Pulmonary Embolism: Clinical Characteristics, Hospital Course and Outcome; Experiences at Lady Reading Hospital Peshawar

Objective: To evaluate the risk factors, clinical characteristics, therapeutic options and outcome of patients with pulmonary embolism (PE). Materials and Methods: Data were collected retrospectively by reviewing medical records of patients admitted to intensive care unit (ICU) of lady Reading Hospital Peshawar, with primary diagnosis of pulmonary embolism (PE). Demographic, clinical, radiological, treatment and outcome data were collected. Results: A total of 62 patients; 37 (60%) male and 25 (40%) female, were included in the study. The mean age (± SD) was 49.3 ± 13.14 years. Immobilization 43 (69.4), recent major surgery 25 (40.3), obesity 35 (56.5), active malignancy 16 (25.8) and recent trauma 15 (25.2) were frequent risk factors. Major presenting symptoms were dyspnea 59 (95.2%) and chest pain 28 (45.2%). Vital signs at presentation were; heart rate 117.41 ± 14.36 beats / min, systolic blood pressure 98.36 ± 15.38 mm Hg and respiratory rate 21.06 ± 2.7 breaths/min. Forty (64.5%) patients had hypoxemia and 12 (19.4%) patients were hypotensive on presentation. The chest radiograph was abnormal in 34 (54.8%) patients with cardiomegaly as the commonest finding 22 (35.5%). The most frequent abnormalities on electrocardiogram were sinus tachycardia 46 (74.2%) and S1Q3T3 pattern 34 (54.8%). Echocardiography showed evidence of right ventricular dysfunction in 59 (95.16%) patients, right ventricular (RV) hypokinesis in 47 (75.8%) and right ventricular dilatation in 47 (75.8%). On spiral CT chest, embolus was visualized in the main pulmonary artery in 19 (30.6%) patients, right pulmonary artery in 40 (64.6%) and left pulmonary artery in 44 (71%) patients. All patients were anti-coagulated with either intravenous heparin 40 (64.5%) or enoxaparin 22 (35.5). In addition intravenous thrombolytic therapy (streptokinase) was given in 15 (24.2%) patients and 6 (9.7%) patients underwent surgical embolectomy. Warfarin was given in 49 (79%) patients at hospital discharge. During ICU stay various complications developed including cardiogenic shock 12 (19.4%), severe hypoxemia 40 (64.5%), right heart failure 24 (38.3%) and nosocomial infection 12 (19.4%). Ten 16.1% patients died mainly due to cardiogenic shock and refractory hypoxemia. Conclusion: Pulmonary embolism is a life threatening disease with certain predisposing risk factors and nonspecific clinical presentation. Early diagnosis and aggressive treatment improves the clinical outcome.