Friday, October 21, 2016

Syncope and Pulmonary Embolism

Prandoni P et al - N Engl J Med 2016; 375:1524-1531 - October 20, 2016
DOI: 10.1056/NEJMoa1602172
..."Although pulmonary embolism is included in the differential diagnosis of syncope in most textbooks, rigorously designed studies to determine the prevalence of pulmonary embolism among patients hospitalized for syncope are lacking. Indeed, current international guidelines, including those from the European Society of Cardiology and the American Heart Association, pay little attention to establishing a diagnostic workup for pulmonary embolism in these patients. Hence, when a patient is admitted to a hospital for an episode of syncope, pulmonary embolism — a potentially fatal disease that can be effectively treated — is rarely considered as a possible cause.
In this study, we used a systematic diagnostic workup to assess the prevalence of pulmonary embolism in a large number of patients who were hospitalized for a first episode of syncope, regardless of whether there were potential alternative explanations for the syncope...
In conclusion, among patients who were hospitalized for a first episode of syncope and who were not receiving anticoagulation therapy, pulmonary embolism was confirmed in 17.3% (approximately one of every six patients). The rate of pulmonary embolism was highest among those who did not have an alternative explanation for syncope."