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

The authors examined the records of all patients referred for right heart catheterization between 1963-84 because of persistent dyspnoea after one or more episodes of pulmonary emboli. Patients with a history of congestive heart failure, angina, restrictive or obstructive pulmonary disease that could explain their symptoms were excluded. Catheterization was performed 15.8 +/- 24 months after the first suspected episode of pulmonary embolism. Seven of the 29 patients included had resting pulmonary hypertension (PH). All of these had an alveolo-arterial oxygen difference (AaDO2) greater than 25 mmHg. Twenty patients of the group, taken as a whole, had an AaDO2 greater than 25 mmHg. Information was available from 1 month to 5 years later in 6/9 patients with an AaDO2 less than 25 mmHg. In all of them dyspnoea improved or resolved. Information was available in 15/20 patients with AaDO2 greater than 25 mmHg. Three of 8 patients without PH but with an increased AaDO2 on the initial catheterization developed PH within 2 years. Dyspnoea increased in 1 of the remaining five. Four patients who initially had PH developed right heart failure 6 months-3 years later. In the remaining 3, dyspnoea was stable in 1, increased in 1 and one patient died with autopsy evidence of multiple pulmonary emboli. Abnormal oxygenation predicts the presence or subsequent development of PH in patients who are chronically dyspnoeic after pulmonary embolism.
Cor Vasa 1991
PMID:AaDO2 as a predictor of pulmonary hypertension resulting from pulmonary emboli. 191 74

The review discusses the potential and limitations of radionuclide (RN) techniques of examination in diagnosing thromboembolic disease of venous origin. The advantages and drawbacks of perfusion pulmonary scintigraphy as the most commonly used method are weighed especially with a view to the diagnosis of pulmonary embolism (PE). The need for a combined examination including inhalation scintigraphy and chest X-ray is underlined. The criteria for interpreting results of RN techniques of examination in assessing the presence of PE are defined. Of the methods used in the diagnosis of venous thrombosis, the benefits and limitations of the fibrinogen uptake test (FUT) and radionuclide venography (RNV) are pointed out. When comparing RNV with X-ray phlebography, the authors found a low sensitivity in the crural area (54%) and, on the contrary, a 100% agreement in the areas of iliac veins and the vena cava inferior.
Cor Vasa 1990
PMID:Use of radionuclides in the diagnosis of thromboembolism of venous origin: its potential and limitations. A review. 219 Jul 55

Four patients with pulmonary embolism and right atrial mobile thrombi (RAMT) are described. One patient died during intravenous heparin treatment because of a "saddle" pulmonary artery embolus, another died from surgical complications after successful embolectomy. One of the two survivors was treated with intravenous streptokinase and the other with intravenous heparin. Echocardiographically detected RAMT seems a reliable sign of impending massive pulmonary embolism. Pulmonary angiography is unnecessary and may be dangerous. Surgical removal of RAMT, fibrinolytic treatment or intravenous heparin introduced promptly may be lifesaving.
Cor Vasa 1987
PMID:Right atrial mobile thrombi: two-dimensional echocardiographic diagnosis and clinical outcome. 367 18

Using the method of equilibrium radionuclide ventriculography (RNV), the right ventricular ejection fraction (RVEF) at rest and at a standard workload of 250 kpm per min was determined in 25 control subjects and in 30 patients with pulmonary hypertension (8 patients with chronic obstructive bronchopulmonary disease, 12 with recurrent pulmonary embolism and 10 with pure mitral stenosis). In the same week as RNV, pulmonary artery pressure was registered in patients with pulmonary hypertension at rest and at standard workload. RVEF was significantly higher (45 +/- 5%) in normal subjects than in patients with pulmonary hypertension (33 +/- 5%) and during exercise increased, whereas in patients with pulmonary hypertension it did not markedly change or decreased. The RVEF correlated at rest (r = -0.6293, p less than 0.001) and during exercise (r = 0.6980, p less than 0.05) with the degree of pulmonary hypertension at rest and during exercise. The results show a good correlation between the RVEF and the degree of pulmonary hypertension in patients with pulmonary hypertension at rest and during exercise.
Cor Vasa 1986
PMID:Equilibrium radionuclide right ventriculography at rest and during exercise in patients with pulmonary hypertension. 369 5

Haemodynamic studies were undertaken in 30 patients with chronic post-embolic pulmonary hypertension (CPEPH), and the findings were compared with those found in acute thromboembolism of the pulmonary artery. The study showed that radiocardiographic examination is a useful supplementary method for diagnosing postembolic lesions of pulmonary arteries and for dynamic examination of patients after pulmonary embolism. The appearance of a "single-hump" curve on the radiocardiogram was an unfavourable prognostic sign and attested both to an increase of pulmonary hypertension or to a latent heart failure. The importance of radiocardiographic examination for determining the prognosis of the disease and for choosing the most suitable method of its treatment is analysed.
Cor Vasa 1986
PMID:Haemodynamics in patients with chronic post-embolic pulmonary hypertension. 369 6

