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Syncope in patients with pulmonary embolism.

M D Thames, J S Alpert, J E Dalen

    JAMA
    |December 5, 1977
    PubMed
    Summary

    Syncope is a key symptom in 13% of acute pulmonary embolism (PE) cases. Early diagnosis of PE requires seeking additional clues beyond transient hypotension, utilizing tests like arterial blood gas analysis and pulmonary scintigraphy.

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    Area of Science:

    • Cardiology
    • Pulmonology
    • Emergency Medicine

    Background:

    • Syncope as a presenting symptom for acute pulmonary embolism (PE) is often overlooked.
    • Massive PE can cause transient hypotension, leading to misattribution of syncope to other causes.
    • Accurate diagnosis of PE requires careful consideration of clinical presentation and diagnostic testing.

    Purpose of the Study:

    • To investigate the frequency of syncope as a primary symptom in acute pulmonary embolism (PE).
    • To highlight the diagnostic challenges associated with PE presenting as syncope.
    • To emphasize the importance of seeking further diagnostic clues when PE is suspected.

    Main Methods:

    • Retrospective review of 132 consecutive cases of acute pulmonary embolism (PE).
    • Documentation of PE was confirmed by pulmonary angiography.
    • Analysis of clinical features, focusing on the incidence of syncope.

    Main Results:

    • Syncope was the initial or predominant clinical feature in 17 (13%) of the reviewed PE cases.
    • Transient hypotension following PE may resolve spontaneously, complicating diagnosis.
    • The diagnosis of PE is frequently missed in non-hospitalized patients presenting with syncope.

    Conclusions:

    • Syncope can be a significant presenting symptom of acute pulmonary embolism (PE).
    • Diagnostic evaluation for PE should be considered in patients with syncope, especially if other suggestive clues are present.
    • Arterial blood gas determinations and pulmonary scintigraphy are valuable tools for diagnosing PE when syncope is a prominent feature.

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