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

Hemodynamic syncope is caused by an impediment to a necessary increase of the cardiac output; therefore, hemodynamic syncopes most often occur during or shortly after exercise. However, a syncope at rest does not exclude a hemodynamic cause. Moreover, arrhythmias which may directly lead to syncope or accentuate the hemodynamic impediment are often present in cardiac diseases causing hemodynamic syncope. Hemodynamic syncopes are responsible for 2 to 3% of all syncopes leading to medical evaluation. Of these, more than half are caused by aortic stenosis and about one quarter by pulmonary embolism. Other reasons are rare. Hypertrophic cardiomyopathy is more often associated with arrhythmic than with hemodynamic syncope. Syncope in primary pulmonary hypertension is often preceded by dizziness, epigastric distress and faintness. Since the medical therapy may lead to hemodynamic deterioration, it must be started under invasive observation. Primary tumors of the heart are rare; secondary cardiac neoplasms are 6 to 40 times more common. Myxoma is the most common primary tumor of the heart. It is important to promptly undertake surgery in order to improve prognosis. Various other diseases may provoke hemodynamic syncope; however, other symptoms are by far more common.
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PMID:[Hemodynamically-induced syncope]. 933 77

Pulmonary embolism presenting as an isolated syncopal spell can be a difficult clinical correlation to make. We present three cases of pulmonary embolism-induced syncope and review the pathophysiology and diagnostic considerations in this setting. Pulmonary embolism should be considered in the differential diagnosis of every syncopal event that presents to the emergency department, even in the face of cardiac dysrhythmias and normal pulse oximetry values.
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PMID:Syncope as an emergency department presentation of pulmonary embolism. 947 70

The purpose of this study was to test the efficacy, feasibility, and safety of outpatient radiofrequency catheter ablation in 162 consecutive patients. There were 83 men and 79 women at a mean age of 47 + 15 years; 13 patients underwent 2 and 1 patient 3 ablation procedures. In 167 cases patients suffered from highly symptomatic paroxysmal tachycardia associated with presyncope or syncope in 74. Severe palpitations were present in 7 cases and recurrent syncope in 1 case. One patient had an asymptomatic Wolff-Parkinson-White syndrome with a shortest RR-interval during atrial fibrillation of 150 ms. The mechanism of tachycardia was found to be atrioventricular nodal reentry in 78 cases, atrioventricular reentry involving an accessory atrioventricular pathway in 56, atrial fibrillation in 16, atrial flutter of the common type in 15, ectopic atrial tachycardia in 8, and idiopathic ventricular tachycardia in 3. Catheter ablation was performed in these 176 cases at an overall success rate of 86%. In 148 cases patients could be treated on an outpatient basis and were discharged after a maximal observation time of 3 hours in 28, and 24 hours in another 120 cases. Short-term follow-up was uneventful in these patients. After 28 ablation procedures patients had to be admitted to the hospital, because of pain at the puncture sites or after pacemaker implantation in 15 cases, because of minor complications in 12, and because of pericardial tamponade in 1 case. Another severe complication occurred in 1 patient after successful ablation of right atrial tachycardia. Three days after discharge the patient suffered from pulmonary embolism originating from a thrombus at the ablation site. After hospital admission the patient recovered completely. In general, complication rate was 2.27%. This study shows that catheter ablation can be performed effectively and safety on an outpatient basis.
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PMID:[Ambulatory catheter ablation. Indications, results and risks]. 959 9

