Clinical, electrocardiographic, biochemical, and roentgenographic abnormalities commonly used as a basis for diagnosing acute pulmonary embolism were often absent in 160 patients with angiographically proven pulmonary embolism. Pulmonary embolism should be suspected in any predisposed patient who experiences sudden, unexplained dyspnea or pleuritic pain; the patient should then be screened with perfusion lung scanning and, if necessary, pulmonary angiography to confirm the diagnosis.
Whereas a clinical history proved relatively insensitive in screening for the presence of pulmonary embolism, physical findings such as ↑S2P, S3 or S4 gallop, and cyanosis often indicated right atrial and pulmonary arterial hypertension; these signs occurred more frequently in patients with massive embolism. Conversely, pleuritic pain and hemoptysis were more common in patients with submassive pulmonary embolism. Age, sex, and a history of prior pulmonary embolism bore no relation to angiographic massiveness, but venous disease was more common in patients with massive than in those with submassive pulmonary embolism. Women taking oral contraceptives tended to have more submassive embolism. Except for LDH, preinfusion enzyme and bilirubin concentrations appeared to have no relation to angiographic massiveness.
- © 1973 American Heart Association, Inc.