Q J Med 2000; 93: 557
© 2000 Association of Physicians
Correspondence |
Pulmonary embolism—an update on thrombolytic therapy
Department of Medicine for the Elderly, Tameside General Hospital, Ashton under Lyne
Sir,
Because of the prevailing preoccupation with myocardial infarction as a cause of out-patient cardiac arrest,1 there is a tendency not to acknowledge the role of pulmonary embolism (PE) in the aetiopathogenesis of this syndrome, notwithstanding some similarities between the clinical signs of the two disorders,1,2 and also notwithstanding the potentially lifesaving role of thrombolysis in pulmonary embolism,2 the latter being a treatment modality of great topical interest.3 In the context of cardiac arrest, diagnosis of PE is aided by evaluation of antecedent symptoms, such as dyspnoea, as well as post-cardiac-arrest electrocardiograms, the latter for signs such as right bundle dbranch block.2 Among 1340 subjects with either in-patient or out-of-hospital cardiac arrest, 60 were identified with PE as the underlying cause, and 55% of these presented outside hospital.2 Therefore, when clinicians are urged to be ‘diligent in diagnosing pulmonary embolism’,3 a high index of suspicion should also be maintained for the possibility that cardiac arrest might have PE as an underlying, and potentially treatable, cause.
References
1.
Norris RM, on behalf of the United Kingdom Heart Attack Study Collaborative Group. Fatality outside hospital from acute coronary events in three British health districts. Br Med J1998; 316:1065–70.
2.
Kurkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as cause of cardiac arrest: presentation and outcome. Arch Intern Med2000; 160:1529–35.
3.
Thomas MD, Chauhan A, More RS. Pulmonary embolism—an update on thrombolytic therapy. Q J Med2000; 93:261–7.
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