum markers (troponin or brain natriuretic peptide), indicating myocardial injury related to right heart strain, have worse short-term survival than those with normal levels.4,5 The true value of measuring troponin levels in affecting patient management, however, is not certain.

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