Cor Vasa 2006, 48(12):433-440 | DOI: 10.33678/cor.2006.137

The incidence, diagnosis, and treatment of pulmonary embolism in a department of medicine. Part 1. Incidence and diagnosis

Jan Mrózek^*, Vladimír Srp, Kamil Novobílský, Petr Černý

II. interní-kardiovaskulární oddělení, Městská nemocnice Ostrava, Ostrava, Česká republika

Background:
The aim of our study was to assess the incidence of pulmonary embolism (PE) in an unselected group of patients hospitalized in the department of medicine of a community hospital, to find out the incidence of risk factors, signs and symptoms of PE, to evaluate the accuracy and the benefit of paraclinical examinations, to analyze the therapeutic approaches, mortality and its risk factors. We compared our group of patients with the group of patients hospitalized for PE in 1996-1998.

Methods:
We analyzed the medical records of 120 patients hospitalized between 1 November 2001 and 30 June 2004 and diagnosed to have PE. The data were evaluated and compared with group of patients examined in 1996-1998.

Results:
The mean age of our patients was 67.7 years; 76 patients (63%) were women. The following risk factors were identified: a history of PE or deep venous thrombosis (DVT) in 37 patients (30%), surgery in 15 (12.5%), a family history of PE or DVT in 11 patients (9.2%), trauma in 10 (8.3%), and contraception or hormonal replacement therapy in 8 patients (6.7%). The following clinical signs were noted: dyspnoe in 103 patients (85%), chest pain or discomfort in 49 (40.8%), and dizziness in 45 (37.5%). Tachycardia > 100 bpm was present in 39 patients (32%), hypotension in 10 (8.3%), and clinical symptoms of DVT in 55 patients (45.8%).


The following examinations were performed:
ECG in 119 patients (99%), with typical findings for PE present in 61 (51%) patients; chest X-ray in 103 patients (85%), with only 17 (16.5%) showing typical findings for PE. Echocardiography was performed in 82 patients (68%), with a positive result in 60 patients (73%), duplex ultrasonography in 79 patients (65%); DVT signs were found in 53 patients (67%). D-dimer levels were assessed in 76 patients (63.3%), out of which number 72 (94.7%) had a positive result. Troponin I was assessed in 57 patients (47%), with 31 (54%) showing increased levels. CRP was assessed in 45 patients (37.5%); of this number, 36 (80%) had elevated levels while hypoxia was detected in 13 of 30 (25%) patients having their acid-base balance determined. To document PE, a perfusion scan was performed in 98 patients (85.8%), CT angiogram (CTA) in 17 (14.2%), whereas only 3 patients (2.5%) had conventional pulmonary angiography. The diagnosis of PE was established based solely on clinical symptoms and results of indirect examinations, and not confirmed by perfusion lung scan, CT or by angiography with therapy initiated in 11 patients (9.2%).

Conclusion:
The prevalence of risk factors and symptoms of PE did not differ from rates reported in the literature; there was a lower rate of a massive, unstable PE. The technique of baseline examination shown to be most valuable was echocardiography. The definitive diagnosis of PE was established by the perfusion lung scan or CTA.

Keywords: Pulmonary embolism; Incidence; Diagnosis

Published: December 1, 2006  Show citation