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Pulmonary Vascular Disease |

Features Suggestive of Pulmonary Embolism in Patients Presenting With Syncope

Krittika Teerapuncharoen*, MD; Danai Khemasuwan, MD; Parit Mekaroonkamol, MD; Jeong Yun, MD; Ji Rhee, MD; Patamaporn Lekprasert, MD; Sherry Pomerantz, PhD; Glenn Eiger, MD
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Albert Einstein Medical Center, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):858A. doi:10.1378/chest.1386355
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Abstract

SESSION TYPE: DVT/PE

PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Pulmonary embolism (PE) can be an elusive diagnosis since patients may present differently. Syncope has been reported as a presenting symptom in up to 10% of patients. Delay in diagnosis and initiation of treatment of PE is associated with adverse outcomes. The aim of this study was to identify the characteristics and investigations which suggest the diagnosis of PE in patients presenting with syncope.

METHODS: We conducted a case-control study reviewing patients with syncope and PE who presented to an academic teaching hospital from 2000-2011. The control group included patients that presented with syncope without PE. Patients that had an obvious cause of syncope, missing data or had intermediate to high clinical probability of PE without investigation for PE were excluded. Association of variables and PE diagnosis were estimated by odds ratios from logistic regression analysis.

RESULTS: 26 cases of PE presenting with syncope and 217 controls presenting with syncope without PE were analyzed. There were no statistical differences in age, sex and race among case and control groups. In multivariate logistic regression analysis, the following features were statistically significantly associated with PE; high and intermediate risk modified Well’s criteria score (OR 29 and 3.8 respectively), chest tightness (OR 20), desaturation (SpO2<90%, OR 15), new right bundle branch block on electrocardiogram (OR 6.7) and right ventricular dilatation on echocardiogram (OR 19).

CONCLUSIONS: We have identified certain clinical features and investigations that can help distinguish those patients with syncope when PE is likely. Modified Well’s criteria remains a useful risk stratifier in patients with syncope. Further prospective studies will be needed to validate the predictive value of these clinical features and investigations.

CLINICAL IMPLICATIONS: Certain clinical features, electrocardiographic and echocardiographic findings may be helpful in determining the likelihood of having PE in patients presenting with syncope.

DISCLOSURE: The following authors have nothing to disclose: Krittika Teerapuncharoen, Danai Khemasuwan, Parit Mekaroonkamol, Jeong Yun, Ji Rhee, Patamaporn Lekprasert, Sherry Pomerantz, Glenn Eiger

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Albert Einstein Medical Center, Philadelphia, PA

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