PURPOSE: The trends in the clinical presentation, diagnostic approach, and outcome of pulmonary embolism (PE) have not been studied extensively. We describe a cohort of patients with PE in an urban-teaching hospital.
METHODS: Charts of consecutive patients with PE between January 2004 and January 2005 were reviewed retrospectively. Presenting symptoms such as shortness of breath (SOB), chest pain, syncope, and vital signs were noted. Findings on electrocardiograms, Ventilation-Perfusion scans (V/Q Scan), CT angiography (CTA), and echocardiogram were recorded. Use of unfractionated heparin (UH), low-molecular weight heparin (LMWH), inferior vena cava filters (IVCF) and thrombolysis was assessed. In-hospital mortality and bleeding complications were also evaluated.
RESULTS: Seventy patients were included. The mean age was 62 years; 58% were women. There was linear relation between age and incidence. The most common presenting features were SOB (83%), hypoxia (40%), chest pain (33%), and hypotension (19%). EKG revealed sinus tachycardia (37%), precordial lead T-wave changes (31%), and S1Q3T3 pattern (7%). Diagnosis was made by CTA (58%) and V/Q scan (42%). Echocardiogram revealed right ventricular dysfunction in 45% (17/38). Treatment options included UH (65%), LMWH (20%); IVCF alone (13%); combined anticoagulation/IVCF (19%) and thrombolytics (9%). In-hospital mortality was 6%, and major bleedings occurred in 4%.
CONCLUSION: The clinical presentation of PE remains unchanged compared to prior studies. CTA has been replacing V/Q scans as the diagnostic modality of choice. LMWH seems to be gaining acceptance as the initial treatment for PE. Only 23% of patients with documented right ventricular dysfunction required thrombolytics. In-hospital mortality and overall incidence of major bleeding was low.
CLINICAL IMPLICATIONS: CTA seems to be the preferred modality for the diagnosis of PE and has gained acceptance among physicians in our institution. Although UH is still the preferred treatment modality, LMWH has been gaining acceptance for selected patients. The presence of RV dysfunction does not seem to be determinant in the decision to use thrombolytic agents.
DISCLOSURE: Daniel Schwed, None.