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Pulmonary Vascular Disease |

Syncope in Pulmonary Embolism: Are These Patients Different? FREE TO VIEW

Robert Rifenburg*, DO; Jeffrey Kovar, MD
Author and Funding Information

Resurrection Medical Center, Chicago, IL


Chest. 2012;142(4_MeetingAbstracts):833A. doi:10.1378/chest.1381520
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Published online

Abstract

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Syncope is an uncommon presentation of pulmonary embolism (PE). 13-30% of patients diagnosed with PE have syncope as their presenting complaint. The purpose of this study is to determine if there are any common findings that occur in conjunction with those PE patients that present to the emergency department (ED) with syncope as their presenting complaint.

METHODS: This is a 5-year retrospective medical record review from a community teaching hospital. All ED patients age >18 admitted to the hospital with a new PE were reviewed. Excluded were cardiac arrest and patients without CT confirmation of PE. Data collection included demographics, airplane travel history, initial chief complaint, location and type of PE, ECG findings, and echocardiography results.

RESULTS: There were 674 cases of PE reviewed over five years. 126 were excluded (73 not diagnosed by CT and 53 missing medical records). The mean age was 68.9 years (SD:16.0) with 41.6% males. 10.0% (55/548) presented to the ED with a chief complaint of syncope. Syncope was a more common chief complaint in those PE patients presenting to the ED after recent airline travel (48% versus 8.1%; P=0.0003). The syncope group had more non-specific ST-T wave changes (56.4% versus 36.9%; P=0.005), more sinus tachycardia (40.0% versus 24.9%; P=0.016), and more S1Q3T3 abnormality (20.0% versus 8.1%; P=0.004). The syncope group also had more saddle emboli (14.5% versus 3.9%; P=0.003) and more right ventricular hypertrophy (RVH) (37.8% versus 12.9%; P<0.001) diagnosed on echocardiography.

CONCLUSIONS: Patients diagnosed with PE who presented to the ED with syncope as their presenting complaint were more likely to have a large/saddle embolism, more likely to present from the airport, had more RVH on echocardiogram, and more non-specific ST-T wave changes on ECG.

CLINICAL IMPLICATIONS: Anatomic location and size of PE may have a correlation with syncope as the patient’s presenting complaint. Syncope may be a valuable clinical marker of high-risk, large PE patients prior to definitive diagnostic imaging.

DISCLOSURE: The following authors have nothing to disclose: Robert Rifenburg, Jeffrey Kovar

No Product/Research Disclosure Information

Resurrection Medical Center, Chicago, IL

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  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543