The presence of shock defines the threshold to initiate thrombolytic therapy in patients with pulmonary embolism

Wood, Kenneth E.

doi:10.1007/s00134-002-1486-0

Cited by 27 publications

(8 citation statements)

References 49 publications

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“…The importance of identifying pulmonary artery embolism (PE) is well established (1-8). Unfortunately, symptoms are often non-specific, making a diagnosis of PE very challenging, based upon clinical presentation alone.…”

Section: Introductionmentioning

confidence: 99%

Contrast enhanced pulmonary magnetic resonance angiography for pulmonary embolism: Building a successful program

Nagle

Schiebler

Repplinger

et al. 2016

European Journal of Radiology

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The performance of contrast enhanced pulmonary magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism (PE) is an effective non-ionizing alternative to contrast enhanced computed tomography and nuclear medicine ventilation/perfusion scanning. However, the technical success of these exams is very dependent on careful attention to the details of the MRA acquisition protocol and requires reader familiarity with MRI and its artifacts. Most practicing radiologists are very comfortable with the performance and interpretation of computed tomographic angiography (CTA) performed to detect pulmonary embolism but not all are as comfortable with the use of MRA in this setting. The purpose of this review is to provide the general radiologist with the tools necessary to build a successful pulmonary embolism MRA program. This review will cover in detail image acquisition, image interpretation, and some key elements of outreach that help to frame the role of MRA to consulting clinicians and hospital administrators. It is our aim that this resource will help build successful clinical pulmonary embolism MRA programs that are well received by patients and physicians, reduce the burden of medical imaging radiation, and maintain good patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Contrast enhanced pulmonary magnetic resonance angiography for pulmonary embolism: Building a successful program

Nagle

Schiebler

Repplinger

et al. 2016

European Journal of Radiology

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“…It has been argued that development of right ventricular dysfunction as a result of acute pulmonary hypertension (PH) is a crucial pathophysiological event, which may initiate a vicious circle of progressive haemodynamic instability [2]. In accordance with this hypothesis, it is presently acknowledged that overt right ventricular failure with persistent arterial hypotension or shock predicts a particularly poor outcome and, thus, should set the indication for immediate thrombolytic, interventional or surgical treatment of PE [3,4]. Furthermore, and importantly, a number of prospective [5][6][7] and retrospective [8] studies, as well as two large registries [1,9], have demonstrated that echocardiographic diagnosis of right ventricular enlargement or hypokinesis [10] is associated with an increased risk of death or potentially life-threatening complications, even in the absence of arterial hypotension on admission.…”

mentioning

confidence: 99%

Prognostic value of the ECG on admission in patients with acute major pulmonary embolism

Geibel

Zehender²,

Kasper³

et al. 2005

Eur Respir J

192

109

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A number of ECG abnormalities can be observed in the acute phase of pulmonary embolism (PE). Their prognostic value has not yet been systematically studied in large patient populations.In 508 patients with acute major PE derived from a large prospective registry, the current authors assessed, on admission, the impact of specific pathological ECG findings on early (30-day) mortality.Atrial arrhythmias, complete right bundle branch block, peripheral low voltage, pseudoinfarction pattern (Q waves) in leads III and aVF, and ST segment changes (elevation or depression) over the left precordial leads, were all significantly more frequent in patients with a fatal outcome. Overall, 29% of the patients who exhibited at least one of these abnormalities on admission did not survive to hospital discharge, as opposed to only 11% of the patients without a pathological 12-lead ECG. Multivariate analysis revealed that the presence of at least one of the above ECG findings was, besides haemodynamic instability, syncope and pre-existing chronic pulmonary disease, a significant independent predictor of outcome.In conclusion, ECG may be a useful, simple, non-costly tool for initial risk stratification of patients with acute major pulmonary embolism.

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“…3 Thus, the primary benefit of thrombolysis is rapid reduction in right ventricular work and improvement in cardiac output, an effect that may be most important in those patients who have myocardial damage or inadequate tissue perfusion. A recent study has shown that troponin I has prognostic value and is closely linked to echocardiographic evidence of right ventricular dysfunction.…”

Section: Co Om MM Me En Nt Ta Ar Ry Y B By Y R R C C M Mc Cd mentioning

confidence: 99%

Best evidence in critical care medicine

McDermid

2004

Can J Anesth/J Can Anesth

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The presence of shock defines the threshold to initiate thrombolytic therapy in patients with pulmonary embolism

Cited by 27 publications

References 49 publications

Contrast enhanced pulmonary magnetic resonance angiography for pulmonary embolism: Building a successful program

Contrast enhanced pulmonary magnetic resonance angiography for pulmonary embolism: Building a successful program

Prognostic value of the ECG on admission in patients with acute major pulmonary embolism

Best evidence in critical care medicine

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