Analysis of clinical characteristics of 50 cases of acute pulmonary embolism with syncope as the first symptom
Objective:To investigate the clinical characteristics of acute pulmonary embolism patients with syncope as the first symptom,so as to improve the efficiency of clinical diagnosis.Methods:The clinical data of 50 patients with acute pulmonary embolism diagnosed with sudden syncope as the first symptom in the Affiliated Hospital of Jining Medical University from April 2020 to April 2023 were retrospectively analyzed.Including gen-der,age of onset,underlying diseases,clinical symptoms,laboratory tests(blood gas analysis,plasma D-dimer,brain natriuretic peptide,troponin,etc.),electrocardiogram,echocardiography,lower limb venous color ultra-sound,pulmonary artery CTA,pulmonary embolism severity index,risk stratification of pulmonary embolism,etc.Results:Among the 50 patients,19 were male(38％)and 31 were female(62％).The mean age of onset was(67.4±8.5)years old,the onset time was 0.5-264.0 hours,and the mean onset time was 6.5(3.75,24.00)hours.There were 43 cases(86％)with underlying diseases.All patients started with syncope(100％),accompa-nied by dyspnea(36 cases,72％),chest pain(10 cases,20％),dizziness(13 cases,26％),vomiting(7 cases,14％),limb convulsions(6 cases,12％)and other nonspecific symptoms.Blood gas analysis showed 32 cases(64％)of hypoxemia.Mean plasma D-dimer(9.54±7.1)mg/mL;Electrocardiogram indicated tachycardia in 35 cases(70％).There were 30 cases(60％)with right ventricular enlargement by echocardiography,of which the mean value of right atrial and right ventricular measurements was(42.7±3.6)mm,(41.8±4.6)mm and 38 ca-ses(76％)with pulmonary hypertension.In 40 cases(80％),venous ultrasonography of both lower limbs indica-ted thrombus.Pulmonary artery CTA all indicated pulmonary artery filling defect in 45 cases(90％)of central type and 5 cases(10％)of peripheral type.There were 46 patients(92％)with grade Ⅲ pulmonary embolism se-verity index,45 patients(90％)with medium-high risk stratification of pulmonary embolism risk,50 patients with timely anticoagulation treatment after admission,8 patients(16％)received alteplase thrombolysis,and 13 pa-tients(26％)underwent inferior vena cava filter placement.Forty-eight patients(96％)were discharged with im-provement and continued oral anticoagulant therapy,one patient was lost to follow-up after automatic discharge,and one patient died.Conclusion:Acute pulmonary embolism patients with syncope as the first symptom are char-acterized by advanced age,rapid onset,lack of typical symptoms,and high clinical risk stratification.It is of great significance for timely screening of high-risk syncope patients,as well as diagnosis and risk assessment of acute pulmonary embolism.Good prognosis may be found in patients with clear emergency diagnosis and effective anti-coagulation treatment.
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