Author + information
- Received March 4, 1991
- Revision received June 6, 1991
- Accepted July 2, 1991
- Published online November 15, 1991.
- Paul D. Stein, MD, FACC∗,a,
- Alexander Gottschalk, MDa,∗,
- Herbert A. Saltzman, MDa,† and
- Michael L. Terrin, MD, MPHa,‡
- ↵∗Address for reprints: Paul D. Stein, MD, Henry Ford Heart and Vascular Institute, 2799 West Grand Boulevard, Detroit, Michigan 48202.
The diagnostic features of acute pulmonary embolism among 72 patients ≥70 years old were evaluated and compared with characteristics of pulmonary embolism among 144 patients 40 to 69 years and 44 patients <40 years old. Syndromes characterized by either 1) pleuritic pain or hemoptysis, 2) isolated dyspnea, or 3) circulatory collapse were observed with comparable frequency among patients ≥70 years old and younger patients. One of these presenting syndromes occurred in 64 (89%) of the 72 patients ≥70 years old. Those who did not show these syndromes were identified on the basis of unexpected radiographic abnormalities, which may have been accompanied by tachypnea or 3 history of thrombophlebitis.
Among the 72 patients ≥70 years with pulmonary embolism, dyspnea or tachypnea (respirations ≥20/min) occurred in 66 (92%), dyspnea or tachypnea or pleuritic pain in 68 (94%) and dyspnea or tachypnea or radiographic evidence of atelectasis or a parenchymal abnormality in 72 (100%). Complications of angiography were evaluated among patients with and without pulmonary embolism. Major complications of pulmonary angiography among patients ≥70 years old (2 [1%] of 200) were not more frequent than among younger patients (6 [1.1%] of 562) (p = NS). However, renal failure (major or minor) was more frequent in patients ≥70 years old than in younger patients (6 [3%] of 200 versus 4 [0.7%] of 562) (p < 0.05).
The nonspecific manifestations of pulmonary embolism, even among patients ≥70 years of age, are usually present. When necessary, pulmonary angiography can be performed with no greater overall frequency of complications in elderly patients, although renal failure after angiography is a problem in the elderly.
☆ This study was supported by Contracts NO1-HR-34007, NO1-HR-34008, NO1-HR-34012 and NO1-HR-34013 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
- Received March 4, 1991.
- Revision received June 6, 1991.
- Accepted July 2, 1991.