Skip to main content

Pulmonary Embolism

  • Chapter
  • First Online:
Echocardiography

Abstract

Pulmonary embolism (PE) is a common condition with an incidence exceeding 1 in 1000 and a mortality rate of >15% in the first 3 months after diagnosis. It has a wide clinical spectrum ranging from asymptomatic, small PE to large, life-threatening causing haemodynamic instability and cardiogenic shock. Early diagnosis is therefore essential so early treatment can be instituted. PE may be separated in acute PE often presenting in the emergency department with acute onset of chest pain and the differential diagnosis from myocardial infarction is often challenging. Chronic PE in the other hand may be a more long-standing condition leading to breathlessness and right heart failure. The differential diagnosis from other causes of breathlessness and heart failure may be difficult.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet. 1999;353:1386–9.

    Article  CAS  Google Scholar 

  2. Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, Thompson JR, Hiestand B, Briese BA, Pendleton RC, Miller CD, Kline JA. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter emergency medicine pulmonary embolism in the real world registry). J Am Coll Cardiol. 2011;57(6):700–6.

    Article  Google Scholar 

  3. Stein PD, Goldhaber SZ, Henry JW. Alveolar-arterial oxygen gradient in the assessment of acute pulmonary embolism. Chest. 1995;107:139–43.

    Article  CAS  Google Scholar 

  4. Stein PD, Goldhaber SZ, Henry JW, et al. Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. Chest. 1996;109:78–81.

    Article  CAS  Google Scholar 

  5. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax. 2003;58:470–83.

    Article  Google Scholar 

  6. Panoulas VF, Daigeler A-L, Malaweera ASN, Lota AS, Baskaran D, Rahman S, Nihoyannopoulos P. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging. 2013;14:323–30.

    Article  Google Scholar 

  7. Lapostolle F, Surget V, Borron SW, et al. Severe pulmonary embolism associated with air travel. N Engl J Med. 2001;345:779–83.

    Article  CAS  Google Scholar 

  8. Schulman S, Lindmarker P. Incidence of cancer after prophylaxis with warfarin against recurrent venous thromboembolism: duration of anticoagulation trial. N Engl J Med. 2000;342:1953–8.

    Article  CAS  Google Scholar 

  9. Vandenbroucke JP, Rosing J, Bloemenkamp KW, et al. Oral contraceptives and the risk of venous thrombosis. N Engl J Med. 2001;344:1527–35.

    Article  CAS  Google Scholar 

  10. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s health initiative randomized controlled trial. JAMA. 2002;288:321–33.

    Article  CAS  Google Scholar 

  11. Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest. 2002;121:877–905.

    Article  Google Scholar 

  12. Molloy WD, Lee KY, Girling L, Schick U, Prewitt RM. Treatment of shock in a canine model of pulmonary embolism. Am Rev Respir Dis. 1984;130(5):870–4.

    CAS  PubMed  Google Scholar 

  13. Goldhaber SZ, Elliott DG. Acute pulmonary embolism: part I: epidemiology, pathophysiology, and diagnosis. Circulation. 2003;108:2728–9.

    Google Scholar 

  14. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galié N, et al. ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35:3033–80.

    Article  CAS  Google Scholar 

  15. Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary 2165 embolism. Results from the international cooperative pulmonary embolism registry. Chest 2166. 2000;118(1):33–8.

    Article  CAS  Google Scholar 

  16. Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir 2169 J. 2005;25(5):843–8.

    Article  CAS  Google Scholar 

  17. Ghaye B, Szapiro D, Mastora I, Delannoy V, Duhamel A, Remy J, Remy-Jardin M. 2300 Peripheral pulmonary arteries: how far in the lung does multi-detector row spiral CT allow 2301 analysis? Radiology. 2001;219(3):629–36.

    Article  CAS  Google Scholar 

  18. Alderson PO. Scintigraphic evaluation of pulmonary embolism. Eur J Nucl Med. 1987;13(2346 Suppl):S6–10.

    PubMed  Google Scholar 

  19. van Beek EJ, Reekers JA, Batchelor DA, Brandjes DP, Buller HR. Feasibility, safety and 2395 clinical utility of angiography in patients with suspected pulmonary embolism. Eur Radiol 2396. 1996;6(4):415–9.

    Article  CAS  Google Scholar 

  20. Kucher N, Luder CM, Dornhofer T, Windecker S, Meier B, Hess OM. Novel management 2455 strategy for patients with suspected pulmonary embolism. Eur Heart J. 2003;24(4):366–76.

    Article  CAS  Google Scholar 

  21. Nass N, McConnell MV, Goldhaber SZ, Chyu S, Solomon SD. Recovery of regional right ventricular function after thrombolysis for pulmonary embolism. Am J Cardiol. 1999;83:804–6.

    Article  CAS  Google Scholar 

  22. Vitarelli A, Barillà F, Capotosto L, D'Angeli I, Truscelli G, De Maio M, Ashurov R. Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography. J Am Soc Echocardiogr. 2014;27(3):329–38. https://doi.org/10.1016/j.echo.2013.11.013.

    Article  PubMed  Google Scholar 

  23. Wright L, Dwyer N, Power J, Kritharides L, Celermajer D, Marwick TH. Right ventricular systolic function responses to acute and chronic pulmonary hypertension: assessment with myocardial deformation. J Am Soc Echocardiogr. 2016;29(3):259–66. https://doi.org/10.1016/j.echo.2015.11.010.

    Article  PubMed  Google Scholar 

  24. Smith BC, Dobson G, Dawson D, Charalampopoulos A, Grapsa J, Nihoyannopoulos P. Three-dimensional speckle tracking of the right ventricle: toward optimal quantification of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol. 2014;64:41–51.

    Article  Google Scholar 

  25. Coutance G, Cauderlier E, Ehtisham J, Hamon M, Hamon M. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care. 2011;15(2):R103.

    Article  Google Scholar 

  26. Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, Meyer G. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J. 2008;29(12):1569–77.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Petros Nihoyannopoulos .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dawson, D., Nihoyannopoulos, P. (2018). Pulmonary Embolism. In: Nihoyannopoulos, P., Kisslo, J. (eds) Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-71617-6_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71617-6_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71615-2

  • Online ISBN: 978-3-319-71617-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics