Background: Echocardiography is recommended after acute pulmonary embolisms (PE) to risk stratify patients at risk of developing chronic thromboembolic pulmonary hypertension (CTEPH) and then at six to eight weeks if elevated pulmonary artery systolic pressure (PASP) is found initially. The true incidence of CTEPH is unknown but ranges from 0.01% to 3%. PASP >50 mm Hg and age >70 years are risk factors for CTEPH. CTEPH is insidious in onset and missed in many patients. It is potentially curable if diagnosed early.
Methods: A retrospective one year case note review was undertaken of all confirmed (CT pulmonary angiography proven) PE cases (66 patients) admitted in Ballarat Base Hospital. Clinical variables, management and echocardiography reports were reviewed.
Results: Mean age was 59 years. Forty-seven percent of patients had troponin measured at diagnosis (Males 48%, females 44%) those with elevated troponin I (>0.04 ng/L) had prolonged hospital stay compared to normal result (10 days versus 5.4 days). Sinus tachycardia was most common ECG finding (30.3%).S1Q3T3 pattern on ECG was found in six patients. Deep venous thrombosis (DVT) accompanying PE was confirmed in 33% (22) patients. Echocardiogram was done in 45% (30) patients, with three patients (10%) all aged <70 years having pulmonary artery systolic pressure >50 mm Hg. Thus 33 eligible patients did not have echocardiogram.
Conclusion: Echocardiography is underutilised in acute PE in some regional hospitals in Australia. Elevated troponin levels are associated with increased short term morbidity in acute PE. There is a high proportion of accompanying DVT with acute PE.
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© 2011 Published by Elsevier Inc.
