Volschan et al identified clinical findings associated with right ventricular dysfunction in patients with a pulmonary embolus. These can help identify patients who may require more aggressive management. The authors are from the Estudo Multicentrico de Embolia Pulmonar.
Patient selection: Patients with a confirmed pulmonary embolus.
Criteria for right ventricular dysfunction - one or both of the following:
(1) dilatation of the right ventricle
(2) right ventricular hypokinesia
Risk factors associated with right ventricular dysfunction:
(1) tachypnea (> 20 breaths per minute)
(2) hypotension (systolic blood pressure < 90 mm Hg)
(3) S1Q3T3 pattern
(4) right bundle branch block
(5) T wave inversion in leads V1 to V4
Factors associated with a reduced risk for right ventricular dysfunction:
(1) recent surgery (within past 30 days)
|
Parameter |
Finding |
Points |
|
breathing rate |
<= 20 breaths per minute |
0 |
|
|
> 20 breaths per minute |
1 |
|
systolic blood pressure |
>= 90 mm Hg |
0 |
|
|
< 90 mm Hg |
1 |
|
S1Q3T3 pattern |
absent |
0 |
|
|
present |
1 |
|
right bundle branch block |
absent |
0 |
|
|
present |
1 |
|
T wave in V1 to V4 |
not inverted |
0 |
|
|
inverted |
1 |
|
history of surgery |
none |
0 |
|
|
>= 30 days previous |
0 |
|
|
< 30 days previous |
- 1 |
number of risk factors =
= SUM(points for all 6 factors)
Interpretation:
• minimum number of risk factors: -1
• maximum number of risk factors: 5
• The presence of multiple risk factors was associated with an increased risk for right ventricular dysfunction.
Specialty: Pulmonology
ICD-10: ,
