Pulmonary embolism: An unsuspected killer

Department of Pediatric and Adolescent Medicine, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Emergency Medicine Clinics of North America (Impact Factor: 0.78). 12/2004; 22(4):961-83. DOI: 10.1016/j.emc.2004.05.011
Source: PubMed


The presentation of PE is often subtle and may mimic other diseases. Many pulmonary emboli invariably preclude diagnosis by their occult nature or by leading to rapid death from cardiopulmonary arrest. In patients who do manifest symptoms from PE, accurate diagnosis is essential. Often it is difficult to distinguish the vague symptoms of PE from other diagnoses, such as acute coronary syndrome, pneumonia, COPD, CHF,aortic dissection, myocarditis or pericarditis, pneumothorax, and musculo-skeletal or gastrointestinal causes. Regardless of the presentation, the most fundamental step in making the diagnosis of PE is first to consider it. Historical clues and risk factors should raise the clinician's suspicion.PE is an unsuspected killer with a nebulous presentation and high mortality. In all likelihood, PE will remain an elusive diagnosis despite advances in technology and a wealth of research. A high index of suspicion is required, but no amount of suspicion would eliminate all missed cases. Patients with significant underlying cardiopulmonary disease seem to be the most challenging. Patients with significant comorbidity have poor reserve and are likely to have poor outcomes, especially if the diagnosis is not made and anticoagulation is not initiated early. Controversy exists over the best diagnostic approach to PE. A battery of diagnostic studies is available, with few providing definitive answers. Studies such as CT may be helpful at some institutions but offer poor predictive value at others. Other diagnostic tests are not universally available. It is hoped that further research and improvements in current diagnostic modalities will clear some of the current confusion and controversy of this ubiquitous and deadly disease.

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Available from: Deepi G Goyal, Oct 29, 2015
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    • "More than 650,000 cases of pulmonary embolism (PE) are reported each year, resulting in an estimated 300,000 annual fatalities. This level of occurrence ranks PE as the third leading cause of death in the USA [ Laack TA, 2004; Tapson VF, 2008]. Multidetector CT (MDCT) pulmonary angiography has now largely replaced ventilation/perfusion scintigraphy and conventional pulmonary angiography for the evaluation of possible PE [Patel S,2003]. "

    Full-text · Chapter · Mar 2012
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    • "Chronic obstructive pulmonary disease (COPD) is a worldwide health problem with increased morbidity and mortality [1] [2]. The clinical course of COPD may be complicated by pulmonary embolism (PE), accounting from 10 to 27 % [3] [4] of the patients, and seems to be a relatively frequent cause of death in these patients [5] [6] [7]. "
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    ABSTRACT: Pulmonary embolism (PE) appears to be a major threat in patients who suffer of chronic obstructive pulmonary disease (COPD) and 13% of these patients suffer of embolism events. There are several causes for the development of a thrombophilic condition in patients with COPD, with abnormalities of the coagulation pathway being one of them. The aim of this study was to research the frequency of abnormalities in the anti-clotting proteins in COPD patients who have had a documented event of PE. Methods: Forty-three COPD/PE patients were studied and their levels of anti-clotting proteins were compared with those of 40 patients diagnosed only with COPD. Results: A reduction in anti-clotting proteins was identified in 23% (10/43) of COPD/PE patients, but in none of the COPD patients showed this condition. In the COPD/PE group, 8 patients showed a significant decrease in protein C (mean 27 ± 8%), and also 5 patients showed decrease levels of protein S (mean 28 ± 7%). Interestingly, decreased levels in both protein C and protein S were observed in 3 of them. None of the COPD/PE patients showed evidence of alterations in the values of activated protein C resistance. Conclusion: Our data shows a higher frequency of alterations in the endogenous anticoagulant protein system in COPD/PE patients. More studies are needed to identify a high risk for patients suffer from this disease.
    Full-text · Article · Jan 2012 · The Open Atherosclerosis & Thrombosis Journal
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    • "Furthermore, classic vital sign abnormalities such as tachypnea and tachycardia are inconsistent findings among patients who have PE. In fact, tachypnea is absent in up to 13% of patients diagnosed with PE [39] [46] [54]. Similarly, tachycardia is absent in up to 30% of patients over 40 years of age [39]. "
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    ABSTRACT: The majority of patients presenting to a primary care physician with acute chest pain will have non-life-threatening etiologies. Nevertheless, catastrophic cause of chest pain such as ACS, AD, PE, esophageal perforation, and pericarditis must be considered in the differential diagnosis. Often, these deadly conditions have atypical clinical presentations that must be recognized. Furthermore, the physical examination can be deceptively benign in patients harboring a catastrophic etiology of chest pain. By identifying these atypical presentations, recognizing the utility of the physical examination, and understanding of the limitations of traditional diagnostic imaging, primary care physicians can effectively diagnose patients who have life-threatening cause of acute chest pain.
    Preview · Article · Oct 2006 · Primary Care Clinics in Office Practice
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