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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Electrocardiograms of 90 patients with arteriographically documented acute submassive or massive pulmonary embolism and no associated cardiac or pulmonary disease were studied. Patients were derived from the Urokinase-Pulmonary Embolism Trial National Cooperative Study. In massive embolism, the electrocardiogram was normal in 6 per cent (3 of 50) of patients. With submassive embolism, 23 per cent of patients (9 of 40) had a normal electrocardiogram. Since one or more of the traditional manifestations of acute cor pulmonale (S1Q3T3, right bundle branch block, P pulmonale, or right axis deviation) occurred in only 26 per cent of patients, one could not rely exclusively upon these electrocardiographic abnormalities for the diagnosis of pulmonary embolism. The most common electrocardiographic abnormalities were nonspecific T wave changes which occurred in 42 per cent of patients and nonspecific abnormalities (elevation or depression) of the RST segment which occurred in 41 per cent of patients. Left axis deviation occurring in 7 per cent of the patients was as frequent as right axis deviation. Low voltage QRS complexes, previously undescribed in pulmonary embolism, occurred in 6 per cent of patients. None of the patients had atrial flutter or atrial fibrillation, which appears to occur more typically in patients with pulmonary embolism who have preexistent cardiac disease. All of the varieties of electrocardiographic abnormalities disappeared in some of the patients by 2 wk. Inversion of the T wave was the most persistent abnormality. Larger defects on the lung scan or pulmonary arteriogram occurred in patients with various abnormalities on the electrocardiogram than in patients with normal electrocardiograms. The pulmonary arterial mean pressure and/or right ventricular end-diastolic pressure was significantly higher in patients with several varieties of abnormal electrocardiograms, although the partial pressure of oxygen in arterial blood, in general, did not differ from that in patients with normal electrocardiograms. These hemodynamic correlations, made for the first time in patients, suggest that acute ventricular dilatation, possibly in combination with hypoxemia, is a causative factor of the electrocardiographic changes in acute massive or submassive pulmonary embolism.
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PMID:The electrocardiogram in acute pulmonary embolism. 12 74

In 132 consecutive patients treated for pulmonary embolism, duration of symptoms, number of embolic episodes before the diagnosis, circulatory affection (stable circulation (n = 61), reversible shock (n = 60), circulatory collapse (n = 11), electrocardiographic findings and systolic pulmonary pressure (n = 60) were analysed in relation to 1) underlying diseases (orthopedic surgical patients (n = 43), gynecological-abdominal surgical patients (n = 22), preembolic healthy patients (n = 42), miscellaneous medical patients (n = 25)), and 2) the obstruction of the pulmonary vascular bed quantified by a scintigraphic or angiographic score. While embolic score did not differ between the groups of underlying diseases, preembolic healthy patients with deep vein trombosis (n = 30) had longer mean duration of symptoms (14 days), more embolic episodes, (1.7 episode) and higher pulmonary pressure (72 mmHg) than the material on an average with values of 7 days, 0.9 episodes and 57 mmHg, respectively (p less than 0.001). Among patients with reversible shock or circulatory collapse, half had at least one previous embolic episode, one fifth from two to four. Embolic score correlated well with the circulatory affection (p less than 0.001). A high pulmonary pressure correlated with long duration of symptoms and a high number of embolic episodes (p less than 0.002). Sinus tachycardia and electrocardiographic signs of acute right ventricular strain (complete and incomplete right bundle branch block, SIQIIITIII-pattern and inverted T-waves in V2-4) correlated positively to the circulatory affection and inversely to duration of symptoms and number of embolic episodes (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical picture of acute pulmonary embolism. Relations to the degree of vascular obstruction]. 150 68

A 78-year-old woman, suffering from acute massive pulmonary embolism, was successfully treated with transvenous pulmonary embolectomy by catheter. This patient had been suffering from oppressive chest sensations during exercise, and diagnosed and treated as angina pectoris at a nearby clinic. She consulted our hospital complaining that her chest pains were increasing in frequency. She was admitted to our hospital on July 7, 1988, for coronary angiography (CAG), which she underwent on July 8 by the right femoral approach. After the CAG, she was ordered to rest in bed overnight, with the right inguinal region compressed. 18 hours later, the compression was removed and she was allowed to walk. Soon after she walked to the toilet, she complained of chest discomfort and fell into shock (systolic blood pressure was 60 mmHg). An ECG examination showed a right bundle branch block and an inverted T wave in lead V1-3. An echocardiography showed normal contraction of the left ventricle, but an enlargement of the right ventricle and a flattened interventricular septum. An analysis of arterial blood gas showed hypoxia (Pao2 52.5 mmHg, Paco2, 30.9 mmHg). Acute pulmonary embolism was suspected. 240,000 units of urokinase were administered intravenously, and pulmonary angiography was performed immediately. It revealed that the bilateral pulmonary arteries were almost completely obstructed. Although 720,000 units of urokinase were infused into the pulmonary artery, the obstruction did not improve. At that time, we performed a transvenous pulmonary embolectomy. We used a Judkins R 4 guiding catheter for PTCA made by USCI. The catheter was inserted into the pulmonary artery and clots were aspirated with a syringe.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of acute massive pulmonary embolism successfully treated with transvenous pulmonary embolectomy by catheter]. 261 14

