Acute pulmonary embolism associated with shock-Clinical picture and hospital mortality.:Clinical Picture and Hospital Mortality
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To clarify the clinical picture and hospital mortality of patients with acute pulmonary embolism accompanied by shock, 96 consecutive patients with acute pulmonary embolism admitted to the Hiroo General hospital from Dec. 1980 to Apr. 1995 (51 men and 45 women; mean age 59±12 years) were reviewed. Pulmonary embolism was confirmed by pulmonary angiography, lung perfusion scanning, or autopsy. The patients were subdivided into two groups based on the presence (group A; n=22) or absence (group B; n=74) of shock. Shock was defined simply as hypotension under 70mmHg. The majority of patients in both groups had risk factors for venous thromboembolism. The major presenting manifestations in group A were dyspnea at rest (54%), syncope (23%) and cardiopulmonary arrest (23%), while those in group B were chest pain (43%), dyspnea on exertion (22%) and dyspnea at rest (15%). On 12-lead electrocardiography, complete or incomplete right bundlebranch block, an SIQIIITIIIpattern and T wave inversion in leads V1 to V3 were observed more often in group A. Two-dimensional echocardiography revealed marked right ventricular dilatation in all group A patients and in 43% of group B patients. All patients with this finding were proven to have massive pulmonary embolism. In 75% of group A patients, severe hypokinesis of the right ventricular free wall was also shown. Eighteen (82%) of the 22 group A patients developed shock within 30 minutes after the onset of symptoms, and two developed shock as a result of recurrence of pulmonary embolism 2 or 3 days after the onset. Sixteen patients (73%) in group A and 41 patients (55%) in group B received thrombolytic therapy. In-hospital mortality was 68% in group A and 0% in group B. Conclusions: 1) The hospital mortality in patients with acute pulmonary embolism accompanied by shock is very high and prophylaxis of venous thromboembolism is urgently needed in patients with recognized risk factors. 2) Two-dimensional echocardiography is a sensitive method of detecting the right ventricular overload in massive pulmonary embolism. Utilization of this technique soon after the onset of symptoms is important for diagnosis and treatment.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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