Pulmonary embolism can be a catastrophic event leading to early death or serious hemodynamic instability. Thrombolytic therapy, in addition to heparin therapy, may improve the clinical condition and reduce the chance of recurrent pulmonary embolism in some cases. However, the acceptable "time window" for thrombolytic therapy is not well documented, though it has been used successfully as late as 14 days after pulmonary embolism. Successful delayed thrombolytic therapy beyond this "time window" in patients with massive pulmonary embolism has not been reported. We report a case of massive pulmonary embolism in which thrombolytic therapy was delayed more than 1 month after symptom onset. A 56-year-old woman was taken to National Cheng Kung University Hospital because of an episode of recurrent syncope, followed by progressive shortness of breath of 1 month's duration. Hypoxemia and hemodynamic instability were noted on admission. Echocardiography and a lung perfusion scan provided strong evidence of pulmonary embolism. Subsequent pulmonary angiography confirmed the diagnosis of multiple pulmonary emboli. The patient received a standard dose of intravenous tissue plasminogen activator 7 days after admission because of persistent symptoms and hypoxemia. Her clinical condition dramatically improved after treatment. Follow-up imaging studies showed resolution of the emboli. She was discharged in good condition. This case suggests that delayed thrombolytic therapy in patients with massive pulmonary embolism can still be beneficial in selected cases, even if given more than 2 weeks after symptom onset.
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PMID:Successful delayed thrombolytic therapy in a patient with massive pulmonary embolism. 979 33

Electrocardiographic (ECG) findings of pulmonary embolism (PE) include S1Q3T3 pattern, right bundle-branch block, right-axis deviation, and T-wave inversion in medial precordial leads. We report other uncommon ECG changes associated with various symptoms during recurrent PE as documented by computed tomography (CT) scans in a single patients. An 83-year-old woman was admitted with PE secondary to deep venous thrombosis in the left leg. During episodes of chest pain, ECG showed QTc prolongation (480 ms) with new T-wave inversion in leads III, aVF, and V1-V3, and ST-segment depression in leads V5-V6. Despite adequate anticoagulant therapy, recurrent episodes of PE occurred in the hospital. When the patient experienced sudden chest tightness, ECG showed a new S-wave notch in lead V1 and clock-wise rotation with sinus tachycardia. She also experienced transient syncope with hypotension. At this time, ECG showed transient atrioventricular junctional rhythm followed by sinus arrest, and CT scan showed a new massive embolus in the main pulmonary trunk with right ventricular dilatation, as demonstrated by echocardiography. The mechanism responsible for QTc prolongation with ST-T changes, the S-wave notch in lead V1 with clockwise rotation, or atrioventricular junctional rhythm with sinus arrest during PE may be associated with myocardial ischemia, acute right ventricular overload, or vagal reflex, respectively.
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PMID:Uncommon electrocardiographic changes corresponding to symptoms during recurrent pulmonary embolism as documented by computed tomography scans. 982 4

To provide clinical diagnostic criteria for pulmonary embolism (PE), we evaluated 750 consecutive patients with suspected PE who were enrolled in the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Prior to perfusion lung scanning, patients were examined independently by six pulmonologists according to a standardized diagnostic protocol. Study design required pulmonary angiography in all patients with abnormal scans. Patients are reported as two distinct groups: a first group of 500, whose data were analyzed to derive a clinical diagnostic algorithm for PE, and a second group of 250 in whom the diagnostic algorithm was validated. PE was diagnosed by angiography in 202 (40%) of the 500 patients in the first group. A diagnostic algorithm was developed that includes the identification of three symptoms (sudden onset dyspnea, chest pain, and fainting) and their association with one or more of the following abnormalities: electrocardiographic signs of right ventricular overload, radiographic signs of oligemia, amputation of hilar artery, and pulmonary consolidations compatible with infarction. The above three symptoms (singly or in some combination) were associated with at least one of the above electrocardiographic and radiographic abnormalities in 164 (81%) of 202 patients with confirmed PE and in only 22 (7%) of 298 patients without PE. The rate of correct clinical classification was 88% (440/500). In the validation group of 250 patients the prevalence of PE was 42% (104/250). In this group, the sensitivity and specificity of the clinical diagnostic algorithm for PE were 84% (95% CI: 77 to 91%) and 95% (95% CI: 91 to 99%), respectively. The rate of correct clinical classification was 90% (225/250). Combining clinical estimates of PE, derived from the diagnostic algorithm, with independent interpretation of perfusion lung scans helps restrict the need for angiography to a minority of patients with suspected PE.
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PMID:Accuracy of clinical assessment in the diagnosis of pulmonary embolism. 1005 Dec 64

