This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Piazza, G. Articles by Goldhaber, S. Z. Search for Related Content PubMed PubMed Citation Articles by Piazza, G. Articles by Goldhaber, S. Z. Related Collections Deep vein thrombosis

(Circulation. 2006;114:e28-e32.)
© 2006 American Heart Association, Inc.

Clinician Update

Acute Pulmonary Embolism

Part I: Epidemiology and Diagnosis

Gregory Piazza, MD; Samuel Z. Goldhaber, MD

From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center (G.P.), and the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital (S.Z.G.), Harvard Medical School, Boston, Mass.

Correspondence to Samuel Z. Goldhaber, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail sgoldhaber@partners.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case 1: A 54-year-old previously healthy woman presented to the emergency department with a history of several days of progressive dyspnea. She was taking combined estrogen-progestin therapy for symptoms of menopause. On the basis of elements of her history and physical examination, she was considered to have a moderate clinical likelihood of pulmonary embolism (PE). Her D-dimer level was elevated, and a chest computed tomography (CT) scan with contrast demonstrated a right main pulmonary artery embolus. What is the strongest clinical clue suggesting PE?

Case 2: A 71-year-old man receiving hormonal therapy for prostate cancer presented to the emergency department with acute-onset chest discomfort, dyspnea, and lower extremity edema. Laboratory studies revealed normal cardiac biomarkers. The only electrocardiographic abnormality was sinus tachycardia; the chest x-ray was normal. Chest CT with contrast revealed multiple bilateral pulmonary emboli. Lower extremity venous ultrasonography showed thrombus in the left femoral vein. Should a D-dimer blood test have been ordered before the chest CT?

	Epidemiology

 
The incidence of venous thromboembolism (VTE), which includes PE and deep venous thrombosis (DVT), has remained relatively constant, with age- and sex-adjusted rates of 117 cases per 100 000 person-years.¹ VTE incidence rises sharply after age 60 in both men and women, with PE accounting for the majority of the increase.²

The mortality rate associated with PE is underappreciated; it exceeds 15% in the first 3 months after diagnosis.³ In nearly 25% of patients with PE, the initial clinical manifestation is sudden death.¹

	Risk Factors

 
Risk factors for VTE include various . . . [Full Text of this Article]

This article has been cited by other articles:

				G. Piazza and S. Z. Goldhaber Computerized Decision Support for the Cardiovascular Clinician: Applications for Venous Thromboembolism Prevention and Beyond Circulation, September 22, 2009; 120(12): 1133 - 1137. [Full Text] [PDF]

				G. Piazza and S. Z. Goldhaber Pulmonary Embolism in Heart Failure Circulation, October 7, 2008; 118(15): 1598 - 1601. [Full Text] [PDF]

				S. Z. Goldhaber Percutaneous Mechanical Thrombectomy for Acute Pulmonary Embolism: A Double-Edged Sword Chest, August 1, 2007; 132(2): 363 - 365. [Full Text] [PDF]

				G. Piazza, A. Seddighzadeh, and S. Z. Goldhaber Double Trouble for 2,609 Hospitalized Medical Patients Who Developed Deep Vein Thrombosis: Prophylaxis Omitted More Often and Pulmonary Embolism More Frequent Chest, August 1, 2007; 132(2): 554 - 561. [Abstract] [Full Text] [PDF]

				S. Sreenivasan, S. Bennett, and V. J. Parfitt Westermark's and Palla's Signs in Acute Pulmonary Embolism Circulation, February 27, 2007; 115(8): e211 - e211. [Full Text] [PDF]