Electrocardiographic (ECG) findings in 87 consecutive patients with from minor to massive pulmonary embolism are presented. ECG changes suggestive of acute right ventricular strain defined as the occurrence of complete (c) or incomplete (inc) right bundle branch block (RBBB), an SIQIIITIII pattern, inverted T waves in the second and third precordial leads and/or an increase in the frontal QRS axis of 20 degrees C or more were found in 71 patients (82%). The prevalence of c and inc RBBB and the increase in frontal QRS axis correlated with the extent of embolization (angiographic or scintigraphic score), while the appearance of the SIQIIITIII pattern did not. No patient with a vascular obstruction of two thirds or more had an ECG free of signs of right ventricular strain. In 9 of 11 embolectomized patients with c RBBB, c RBBB disappeared within 24 h postoperatively. Among patients with an embolization of 45% or more, those with c RBBB had a shorter symptom duration, fewer embolic episodes and a lower pulmonary artery pressure than those without c RBBB. As ECG abnormalities were transient and changing in nature, serial ECG recordings are recommended. Pronounced ECG signs of right ventricular strain should, as they may reflect both massive and short-lasting vascular obstruction, arouse the suspicion of pulmonary embolism suitable for embolectomy.
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PMID:Changing electrocardiographic findings in pulmonary embolism in relation to vascular obstruction. 280 14

The classic electrocardiographic abnormalities observed in massive or submassive thromboembolism in the absence of preexistent cardiac or pulmonary disease are: S1Q3T3 pattern, right axis deviation, "pulmonary" P wave, ST segment depression or elevation, subepicardic ischemia and transient right bundle branch block. Left axis deviation due to pulmonary embolism was first described in 1949; this same finding and the presence of low voltage of the frontal plane owed to pulmonary embolism has been reported occasionally in the last decades, but it has had little diffusion. We report on a patient with no prior cardiac or pulmonary disease who suffered massive pulmonary thromboembolism. Electrocardiographically left axis deviation and low voltage of the horizontal plane attributed to pulmonary thromboembolism was observed. The mechanisms that originate this electrocardiographic changes in pulmonary embolism are unknown. Since the electrocardiogram is aspecific method for the diagnosis of this disorder, and the presence of the mentioned changes originate a greater difficulty in the diagnosis; we consider is important to publish it.
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PMID:[Massive pulmonary thromboembolism with left axis deviation and low voltage]. 296 Feb 86

A retrospective study of the medical records of our hospital from 1965 to 1985 was carried out to characterize for the first time chronic Chagas' heart disease in the elderly (more than 70 years old). A total of 25 patients (mean age = 76) were suitable for the study. Congestive heart failure, sudden cardiac death, thromboembolism and atypical chest pain were found in 68, 16, 8 and 8% of cases, respectively. Ventricular premature contractions (60%), right bundle branch block (32%), left anterior hemiblock (28%), atrial fibrillation (28%) and right bundle branch block associated with left anterior hemiblock (20%) were the ECG changes most frequently found. A morphological study was performed on 8 (32%) patients. All of them showed cardiac abnormalities, with apical aneurism being detected in 100% of cases. At autopsy, pulmonary embolism was observed in 3(37%) of these patients who presented with congestive heart failure, ventricular premature contractions and/or intraventricular conduction defect and/or atrial fibrillation. Thus, the characteristics of chronic Chagas' heart disease in the elderly are similar to those found in middle-aged patients. We suggest that these patients are important for the study of the pathogenesis of chronic Chagas' heart disease because they may have less aggressive pathophysiologic mechanisms than middle-aged patients.
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PMID:Chronic Chagas' heart disease in the elderly: a clinicopathologic study. 365 79

Two cases of pulmonary embolism accompanied by syncope in patients with pre-existing left bundle branch block are reported. Contrary to classical descriptions, the syncopes in these two patients could not be ascribed to cardiovascular collapse, but several arguments (such as the clinical features of the syncope and its coexistence in one case with ECG evidence of complete atrio-ventricular dissociation) were in favour of a paroxysmal disorder of conduction. Right bundle branch block is known to be common in pulmonary embolism and may even be more frequent in patients with left bundle branch block. In such cases, sudden and transient arrest of conduction in the right bundle would complete the left bundle branch block, thus accounting for a paroxysmal atrio-ventricular block.
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PMID:[Paroxysmal atrioventricular block, cause of syncope in pulmonary embolism. 2 cases]. 622 89

