Etiology, Predisposing Factors, Clinical Profile, Diagnosis, Management, Outcome, and Way Forward in Pulmonary Embolism at a Tertiary Care Center in East India

Background: Pulmonary embolism (PE) is a quite common condition and is a potentially lethal form of venous thromboembolic phenomenon associated with multiple inherited and acquired risk factors. Despite improvements in diagnostic techniques, delays in recognition and treatment are still common, contributing to increased morbidity and mortality. This study aimed to assess the time from the onset of symptoms to hospital arrival and to analyze delays in diagnosing and initiating treatment for patients with high and intermediate-to-high risk PE.

Materials and methods: A retrospective analysis was performed on 23 patients with high and intermediate-to-high risk PE admitted to a tertiary hospital from January 2021 to December 2023. Patients with pre-existing heart or lung conditions, low-risk PE, or those without follow-up were excluded. Routine blood tests, D-dimer measurement, 2D echocardiography, and CT pulmonary angiography (CTPA) were used to diagnose PE. Thrombolysis with streptokinase was administered in confirmed cases, and patient outcomes were monitored post-hospitalization.

Results: The study included 23 patients, with a mean age of 47.1 years, 65% of whom were male. The most frequent symptom was shortness of breath (78%), followed by chest pain (13%) and syncope (9%). Elevated D-dimer levels were found in 96% of patients, and right ventricular overload was seen in all cases through echocardiography. CTPA confirmed PE in 91% of patients. Significant delays were observed in both hospital arrival and in-hospital diagnosis, with an average delay of more than seven hours before treatment began. Early diagnosis followed by thrombolysis led to favorable outcomes, while delayed diagnosis resulted in poorer outcomes, including residual symptoms and right ventricular dysfunction.

Conclusion: Early diagnosis and treatment of PE greatly enhance patient outcomes, especially with timely thrombolysis. Echocardiography should be utilized promptly in emergency settings to facilitate early treatment. Quick recognition of PE, particularly in patients with risk factors, is essential to reduce mortality and long-term complications.