The Diagnosis and Management of Pulmonary Embolism and Infarction

Abstract

Pulmonary embolism and infarction is a relatively common disorder of serious significance which is commonly mistaken for many other pulmonary conditions. Its recognition and treatment should be of great interest to all physicians, particularly those specializing in diseases of the chest. It should be recognized promptly to initiate treatment and to try to prevent recurrences. Incidence During recent years there has been a marked apparent increase in frequency which is probably due to an increased alertness of this condition on the part of physicians in general. It was formerly believed that pulmonary embolism and infarction was commonly seen only in patients who had recently undergone operation or delivery. Now we know that it is much more commonly encountered in the practice of internal medicine, particularly in patients with cardiovascular diseases. Although pulmonary embolism has always been common, previously It was diagnosed as all sorts of things, notably pneumonia and pleurisy, and was commonly unrecognized during life. However, during recent years we have come to appreciate its frequency and significance, and the diagnosis can be readily made if the condition is thought of. The incidence is variously reported and is found in about 14 per cent of all carefully performed autopsies.’ It appears sooner or later in a large percentage of cardiac patients, being found In 48 per cent of one series who died of congestive heart failure.2 Sixty per cent of all cases occur in medical patients and at least half of these are found In persons with heart disease. Only about 40 per cent occur in surgical and obstetrical patients.’ A representative figure for a general hospital Is about 0.6 per cent of all medical admissions and about 0.25 per cent of all surgical admissions.3 Pulmonary embolism and infarction account for 5 to 10 per cent of all post-operative deaths.2 Our experience with patients confined to bed because of pulmonary tuberculosis has shown that this is a relatively infrequent complication. The sex distribution is about evenly divided between the two sexes. Pulmonary embolism and Infarction occur much more commonly in older patients, but is a fairly frequent complication in middle-aged or young adults with heart failure. Eighty-five per cent of the cases occur In persons over 40, and at least half are over 50.� It is rare before the age of 20.