In 49 consecutive patients (27 men and 22 women, age range 44 to 86 years) presenting with acute symptoms and with subsequently proven pulmonary embolism, and without previous lung disease, the 12-lead electrocardiograms obtained at hospital admission were reviewed in a blinded fashion to identify electrocardiographic features suggestive of right ventricular overload. Pulmonary embolism was considered probable in 37 patients (76%), from the presence of > or = 3 of the following abnormalities: (1) incomplete or complete right bundle branch block (n = 33); which was associated with ST-segment elevation (n = 17) and positive T wave (n = 3) in lead V1; (2) S waves in leads I and aVL of > 1.5 mm (n = 36); (3) a shift in the transition zone in the precordial leads to V5 (n = 25); (4) Q waves in leads III and aVF, but not in lead II (n = 24); (5) right-axis deviation, with a frontal QRS axis of > 90 degrees (n = 16), or an indeterminate axis (n = 15); (6) a low-voltage QRS complex of < 5 mm in the limb leads (n = 10); and (7) T-wave inversion in leads III and aVF (n = 16) or leads V1 to V4 (n = 13), which occurred more often in patients with symptoms for > 7 days. In the 12 patients with normal electrocardiograms at admission, serial electrocardiograms revealed diagnostic features of embolism in an additional 3 patients. Two-dimensional Doppler echocardiography at admission revealed tricuspid valve regurgitation and an increased right ventricular end-diastolic diameter in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism. 829 63

The clinical features of acute pulmonary embolism were evaluated and compared between Group A with 38 cases > 65 years old and Group B with 73 cases < 65 years old. The mortality rate was 58% (22/38) in Group A and 23% (17/73) in Group B (p < 0.01). However the size of the obstructive pulmonary vascular bed showed no significant difference in both groups. In group A dyspnea was the most common symptom in 27 of 31 (87%), in comparison with group B [45 of 66 (68%), p < 0.05]. In group B, dyspnea and other symptoms appeared abruptly in 44 of 57 (77%), compared with 19 of 36 (53%) in group A (p < 0.02). ECG abnormalities including tachycardia, right bundle branch block and clockwise rotation as well as hypoxemia were present more predominantly in group A. The presentation of pulmonary embolism is variable in the elderly, as in any age group. Many autopsy studies showed a significant rise in incidence of pulmonary embolism in higher age groups. We must keep in mind the characteristics of clinical features in pulmonary embolism in the elderly.
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PMID:[Clinical features of acute pulmonary embolism in the elderly]. 855 88

The clinical and laboratory features in 62 patients with acute pulmonary embolism were analized. There were 26 males, and 36 females with mean age of 63 +/- 11 (range 37 to 90). The clinical symptoms include: dyspnea (92%), chest pain and/or chest tightness (65%), cough (50%), wheezing (29%), leg swelling (32%), hemoptysis (24%), syncope (18%), leg pain (10%). Clinical signs include: tachypnea (respiratory rate > or = 20 per minute) (79%), tachycardia (37%), deep vein thrombosis (29%), cyanosis (8%), fever (> 38.5 degrees C) (2%). The possible predisposing factors include: immobilization (18%), surgery (5%), deep vein thrombosis, ever(5%), malignancy (5%), pulmonary embolism, ever (3%). Arterial blood gas analysis (while patients breathed room air) revealed mean PH of 7.46 +/- 0.06, mean PO2 of 64.5 +/- 12.1 mmHg, mean PCO2 of 35.3 +/- 4.6 mmHg, mean Alveolar-arterial O2 difference of 36.5 +/- 16.6 mmHg. The electrocardiographic changes include; nonspecific ST-T change (61%), sinus tachycardia (20%), S1Q2T3 pattern (15%), atrial fibrillation (16%), incomplete right bundle branch block (10%), complete right bundle branch block (8%), atrial premature contraction (7%), paroxysmal supraventricular tachycardia (2%). The chest x-ray findings include: cardiomegaly (48%), regional hypovascularity (31%), atelectasis (5%), pleural effusion (5%), wedge-shaped infiltrate (3%), elevated diaphragm (6%). Venous plethysmography was performed in 49 of 62 patients. Of these 49 patients, 28 patients revealed positive finding. Of these 28 patients with positive finding, 18 patients had clinical evidence of deep venous thrombosis. The in-hospital mortality rate was 10% (6/62).
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PMID:[Pulmonary embolism: clinical and laboratory features in 62 patients]. 904 62


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