Pulmonary embolism is a major cause of death in the United States. A high index of suspicion is required to achieve an accurate diagnosis. We report a case of a patient with syncope, ischemic electrocardiographic changes, and an elevated troponin I level, presenting just like acute myocardial infarction. The case highlights the value of an early use of 2-dimensional echocardiography in obtaining an accurate diagnosis, thus avoiding unnecessary and inappropriate treatment.
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PMID:Pulmonary embolism mimicking acute myocardial infarction. 1043 62

Syncope as an initial presentation of pulmonary embolism occurs in about 10% of patients. A 68-year-old woman was admitted to the hospital with syncope. A right lower lobe infiltrate was found on a chest x-ray film, and results of a ventilation-perfusion scan were interpreted to mean that a high probability of pulmonary embolism existed. Other causes of syncope were excluded. A Doppler scan of the lower extremities revealed deep venous thrombosis. Intravenous heparin was administered, and then an inferior vena cava filter was placed to prevent pulmonary embolism from recurring. The patient has been well for 16 months since that episode. A review of 20 case reports in the literature of 10 women and 10 men with pulmonary embolism presenting as syncope revealed that female patients were younger than male patients and that the outcome was fatal in 40% of all cases. Syncope as a presenting symptom of pulmonary embolism is difficult to diagnose. Physicians must be vigilant with patients who have syncope, because this symptom may be the "forgotten sign" of life-threatening pulmonary embolism. The need for prompt diagnosis is clear, because with appropriate treatment the majority of patients may survive.
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PMID:Pulmonary embolism presenting as syncope: case report and review of the literature. 1048 51

Deep venus thrombosis may result in pulmonary embolism. In rare instances, embolization has occurred, not directly to the pulmonary arterial tree, but to the right heart chambers. Although the value of echocardiography in the diagnosis is well recognised, their is no consensus for the appropriate treatment. We report herein six cases of floating right atrial thrombi, diagnosed by echocardiography, in patients with pulmonary embolism, or unexplained shock or syncope. Surgical embolectomy was carried out in 4 patients, and thrombolytic therapy in 2, without in-hospital mortality. The high mortality associated to this entity may be improved by rapid echocardiographic recognition and emergency treatment with thrombolysis or surgery. Our data suggest the possible use of thrombolysis as a first-choice therapy in selected patients.
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PMID:[Embolism in the right heart chambers: the diagnostic and therapeutic aspects]. 1052 57

Pulmonary embolism is a leading cause of death and morbidity in the perioperative period. To obtain a contemporary overview of the epidemiology of acute pulmonary embolism, a questionnaire was mailed to anesthesia department chair-persons at 179 hospitals in Japan. The 158 cases were reported from the 88 hospitals. The cause of embolism was thromboembolism 127, gas 13, fat 9, amniotic fluid 4 and tumor 3. The mortality rate for patients with thromboembolism was high (29%). Dyspnea was the most frequent symptom (60%) and hypotension was the most frequent clinical sign (54%). The signs which suggested massive pulmonary embolism, such as hypotension, cyanosis (53%), syncope (39%) and cardiac arrest (29%) were frequently seen. Most of the pulmonary embolisms occurred during the operation and within 7 days after the operation. The high risk factors associated with thromboembolism were age, malignancy, obesity and the type of surgery performed. Treatment performed included anticoagulation 81%, catecholamine infusion 66%, thrombolysis 14%, surgical embolectomy 8% and extra-corporeal circulation 4%. This study indicates that the perioperative pulmonary embolism is still associated with high mortality and requires an immediate diagnosis and intensive therapy.
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PMID:[Perioperative pulmonary embolism: a nationwide survey in Japan]. 1055 10


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