Syncope in pulmonary embolism: a retrospective cohort study

Area of Science:

• Cardiology
• Pulmonary Medicine
• Emergency Medicine

Background:

• Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
• Syncope, or fainting, can be a presenting symptom of various cardiovascular and pulmonary conditions.
• Understanding the role of syncope in PE diagnosis is crucial for appropriate patient management.

Purpose of the Study:

• To determine the prevalence of syncope or collapse as a presenting symptom in patients diagnosed with pulmonary embolism (PE).
• To assess whether syncope is ever the sole clinical feature leading to a PE diagnosis.

Main Methods:

• A retrospective cohort study involving 224 patients diagnosed with PE.
• Analysis of patient records to identify the frequency of syncope or collapse (presyncope) alongside other clinical signs and symptoms.
• Confirmation of PE diagnosis via CT pulmonary angiogram.

Main Results:

• Syncope or collapse occurred in 9.8% (22 out of 224) of patients with PE.
• Syncope was never the sole presenting feature; other common symptoms included hypoxemia, dyspnea, chest pain, tachycardia, and tachypnea.
• Patients presenting with syncope and PE often had a large clot burden (68% of cases).

Conclusions:

• Syncope is a frequent, but not exclusive, presenting symptom in pulmonary embolism.
• Routine diagnostic testing for PE based solely on syncope is not clinically justifiable given these findings.