Pulmonary embolism: an unsuspected killer

Laack, Torrey A.; Goyal, Deepi G.

doi:10.1016/j.emc.2004.05.011

Cited by 81 publications

(44 citation statements)

References 103 publications

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“…Surface ECG readings are altered in about 70% of cases of PE [1]. Numerous ECG findings have been reported, with sinus tachycardia being the most common [2]. Findings such as the S1Q3T3 pattern lack sensitivity and specificity, and also show no correlation with the severity of PE [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous ECG findings have been reported, with sinus tachycardia being the most common [2]. Findings such as the S1Q3T3 pattern lack sensitivity and specificity, and also show no correlation with the severity of PE [2,3]. Several studies have stated that T-wave inversion in lead III, aVF and precordial leads is most often associated with massive PE and/or PE with RV dysfunction, ascribing a high sensitivity, specificity, positive and negative predictive value to these findings [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

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Acute Pulmonary Embolism Masquerading as Acute Inferior Myocardial Infarction

Obiagwu

2014

J Med Cases

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It is always important to maintain a high index of suspicion in the diagnosis of acute pulmonary embolism (PE). Death in patients with undiagnosed PE was shown to be 4 -6 times higher than in those with a definite diagnosis and treatment. The ECG as much as it has great utility, unfortunately lacks sensitivity and specificity, providing findings that might serve as red herrings to the unsuspecting physician by suggesting an alternative diagnosis. This report describes a woman whose EKG showed ST segment elevations suggestive of acute inferior wall myocardial infarction (MI), but eventually was found to have a sub-massive PE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Pulmonary Embolism Masquerading as Acute Inferior Myocardial Infarction

Obiagwu

2014

J Med Cases

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“…3 The large discrepancies are further partially attributed to the fact that many patients are asymptomatic and have no clinical findings. 6,22 When the suspicion of a pulmonary embolism is present, based on the assessment of the patient's risk 14 (ie, physical therapy screening exami- nation and/or Wells score), the patient must be referred for medical evaluation to avoid placing the health of the patient at further risk. The use of the Wells score can provide evidence-based evaluative information when communicating with the medical team.…”

Section: Differential Diagnosismentioning

confidence: 99%

Pulmonary Emboli: The Differential Diagnosis Dilemma

Young

Flynn²

2005

J Orthop Sports Phys Ther

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Pulmonary embolism is a rare but serious medical condition, with an estimated mortality of 5% to 20%. Many patients receiving physical therapy may be at risk for developing pulmonary embolism, especially after periods of immobilization or surgery. Patients presenting with dyspnea, chest pain, or tachypnea, particularly after trauma or surgery, have an increased likelihood of pulmonary embolism. Clinical prediction rules have been developed, which can aid the practitioners in assessing the risk a patient has for developing pulmonary embolism. The present clinical commentary discusses the existing evidence for screening patients for pulmonary embolism. To illustrate the importance of the screening examination, a patient is presented who was referred to physical therapy 5 days after cervical discectomy and fusion. This patient was subsequently referred for medical evaluation and a confirmatory diagnosis of pulmonary embolism. J Orthop Sports Phys Ther 2005;35:637-644. Key Words: chest pain, dyspnea, lungs, screening, thromboembolism P ulmonary embolism occurs when a portion of the pulmonary vessels are occluded, whether by blood clot (deep vein thrombosis), air, fat, or bone marrow. 9,15,22 Deep vein thromboses (DVTs) in the lower extremity are commonly associated with pulmonary embolism, with up to 70% of patients with pulmonary embolism having evidence of leg DVT.6,22 DVT may also form in the pelvis or upper extremity. 13,26 A DVT that develops into a pulmonary embolism is classified as a thromboembolism.11 There are approximately 650 000 cases of pulmonary embolism annually in the United States, 9 with an estimated occurrence rate of 0.23% in a tertiary care hospital. 28 The incidence of pulmonary embolism increases with age (r = 0.94), with females having a significantly greater incidence than males over the age of 50 years. 28 The mortality rate attributed to pulmonary embolism is unknown, but estimated to be between 5% and 20%. 22Physical therapists frequently manage patients who are at increased risk for pulmonary embolism. Approximately 1 in 20 (5%) patients undergoing hip arthroplasty will develop a pulmonary embolism, with 50% of these being fatal.7,22 A 5.6% risk of nonfatal, symptomatic pulmonar y embolism has been reported following total knee arthroplasty, 16 with an estimated risk of death occurring in 0.03% to

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“…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].…”

Section: Introductionmentioning

confidence: 99%