Pulmonary Embolism (cont.)
Basic testing
Basic testing may include:
The chest x-ray is often normal in pulmonary embolism. The EKG may be normal,
but usually demonstrates a rapid heart rate, so-called sinus tachycardia (heart
rate > 100 bpm). If there is
significant blockage in a pulmonary artery, it acts like a dam and it is harder
for the heart to push blood past the obstructing clot or clots. This can result
in a change in the electrical signal passing through the heart by stretching the
heart muscle, revealed on an EKG a so-called right heart strain.
Since the cost of missing the diagnosis of pulmonary embolus can be death,
the approach to diagnosis is to prove that no pulmonary embolus exists.
Pulmonary angiogram
The gold standard for the diagnosis of pulmonary embolus is a pulmonary
angiogram in which a catheter is threaded into the pulmonary arteries, usually
from veins in the leg. Dye is injected and a clot or clots can be identified
on imaging studies. This is considered an invasive test and should be performed
only by someone with expertise in this procedure.
Fortunately, there are other, less invasive ways to make the diagnosis. The
decision as to which test might best make the diagnosis needs to be
individualized to the patient and their presentation and situation.
Next: d-Dimer blood test »
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