Pulmonary Embolism, Part I: Epidemiology, Risk Factors and Risk Stratification, Pathophysiology, Clinical Presentation, Diagnosis and Nonthrombotic Pulmonary Embolism

Overview

Journal Exp Clin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2013 Aug 14

PMID 23940438

Citations 176

Authors

Jan Belohlavek

Vladimir Dytrych

Ales Linhart

Affiliations

Soon will be listed here.

Abstract

Pulmonary embolism is an important clinical entity with considerable mortality despite advances in diagnosis and treatment. In the present article, the authors offer a comprehensive review focused mainly on epidemiology, risk factors, risk stratification, pathophysiological considerations and clinical presentation. Diagnosis based on assessment of clinical likelihood, electrocardiography, chest x-ray, D-dimer levels, markers of myocardial injury and overload, and blood gases is discussed in detail. Special attention is devoted to the clinical use of computed tomography, pulmonary angiography and echocardiography in the setting of pulmonary embolism.

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References

Pineda L, Hathwar V, Grant B . Clinical suspicion of fatal pulmonary embolism. Chest. 2001; 120(3):791-5. DOI: 10.1378/chest.120.3.791. View

Chapoutot L, Nazeyrollas P, Metz D, Maes D, Maillier B, Jennesseaux C . Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management. Cardiology. 1996; 87(2):169-74. DOI: 10.1159/000177081. View

Becattini C, Vedovati M, Agnelli G . Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007; 116(4):427-33. DOI: 10.1161/CIRCULATIONAHA.106.680421. View

Kostrubiec M, Pruszczyk P, Kaczynska A, Kucher N . Persistent NT-proBNP elevation in acute pulmonary embolism predicts early death. Clin Chim Acta. 2007; 382(1-2):124-8. DOI: 10.1016/j.cca.2007.04.010. View

Goldhaber S, Visani L, de Rosa M . Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353(9162):1386-9. DOI: 10.1016/s0140-6736(98)07534-5. View

Jimenez D, Diaz G, Valle M, Marti D, Escobar C, Vidal R . [Prognostic value of syncope in the presentation of pulmonary embolism]. Arch Bronconeumol. 2005; 41(7):385-8. DOI: 10.1016/s1579-2129(06)60246-2. View

Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L . Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000; 160(2):159-64. DOI: 10.1001/archinte.160.2.159. View

Douketis J, Tosetto A, Marcucci M, Baglin T, Cushman M, Eichinger S . Patient-level meta-analysis: effect of measurement timing, threshold, and patient age on ability of D-dimer testing to assess recurrence risk after unprovoked venous thromboembolism. Ann Intern Med. 2010; 153(8):523-31. DOI: 10.7326/0003-4819-153-8-201010190-00009. View

Vieillard-Baron A, Page B, Augarde R, Prin S, Qanadli S, Beauchet A . Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate. Intensive Care Med. 2001; 27(9):1481-6. DOI: 10.1007/s001340101032. View

10.

. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax. 2003; 58(6):470-83. PMC: 1746692. DOI: 10.1136/thorax.58.6.470. View

11.

Goldhaber S . Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002; 136(9):691-700. DOI: 10.7326/0003-4819-136-9-200205070-00012. View

12.

Haap M, Gatidis S, Horger M, Riessen R, Lehnert H, Haas C . Computed tomography angiography in patients with suspected pulmonary embolism-too often considered?. Am J Emerg Med. 2011; 30(2):325-30. DOI: 10.1016/j.ajem.2010.12.013. View

13.

Torbicki A, Galie N, Covezzoli A, Rossi E, De Rosa M, Goldhaber S . Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol. 2003; 41(12):2245-51. DOI: 10.1016/s0735-1097(03)00479-0. View

14.

Gromadzinski L, Ciurzynski M, Januszko-Giergielewicz B, Targonski R, Cyganski P, Pruszczyk P . Diagnostic value of mitral and tricuspid annular excursion in the diagnostics of acute pulmonary embolism patients with chronic heart failure. Int J Cardiol. 2011; 149(1):118-9. DOI: 10.1016/j.ijcard.2011.01.070. View

15.

Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman M, Chatellier G . Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J. 2008; 29(12):1569-77. DOI: 10.1093/eurheartj/ehn208. View

16.

Hugli O, Righini M, Le Gal G, Roy P, Sanchez O, Verschuren F . The pulmonary embolism rule-out criteria (PERC) rule does not safely exclude pulmonary embolism. J Thromb Haemost. 2010; 9(2):300-4. DOI: 10.1111/j.1538-7836.2010.04147.x. View

17.

Thieme S, Ashoori N, Bamberg F, Sommer W, Johnson T, Leuchte H . Severity assessment of pulmonary embolism using dual energy CT - correlation of a pulmonary perfusion defect score with clinical and morphological parameters of blood oxygenation and right ventricular failure. Eur Radiol. 2011; 22(2):269-78. DOI: 10.1007/s00330-011-2267-3. View

18.

Belohlavek J, Dytrych V, Linhart A . Pulmonary embolism, part II: Management. Exp Clin Cardiol. 2013; 18(2):139-47. PMC: 3718594. View

19.

Burge A, Freeman K, Klapper P, Haramati L . Increased diagnosis of pulmonary embolism without a corresponding decline in mortality during the CT era. Clin Radiol. 2008; 63(4):381-6. DOI: 10.1016/j.crad.2007.10.004. View

20.

Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G . Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000; 101(24):2817-22. DOI: 10.1161/01.cir.101.24.2817. View