title: [Pulmonary embolism in the coronary care unit].
abstract: Massive pulmonary embolism (MPE), as seen in cardiac care units (CCU), is almost invariably characterized by severe obstruction of the pulmonary vasculature and/or a background of poor cardiorespiratory conditions, all contributing their share to a grave overall situation, often compounded by cardiogenic shock and not exceptionally eventuating in cardiocirculatory arrest (CCA). In such circumstances, echocardiography offers both direct and indirect diagnostic elements that may help, among other things, differentiate pulmonary embolism from acute myocardial infarction--the latter not always easily identified, also in view of its possible occurrence in association with MPE. Conversely, some problems are still open concerning the meaning and treatment of right-sided intracavitary thrombus formations revealed by echocardiography. Among less familiar hemodynamic aspects we must consider right-sided pulsus alternans and the so-called ventricularization of pulmonary pressure curves--a phenomenon to be viewed with caution because of possible modifications imputable to the recording system. Bedside pulmonary angiography, now generally feasible with standard CCU equipment, may readily diagnose or rule out MPE in situations where an angiography room is not available or momentarily not accessible. Numerous personal anatomoclinical observations bear witness to the role of electromechanical dissociation (EMD) as a cause of CCA in patients with MPE. Such dissociation may prove at least temporarily reversible, especially in cases not featuring bradycardia and showing narrow QRS complexes; the concurrent administration of fibrinolytic agents along with cardiopulmonary resuscitation may prove successful while it does not seem to invite important hemorrhagic complications.
authors.affiliation: Divisione di Cardiologia, Ente Ospedaliero S Carlo Borromeo, Milano.
authors.forename: M
authors.initials: M
authors.lastname: Morpurgo
authors.forename: M
authors.initials: M
authors.lastname: Marzegalli
authors.forename: F
authors.initials: F
authors.lastname: Casazza
mesh_terms: D000792:Angiography; D003325:Coronary Care Units; D004452:Echocardiography; D004562:Electrocardiography; D006439:Hemodynamics; D006801:Humans; D011029:Pneumoradiography; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
vernacular_title: L'embolia polmonare in unità di cure coronariche.