SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Acute Pulmonary Embolism(PE) is common but frequently under-diagnosed clinical problem, associated with potentially fatal outcomes. Clinical presentation is highly variable and non-specific. Most patients have an underlying identifiable risk factor. This study is done to assess the various clinical features, risk factors and electrocardiographic(EKG) findings in patients to raise suspicion of PE.
METHODS: All patients diagnosed with PE(2007-2010) using CT angiography were included and retrospectively studied for clinical features, risk factors and EKG findings.
RESULTS: PE was confirmed in 334 patients with mean age of 65.8 years. Dyspnea, chest pain and cough were present in 72%, 38% and 19% of the patients, respectively and dyspnea as the only presenting symptom in 29%. Tachypnea, hypoxia, tachycardia and signs of DVT were present in 39%, 35%, 33% and 29%, respectively. Cancer was most common risk factor present in 27% followed by prior history of DVT/PE, immobilization and surgery in 19%, 15% and 15% respectively. EKG interpretation revealed normal sinus rhythm in 53%, sinus tachycardia 31%, S1Q3T3 6% and atrial fibrillation(AF) in 6%.
CONCLUSIONS: Our data shows dyspnea is the most common presenting symptom of PE followed by chest pain and cough. Either of these symptoms were present in four out of every five patients. Tachypnea, hypoxia, tachycardia and clinical signs of DVT were most frequent signs present in almost three quarters of patient. Most of the symptoms and signs were present in similar frequency in younger and older population. Majority of the patients diagnosed with PE had a normal EKG and two out of five patients had new identifiable EKG change (sinus tachycardia, new onset AF, SIQ3T3). We also noted that 8% of elderly patients had new onset AF at the time of diagnosis of PE.
CLINICAL IMPLICATIONS: This data re-emphasizes a wide spectrum of clinical presentation and non specificity of symptoms of PE. Clinical suspicion of PE is a critical step and of paramount importance for further objective investigations which would assist in the diagnosis and appropriate timely management of PE.
DISCLOSURE: The following authors have nothing to disclose: Navin Bajaj, Juan Guillot, Sri Appalaneni, Joseph Kittah, Cesar Cestero, Raymond Amankona, James Pippim
No Product/Research Disclosure InformationSaint Vincent's Medical Center, Bridgeport, CT