LUNGENEMBOLIE

Abstract

Patients with pulmonary embolism present nonspecific symptoms (chest pain, dyspnea, circulation disorders) which lead to wide range of differential diagnoses. In most cases standard diagnostic procedures like electrocardiogram, chest X-ray, laboratory workup and transthoracic echocardiography could only give a hint. However these examinations often provide the diagnosis of other thoracic disorders with similiar symptoms. In patients with acute respiratory insufficiency and unstable hemodynamics a transesophageal echocardiogram should be the first procedures after standard investigations. Emboli in the central parts of the pulmonary arteries are detected with this method. If the patient is in a stable condition we recommend phlebography adjacent to standard tests to plan treatment. Thrombolysis should be performed only in patients with severe pulmonary embolism, since improvement of the prognosis is questionable. To classify pulmonary embolism and to select patients for thrombolysis measurement of the blood pressure, heart rate and arterial oxygen are recommended. Rt-PA has been shown to be superior to other thrombolytic drugs in achieving rapid reperfusion of the occluded pulmonary arteries. In life-threatening cases a bolus regimen offers advantages and fragmentation of the emboli by catheters should be considered.