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Hemodynamic Alterations Related to Extent of Lung Scan Perfusion Defect in Pulmonary Embolism

Veterans Administration Hospital, West Roxbury, Massachusetts
Harvard Medical School, Boston, Massachusetts

Correspondence: For reprints contact: Kevin M. McIntyre, Veterans Administration Hospital, West Roxbury, Mass. 02132.

ABSTRACT

The severity of the hemodynamic abnormality after pulmonary embolism can be related directly to the magnitude of the perfusion defect by pulmonary photoscans in patients free of underlying cardiopulmonary disease. Photoscan defects ranged from 13 to 62%. Systemic hypoxemia was present in all patients. Elevations of pulmonary artery pressure were present in ten patients (71%), all of whom had defects in excess of 25%. Right atrial mean pressure was elevated in half the population, all of whom had defects in excess of 30%. Cardiac index was depressed in only three patients, all of whom had defects of 50% or more, and the depression appeared to be mediated by a progressive impairment in stroke volume as the perfusion defect increased. Each of these hemodynamic parameters became progressively more abnormal as the perfusion defect increased. These relationships permit hemodynamic inferences to be made after pulmonary embolism in patients free of underlying cardiopulmonary disease on the basis of a minimally invasive technique.