Current management strategies of acute major pulmonary embolism are largely dependent on the degree of hemodynamic instability at presentation. In the presence of severe hemodynamic compromise, physicians often rely on the findings of bedside echocardiography and proceed to thrombolytic treatment without seeking further diagnostic certainty in nuclear imaging or angiographic studies.

When given in conjunction with heparin, alteplase can improve the clinical course of stable patients who have acute submassive pulmonary embolism and can prevent clinical deterioration requiring the escalation of treatment during the hospital stay.

The results of our study suggest that thrombolysis may favorably affect the clinical outcome of hemodynamically stable patients with major pulmonary embolism.

No abstract

Background and objectives: In hemodialysis, applicable guidelines recommend regular electrocardiogram (ECG) recordings.However, respective systematic evaluations are absent. Thus, the authors investigated whether routine ECG findings add prognostic information to standard risk assessment in hemodialysis.Design, setting, participants, & measurements: The relationship between nine common baseline ECG variables and a combined cardiovascular endpoint (CVE; cardiac death, myocardial infarction, stroke), sudden death, stroke, MI, and all-cause death in 1253 patients from the German Diabetes and Dialysis Study was evaluated. All patients were on maintenance hemodialysis, had type 2 diabetes mellitus, and received randomized treatment with atorvastatin or placebo.Results: During 4 yr of follow-up (March 1998 to March 2004), 469 patients reached the CVE, and 617 died. After adjustment for demographics, comorbidities, and biomarkers in multivariate analysis, patients presenting without sinus rhythm were 89% more likely to die, and the risk of CVE and stroke increased by 75% and 164%, respectively, compared with patients with preserved sinus rhythm. Left ventricular hypertrophy was associated with >2-fold increase in the risk of stroke and a 60% increase in the risk of sudden death.Conclusions: In hemodialysis patients with type 2 diabetes mellitus, the absence of sinus rhythm is a risk indicator for CVE, stroke, and all-cause death, and left ventricular hypertrophy is associated with stroke and sudden death. Thus, routine ECG recording adds prognostic information to standard risk assessment.