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Syncope in pulmonary embolism: a retrospective cohort study
  1. Craig Richmond,
  2. Hannah Jolly,
  3. Chris Isles
  1. Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  1. Correspondence to Chris Isles, Medical Unit, Dumfries Infirmary, Dumfries DG2 8RX, UK; chris.isles{at}nhs.net

Abstract

Objective To determine the prevalence of syncope or collapse in pulmonary embolism (PE).

Methods A retrospective cohort study was conducted. We examined the frequency with which syncope or collapse (presyncope) occurred alone or with other symptoms and signs in an unselected series of 224 patients presenting to a district general hospital with PE between September 2012 and March 2016. Confirmation of PE was by CT pulmonary angiogram in each case.

Results Our cohort of 224 patients comprised 97 men and 127 women, average age 66 years with age range of 21–94 years. Syncope or collapse was one of several symptoms and signs that led to a diagnosis of PE in 22 patients (9.8%) but was never the sole presenting feature. In descending order, these other clinical features were hypoxaemia (17 patients), dyspnoea (12), chest pain (9), tachycardia (7) and tachypnoea (7). ECG abnormalities reported to occur more commonly in PE were found in 13/17 patients for whom ECGs were available. Patients with PE presenting with syncope or collapse were judged to have a large clot load in 15/22 (68%) cases.

Conclusion Syncope was a frequent presenting symptom in our study of 224 consecutive patients with PE but was never the sole clinical feature. It would be difficult to justify routine testing for PE in patients presenting only with syncope or collapse.

  • Accident & emergency medicine
  • cardiology
  • thromboembolism
  • general medicine (see internal medicine)

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Footnotes

  • Contributors CI had the idea for the article, CR and HJ extracted the clinical data from the electronic case sheet, CI wrote the first draft and all three authors contributed to the final draft.

  • Funding This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests We have read and understood the BMJ Group policy on declaration of interests and declare there are no competing interests. We have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the 3 previous years; no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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