Clinical, Laboratory, Roentgenographic, and Electrocardiographic Findings in Patients with Acute Pulmonary Embolism and No Pre-Existing Cardiac or Pulmonary Disease

Stein, P D; Terrin, Michael L.; Hales, Charles A.; Palevsky, Harold I.; Saltzman, Herbert A.; Thompson, B. Taylor; Weg, John G.

doi:10.1378/chest.100.3.598

Cited by 709 publications

(391 citation statements)

References 9 publications

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“…[1][2][3][4][5][6][7] The Wells score combines multiple variables into a prediction tool ( Table 1). The original model identified three categories of patients with increasing likelihoods of having a PE, 6 but a simpler, dichotomous version was subsequently proposed.…”

mentioning

confidence: 99%

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Bahia¹,

Albert²

2011

Journal of Hospital Medicine

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BACKGROUND:The usefulness of the Wells score has not been assessed in hospitalized patients receiving prophylactic heparin.METHODS:Retrospective, observational study of hospitalized patients receiving prophylactic heparin who underwent contrast‐enhanced chest computed tomography (CT) for a concern of pulmonary embolism (PE) more than 2 days after admission. Patients with contraindications to, or interruptions in, prophylactic heparin were excluded. The modified (eg, dichotomous) Wells score was retrospectively calculated by reviewing each patient's record. Requesting a d‐dimer was taken to mean that alternate diagnoses were of equal or greater likelihood than acute PE.RESULTS:From January 2006 through December 2007, 286 patients met inclusion criteria. Pulmonary embolus diagnosed by CT was present in 20 patients (7%). The sensitivity, specificity, positive and negative predictive values of a Wells score ≥4.0 were 95%, 27%, 9% and 99%, respectively. A d‐dimer was ordered in 70 of the 74 PE‐unlikely cases, was elevated in 67, and falsely positive in all but 1.CONCLUSIONS:The prevalence of PE in hospitalized patients receiving prophylactic heparin is lower than in cohorts from which the Wells prediction criteria were derived and validated. A modified Wells score <4 safely excludes PE in such patients and reduces the need for CT. D‐dimer testing adds nothing to the evaluation. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

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mentioning

confidence: 99%

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Bahia¹,

Albert²

2011

Journal of Hospital Medicine

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“…Relatively acute pulmonary disease such as a pulmonary embolism can also impact the ECG [19]. Similarly, positive pressure ventilation is typically thought of as an acute change in normal cardiopulmonary physiology and as such is assumed to have predictable and consistent ECG changes.…”

Section: Discussionmentioning

confidence: 99%

Effects of Mechanical Ventilation on the Electrocardiogram in Adults

Elinoff

Talmor

Subramaniam

et al. 2008

Lung

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The effects of mechanical ventilation on the surface electrocardiogram (ECG) have not been systematically investigated and the anticipated changes such as rightward P and QRS axes shifts, reduced QRS voltage, and slow R-wave progression are not supported by definitive data. We sought to determine the effects of mechanical ventilation on the surface ECG in hemodynamically stable adults without active cardiopulmonary disease. Seventeen patients in good overall health who were undergoing elective outpatient surgery had serial ECGs done preoperatively, intraoperatively, and postoperatively. No clinically significant changes in QRS or P-wave axis were detected. R-wave progression was not altered and there were no significant differences in the QRS amplitudes pre-, intra-, or postoperatively in either the precordial or limb leads. The present study shows that hemodynamically stable patients without active cardiopulmonary disease undergoing elective surgery demonstrate relatively minor ECG changes from baseline despite the addition of positive pressure ventilation. Clinicians should not assume that substantial changes in P wave or QRS axis or amplitude in patients undergoing mechanical ventilation are due to the effects of positive pressure ventilation alone.

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“…Indeed, ageing is associated with an increasing prevalence of cardiac or pulmonary comorbidities, and as none of the clinical symptoms and signs of PE is specific to PE, the initial assessment of patients can be really puzzling for the clinician. Whereas typical symptoms and signs suggestive of PE are found in the majority of patients with PE who do not have pre-existing cardiac or pulmonary diseases [5], this is not the case for elderly patients. In small retrospective series of elderly patients with confirmed PE, clinical presentation is shown to differ from younger patients, syncope being more often present [6][7][8] whereas pleuritic chest pain is consistently less frequently reported than in younger patients [8][9][10].…”

Section: Suspecting Pulmonary Embolism In the Elderly: A Real Challengementioning

confidence: 91%

“…No single symptom or sign can therefore confirm or exclude PE, even less so in the elderly, but the presence of a given combination can raise its suspicion. As for clinical features, findings on the general first line tests such as oxygen saturation, electrocardiogram and chest X-ray are neither sensitive nor specific for the diagnosis of PE and can at best help to increase or decrease its probability [5].…”

Section: Suspecting Pulmonary Embolism In the Elderly: A Real Challengementioning

confidence: 99%

Diagnosis and management of pulmonary embolism in the elderly

Robert‐Ebadi

Righini

2014

European Journal of Internal Medicine

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a b s t r a c t a r t i c l e i n f oElderly patients are a population not only at particularly high risk of venous thromboembolism including pulmonary embolism (PE), but also at high risk of adverse clinical outcomes and treatment-related complications. Major progresses have been achieved in the diagnosis and treatment of PE over the last two decades. Nevertheless, some of elderly patients' specificities still represent important challenges in the management of PE in this population, from its suspicion to its diagnosis and treatment, and are discussed in this review. Perspectives for the future are from a diagnostic point of view the potential implementation of age-adjusted D-dimer cut-offs that will allow ruling out PE in a greater proportion of elderly patients without the need for thoracic imaging. From a therapeutic point of view, acquisition of post-marketing clinical experience with the use of new oral anticoagulants is still necessary, and in the meantime, these drugs should be prescribed with great caution in thoroughly selected elderly patients.

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Clinical, Laboratory, Roentgenographic, and Electrocardiographic Findings in Patients with Acute Pulmonary Embolism and No Pre-Existing Cardiac or Pulmonary Disease

Cited by 709 publications

References 9 publications

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Effects of Mechanical Ventilation on the Electrocardiogram in Adults

Diagnosis and management of pulmonary embolism in the elderly

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