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KMID : 0616620000060020361
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Journal of Soonchunhyang Medical College
2000 Volume.6 No. 2 p.361 ~ p.366
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Evaluation for Clinical Findings in Patient with Pulmonary Embolism
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Abstract
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Purpose: The purpose of this investigation is to determine the characteristics of the history, laboratory findings, perfusion lung scans, and angiographys in patients with pulmonary embolism and to analyze the value of the electrocardiogram for the diagnosis of pulomary embolism
Background: Pulmonary embolism is a major cause of morbidity and death in hospital, but, it remains a common condition that is both severe and difficult to diagnose, While the "gold standard" for diagnosis of pulmonary embolism remains selective pulmonary angiography and its sensitivity and specficty are very high, it is not frequently used, and its diagnosis in the clinical practice is far below the actual incidence. We suppose that the gap between frequency of diagnosis and actual incidence is mainly due to missed suspicion and lack of early diagnostic tool in screening for pulmonary embolism.
Methods: Retrospective review of 55 inpatients with pulmonary embolism from January, 1995 to December, 1999 was performed, For diagnosis of pulmonary embolism, clinical suspicion, aBGA, ECG, echocardiogram, perfusion lung scan, and angiography were performed and reviewed literatures.
Results: Median age was 52.2 years old with range of 20-86. Dyspnea was the most common symptom, 39 of 55(70.9%), followed by chest pain, 38 of 55(69.1%). Hypoxemia(PaO2<60mmHg) was observed in 11 of 26(42.3%), and perfusion defect in 49 of 52(94.2%). Angiography was performed in only 8, and abnormality has shown in 7(87.5%). The most frequent changes of ECG signs was S wave in lead I, aVL(50.9%), Q wave in lead III, aVF(49,1%). There was a strong correllation between SIQ3 and right ventricular diastolic dimension (p<0.02) by echocardiography.
Conclusios: Lung perfusion scan and pulmonary angiogram are the gold standard for diagnosis of pulmonary embolism. But, they are invasive, expensive, and difficult for an emergency situation. Hence, inspite of the low sensitivity and specificity for diagnosis, electrocardiogram and echocardiogram which is easy to perform rapidly should be done for the early diagnosis and treatment of pulmonary embolism.
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