ABSTRACT. Lund, O, Nielsen, TT, Rønne, K, Schifter S (Departments of Thoracic and Cardiovascular Surgery, Cardiology, Respiratory Diseases, and Clinical Physiology and Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark). Pulmonary Embolism: Long‐term follow‐up after treatment with full‐dose heparin, streptokinase or embolectomy. Acta Med Scand 1987; 221:61–71. The study comprises 74 patients alive 30 days after the start of treatment of pulmonary embolism with heparin (n=32), streptokinase (n=22) or embolectomy (n=20). The cumulative 5‐year survival was 100% in the embolectomy group, compared to 75±7% (SE) in the medically treated patients (p<0.05). Cancer caused 78% of the late deaths. At follow‐up 0.5–8.7 years after treatment the treatment groups were indistinguishable as regards right‐sided heart catheterization data, pulmonary artery rest‐obstruction, right ventricular diameter and wall thickness, ventilatory function and ECG changes. The embolectomized patients were in a more favourable NYHA classification level than the medically treated. Chronic pulmonary artery hypertension was found in 75 % of patients with ≤3 anamnestic recurrent embolic episodes before diagnosis compared to 8 % of patients with ≥2 recurrent episodes (p<0.001). Patients with irreversible cardiocirculatory shock before embolectomy all had abnormal pulmonary vascular resistance (>1.5 mmHg/1/min), depressed ventilatory function and more than 25% reduced pulmonary perfusion at follow‐up. The major prognostic factors thus were cancer, the number of recurrent episodes and the degree of cardiocirculatory affection in the acute event. Although the embolectomized patients were the most affected initially, they had a good prognosis. This led us to extend our indications for embolectomy to include all patients with central emboli, irrespective of the degree of cardiocirculatory impairment.
Electrocardiographic (ECG) findings in 87 consecutive patients with from minor to massive pulmonary embolism are presented. ECG changes suggestive of acute right ventricular strain defined as the occurrence of complete (c) or incomplete (inc) right bundle branch block (RBBB), an pattern, SIQIIItIIIpattern inverted T waves in the second and third pre-cordial leads and/or an increase in the frontal QRS axis of 20 °C or more were found in 71 patients (82%). The prevalence of c and inc RBBB and the increase in frontal QRS axis correlated with the extent of embohzation (angiographic or scintigraphic score), while the appearance of the SIQIIItIIIpattern did not. No patient with a vascular obstruction of two thirds or more had an ECG free of signs of right ventricular strain. In 9 of 11 embolectomized patients with c RBBB, c RBBB disappeared within 24 h postoperatively. Among patients with an embohzation of 45 % or more, those with c RBBB had a shorter symptom duration, fewer embolic episodes and a lower pulmonary artery pressure than those without c RBBB. As ECG abnormalities were transient and changing in nature, serial ECG recordings are recommended. Pronounced ECG signs of right ventricular strain should, as they may reflect both massive and short-lasting vascular obstruction, arouse the suspicion of pulmonary embolism suitable for embolectomy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.