Twenty-two patients with acute pulmonary embolism were examined by M-mode echocardiography. It was possible to examine both ventricles (with precordial approach) and the right branch of the pulmonary artery (with suprasternal approach) in all patients. With significant pulmonary embolism there occurs dilatation of the right ventricle and of the right branch of the pulmonary artery. The size of the right branch of the pulmonary artery in patients was significantly different from that of healthy volunteers. However, no significant correlation between the degree of anatomic changes (documented by echocardiography) and haemodynamics in the lesser circulation was found. Literature concerning other possibilities of echocardiography in the diagnosis of acute pulmonary embolism is reviewed. Echocardiography represents a suitable complement to diagnostic methods used for the assessment of acute states.
Cor Vasa 1986
PMID:M-mode echocardiography in acute pulmonary embolism. 376 88

The purpose of the study was to assess the clinical value of echocardiography in a coronary care unit. 133 patients admitted for an acute cardiovascular disorder were examined by a mobile echocardiograph. 83 patients had an acute myocardial infarction, 8 extracardiac chest pain, 6 unstable angina pectoris, 6 acute pulmonary embolism and 16 other acute cardiovascular diseases. 14 patients were excluded from the study because of poor image quality. Echocardiography was found most advantageous in solving the following clinical problems: 1) early diagnosis of acute myocardial infarction (probably the earliest of all available methods); 2) immediate and precise diagnosis of complications in myocardial infarction; 3) differential diagnosis of chest pain; 4) detection of left ventricular thrombi (the most useful method for this purpose); 5) differential diagnosis of other acute cardiovascular diseases (pulmonary embolism, aortic root dissection etc.).
Cor Vasa 1985
PMID:The role of echocardiography in a coronary care unit. 405 18

The study analyses 58 consecutive (1971-1981) cases with haemodynamically significant pulmonary embolism (PE) treated in a coronary unit. The diagnosis was confirmed either by pulmonary angiography or a combination of scintigraphy with haemodynamic examination, or by autopsy. In 75.8% of cases there were present predisposing factors. A combination of sudden dyspnoea with venous thrombosis or with recurrent thrombophlebitis in the anamnesis was present in 59.3% acute cor pulmonale in 1/3 of the patients. The chest X-ray showed in 83.9% of the patients one of the following signs: pulmonary infarction, oligaemia, elevation of the diaphragm, enlargement of the hili, amputation of the hili, pleural effusion. In 62.7% of the patients, PE could be diagnosed on the basis of the ECG. Most patients had elevated pulmonary artery pressure, with a worse prognosis in patients exhibiting a pressure higher than 40 mmHg. For suspecting the presence of haemodynamically significant PE, it is in most patients sufficient to rely on the anamnesis and the results of physical, ECG and X-ray examination. The diagnosis should be confirmed by scintigraphy or angiography and haemodynamic examination.
Cor Vasa 1985
PMID:Clinical diagnosis of haemodynamically significant pulmonary embolism in a coronary care unit. 407 98

The collateral pulmonary blood flow was measured by the dye dilution method in four patients with chronic obstructive pulmonary disease, in 16 patients with diffuse pulmonary fibrosis, in 15 patients with pulmonary embolism, and in three patients with primary pulmonary hypertension. The authors found that collateral pulmonary circulation was small in the first two groups (0.3 % and 1.7% of the pulmonary blood flow, respectively), absent in primary pulmonary hypertension, and high (14.0% of pulmonary flow) in pulmonary embolism. The magnitude of the bronchopulmonary collateral circulation did not correlate with degree of precapillary pulmonary hypertension, left atrial pressure and left ventricular enddiastolic pressure. It seems that the bronchopulmonary collateral flow does not produce diastolic left ventricular overload in chronic pneumopathies.
Cor Vasa 1981
PMID:Left ventricular overload caused by collateral pulmonary circulation in chronic pneumopathies-myth or reality? 724 59

Pulmonary emboli (PE) were found in 18.5% of all consecutive autopsies at the Institute for Clinical and Experimental Medicine in Prague. In 11% of autopsies PE was the sole or major contributing cause of death; in 3.4% death occurred in patients who were expected to recover from the original illness. Pulmonary infarct was found in 42.6% of the patients with PE, multiple embolic phenomena of various ages in 43.7%, and venous thrombosis in 55.4% of cases with PE. The frequency of false negative and false positive clinical diagnosis of PE was 66.9% and 41.9%, respectively. PE went undetected in 57.1% of cases where it was directly responsible for death, and in 54.3% of patients with otherwise good long-term prognosis. The main factors responsible for incorrect diagnosis are the time interval from the onset of symptoms, missed clinical diagnosis of venous thrombosis, lack of laboratory examinations or their incorrect interpretation.
Cor Vasa 1980
PMID:Clinico--pathologic correlations in pulmonary thromboembolism. 742 80


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