The diagnosis of pulmonary embolism

Pulmonary embolism is poorly diagnosed and therefore not treated in patients with chronic diseases, whereas it is overdiagnosed in formerly healthy patients. The diagnostic level is not satisfactory even in departments of cardiology. Insufficient use of auxiliary laboratory tests constitutes one of the main reasons for the unsatisfactory state of pulmonary embolism diagnostics. The clinical picture of pulmonary embolism depends on a) the size of pulmonary embolism, b) the previous state of the cardiopulmonary system. A massive pulmonary embolism can lead to a) sudden death, b) shock, c) acute cor pulmonale. The most typical diagnostic sign is suddenly developed or deteriorated dyspnea (present in 94% of patients). The presence of venous thrombosis and the appearance of sudden dyspnea always support the diagnosis very strongly. Dyspnea or tachypnea occur in more than 90% of patients. Dyspnea, tachypnea or deep venous thrombosis occur in 99% of patients with acute pulmonary embolism. Electrocardiographic signs of acute pulmonary embolism were present in 67% of our patients with hemodynamically significant pulmonary embolism. Electrocardiographic signs are most marked in cases in which pulmonary embolism originates suddenly, in patients with a normal cardiopulmonary system, if the pulmonary embolism is extensive and the electrocardiogram is carried out early and repeatedly. The electrocardiographic signs of pulmonary embolism in cardiac patients, however, are not specific and only rarely present. The principal advantages of the chest X-ray are simplicity, safety and low costs. A negative chest X-ray was found only in 16.6% of our patients with pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)