A Six Cases Clinical Analysis Of Acute Pulmonary Embolism Initially Presenting As Syncope

Objective To explore the characteristics of the clinical manifestation,diagnoses, treatment and outcome of patients with pulmonary embolism presenting as syncope.Method A retrospective evaluation was conducted on 6 patients with acute pulmonary embolism(APE) presenting as syncope,focused on the clinical manifestation,physical examination,laboratory tests imaging,treatment and outcome.Result Apart from syncope as the common symptom,dyspnea(6/6),heart palpitations(4/6),chest pain (2/6),cough and sputum(1/6) were also recorded.Physical examination showed that one patient did not show any abnormal signs,the other five manifested lower extremity edema(3/6),the second heart sound split in pulmonary valve auscultation area(1/6),jugular vein distention and liver carotid positive reflux symptoms(1/6),a 3/ 6 systolic murmur in aortic valve auscultation area(1/6),etc.At the same time.Wells prediction scores showed that three patients with high pretest probabilities and three with moderate pretest probabilities.ECG showed pulmonary hypertension(5/6) and tricuspid regurgitation(5/6).The diagnoses were confirmed during the early period of hospitalization by V/Q scan(3/6),CTPA(2/6),pulmonary angiography(1/6), respectively.Thrombolysis and anti-coagulation treatments were given and all the patients were cured.Conclusion APE patients with syncope are likely to have other clinical manifestations,such as dyspnea,heart palpitations,lower extremity edema,etc. The cardiac ultrasonography show abnormalities like pulmonary hypertension, tricuspid regurgitation.To confirm diagnosis,examinations like V/Q scan,CTPA or pulmonary angiography should be performed.Early diagnosis followed by appropriate treatments(like thrombolysis,anticoagulation)are crucial to the patients'early recovery.