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Vascular Medicine, Vol. 8, No. 4, 257-261 (2003)
DOI: 10.1191/1358863x03vm510oa

Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope

R Castelli

Department of Emergency Medicine University of Milan, IRCCS Ospedale Maggiore Policlinico di Milano, castelli39{at}interfree.it

P Tarsia

Department of Emergency Medicine University of Milan, IRCCS Ospedale Maggiore Policlinico di Milano

C Tantardini

Vita-Salute San Raffaele University of Milan, Milan, Italy

G Pantaleo

Department of Emergency Medicine University of Milan, IRCCS Ospedale Maggiore Policlinico di Milano

A Guariglia F Porro

Department of Emergency Medicine University of Milan, IRCCS Ospedale Maggiore Policlinico di Milano

Syncope as an initial presentation of pulmonary embolism occurs in 10% of patients. We compared clinical and instrumental parameters in patients with syncope as the presenting symptom of pulmonary embolism and in patients with documented pulmonary embolism without syncope. Seventy patients with the diagnosis of pulmonary embolism and apparently stable clinical conditions were evaluated. They were divided in two groups: 10 patients with syncope as the presenting symptom of pulmonary embolism (group 1) and 60 patients without syncope (group 2). Patients with syncope showed a more pronounced tendency to present with main pulmonary artery embolus than patients without syncope (contingency coefficient = 0.301, p < 0.04; one-tailed). However, despite the evidence that patients with syncope have significant reductions in systolic and=or diastolic blood pressure, shock was not observed in any patient. In no case was thrombolytic treatment given and all patients received standard anticoagulation with unfractioned heparin and oral anticoagulant. We suggest that syncope in the setting of non-massive pulmonary embolism may be due to vaso-vagal mechanism that can lead to a reduction of arterial blood pressure when central artery thrombosis is involved.

Key Words: pulmonary embolism • syncope • vasovagal reflex


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