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Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
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A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...
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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Assessing respiratory rate concurrently with pulse measurement is fundamental to patient care, providing valuable insights into the patient's respiratory function. The normal breathing rate for an adult usually falls within a normal range of 12 to 20 breaths per minute. Abnormal respiratory rates can signal underlying health conditions or the need for immediate intervention.
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When the heart pumps blood out, arterial elastic fibers play a crucial role in sustaining a high-pressure gradient. They expand to accommodate the received blood and then recoil - a process known as the pulse that can be either manually palpated or electronically quantified. Despite a reduction in its effect with increased distance from the heart, elements of the pulse's systolic and diastolic components persist, observable even at the arteriole level.
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Heart rate in pulmonary embolism.

Karsten Keller1, Johannes Beule, Meike Coldewey

  • 1Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany, Karsten.Keller@unimedizin-mainz.de.

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Elevated heart rate in acute pulmonary embolism (PE) indicates a worse outcome. A heart rate above 86 beats/min effectively predicts right ventricular dysfunction and intermediate risk PE, while higher rates predict in-hospital death.

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Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Critical Care Medicine

Background:

  • Heart rate is a readily available parameter for risk stratification in acute pulmonary embolism (PE).
  • Predicting outcomes in acute PE is crucial for timely intervention and management.
  • The prognostic value of heart rate in acute PE requires further elucidation.

Purpose of the Study:

  • To investigate the effectiveness of heart rate in predicting outcomes in patients with acute PE.
  • To determine the association between heart rate and in-hospital death, myocardial necrosis, PE status, and right ventricular dysfunction (RVD).

Main Methods:

  • Retrospective analysis of data from 182 patients with acute PE.
  • Logistic regression models to assess associations between heart rate and adverse outcomes.
  • Receiver Operating Characteristic (ROC) curve analysis to determine cut-off values for predicting RVD, intermediate risk PE, in-hospital death, and myocardial necrosis.

Main Results:

  • A heart rate >85 beats/min was significantly associated with RVD (OR 4.871) and intermediate risk PE (OR 5.244).
  • ROC analysis showed heart rate cut-off values of 86 beats/min for predicting RVD and intermediate risk PE in normotensive patients.
  • Heart rate demonstrated acceptable effectiveness in predicting RVD, intermediate PE status, cardiac injury, and in-hospital death, with specific cut-off values identified.

Conclusions:

  • Elevated heart rate in acute PE is linked to adverse outcomes.
  • Heart rate serves as an acceptable predictor for RVD, intermediate PE status, cardiac injury, and in-hospital death.
  • A heart rate of 86 beats/min is a key threshold for predicting RVD and intermediate risk PE in normotensive patients.