Elsevier

American Heart Journal

Volume 74, Issue 6, December 1967, Pages 829-847
American Heart Journal

Acute pulmonary embolism: II. Clinical,☆☆

https://doi.org/10.1016/0002-8703(67)90102-0Get rights and content

Abstract

Pulmonary embolism is the commonest lethal pulmonary disease in the United States and is a contributing cause to the deaths of many additional patients. Yet its clinical recognition remains difficult and often impossible. This is so because the lung has no pain fibers, and has a large vascular reserve, and because clinical manifestations, when present, are variable, complex, and not infrequently completely obscured by the underlying disorder. It is unlikely that additional clinical observations will significantly increase accuracy of diagnosis. Increased accuracy of diagnosis will depend upon the development of new screening tests and the fullest use of those presently available. These latter are the triad of increased serum lactic dehydrogenase and bilirubin with a normal serum glutamic oxalacetic transaminase, frequently repeated electrocardiograms and roentgenograms of the chest, lung scanning, and (hopefully) ultrasound. There would appear to be no reason to use screening tests in the vast majority of instances of pulmonary embolism which are clinically silent and free of clinical precursors, and yet these emboli may be forerunners of an additional pulmonary embolism for which treatment is still not satisfactory. Hence the best hope for reducing the morbidity and mortality from pulmonary emboli lies not in treatment but in prevention.

References (68)

  • K.M. Moser et al.

    Correlation of lung photoscans with pulmonary angiography in pulmonary embolism

    Am. J. Cardiol.

    (1966)
  • N.O. Fowler et al.

    Idiopathic and thromboembolic pulmonary hypertension

    Am. J. Med.

    (1966)
  • S. Sevitt et al.

    Prevention of venous thrombosis and pulmonary embolism in injured patients

    Lancet

    (1959)
  • R.J. Kernohan et al.

    Heparin therapy in thromboembolic disease

    Lancet

    (1966)
  • A.C. Beall et al.

    Surgical management of pulmonary embolism

    Dis. Chest

    (1965)
  • A.R. Makey et al.

    Pulmonary embolectomy

    Lancet

    (1966)
  • N.W. Barker et al.

    Statistical study of postoperative venous thrombosis and pulmonary embolism: Incidence in various types of operations

  • R.F. Rushmer et al.

    Clinical applications of a transcutaneous ultrasonic flow detector

    J. A. M. A.

    (1967)
  • Sigel, B.: Personal...
  • S. McGinn et al.

    Acute cor pulmonale resulting from pulmonary embolism. Its clinical recognition

    J. A. M. A.

    (1935)
  • N. Westermark

    On roentgen diagnosis of lung embolism

    Acta radiol.

    (1938)
  • L.A. Soloff et al.

    An early hitherto unrecognized simple roentgenographic aid in the diagnosis of major pulmonary embolism

    Am. J. M. Sc.

    (1959)
  • A. Laur

    Roentgen diagnosis of pulmonary embolism and its differentiation from myocardial infarction

    Am. J. Roentgenol.

    (1963)
  • P.D. White

    The acute cor pulmonale

    Ann. Int. Med.

    (1935)
  • D.M. Weber et al.

    A reevaluation of electrocardiographic changes accompanying acute pulmonary embolism

    Am. J. M. Sc.

    (1966)
  • R.H. Cutforth et al.

    The electrocardiogram in pulmonary embolism

    Brit. Heart J.

    (1958)
  • G. Spruth et al.

    Electrokardiographische fruhbeobactungen bei Lungenembolie

    Ztschr. f. Kreislaufforsch

    (1964)
  • W.E.C. Wacker et al.

    A triad for the diagnosis of pulmonary embolism and infarction

    J.A.M.A.

    (1961)
  • E. Amador et al.

    Serum lactic dehydrogenase activity: An analytic assessment of current assays

    Clin. Chem.

    (1963)
  • M.E. Schonell et al.

    Failure to differentiate pulmonary infarction from pneumonia by biochemical tests

    Brit. M. J.

    (1966)
  • E. Amador et al.

    Serum lactic dehydrogenase activity and radioactive lung scanning in the diagnosis of pulmonary embolism

    Ann. Int. Med.

    (1966)
  • J.H. Dijkman et al.

    Increased serum alkaline phosphotase activity in pulmonary infarction

    Acta med. scandinav.

    (1966)
  • H.N. Wagner et al.

    Diagnosis of massive pulmonary embolism in man by radio-isotope scanning

    New England J. Med.

    (1964)
  • H.N. Wagner et al.

    Factors influencing regional pulmonary blood in man

    Scandinav. J. Resp. Dis. Suppl.

    (1966)
  • Cited by (0)

    Supported in part by United States Public Health Service Grants 1 TO1 HE 05712-01 and HF 06587-06, and The Council for Tobacco Research.

    ☆☆

    Part I appeared in the Nov. issue of the Journal.

    ∗∗

    Professor of Medicine and Chief of the Division of Cardiology, Temple University Health Sciences Center, Philadelphia, Pa.

    ∗∗∗

    Associate Professor of Medicine,Temple University Health Sciences Center, Philadelphia, Pa.

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