Acute pulmonary embolism and pulmonary infarction]

32 cases of pulmonary embolism were reported, 18 cases had been autopsied (massive pulmonary embolism 9 cases. moderate pulmonary embolism 23 cases). The incidence risk factors pathogenesis, clinical manifestations of pulmonary embolism were presented. The relation between pulmonary embolism and pulmonary infarction and treatment of massive pulmonary infarction were discussed.     

Clinico-pathological analysis of 100 autopsy cases of massive or submassive pulmonary thrombo-obstruction in cardiovascular and pulmonary diseases

A clinico-pathological analysis of 100 autopsy cases of thrombo-obstruction in the segmental and those bigger arteries of the lungs caused by cardiovascular and pulmonary disease was reported. These complications of pulmonary thrombosis and/or embolism were more commonly observed in rheumatic heart disease (29% of the same disease in autopsies), congestive cardiomyopathy (26%) and cor pulmonale (19%). There were 2-4% of the autopsy cases of other cardiovascular and pulmonary diseases. The pulmonary thrombo-obstruction and/or infarction were more frequent in right lower lobes of the lungs and they were often multiple. The pulmonary infarction occurred in 76% of these cases. 35% of 100 cases occurred with sudden death. Only 13% of 100 patients with pulmonary thrombosis and/or embolism were diagnosed before autopsy. The causes of pulmonary thrombo-obstruction and the diagnostic suggestion were discussed in this paper.     

Elevations of CK-MB following pulmonary embolism. A manifestation of occult right ventricular infarction.

To determine the frequency and etiology of elevations of CK-MB in patients with pulmonary emboli, we studied 52 patients with well-documented emboli and the absence of known ischemic heart disease or ECG changes suggestive of acute infarction. All patients were evaluated with serial CK-MB determinations at 8-h intervals. All patients with elevations of CK-MB had noninvasive cardiac evaluations. Four (7.7 percent) of the 52 patients had a rising and falling pattern of CK-MB that satisfied enzyme criteria of acute infarction. Three of these four also manifested classic echocardiographic features of right ventricular infarction. None of the four had evidence of left ventricular regional wall motion abnormalities or dysfunction. Of the 48 patients without elevations of CK-MB, only two had segmental right ventricular dysfunction. These findings suggest that pulmonary emboli can induce right ventricular infarction in some (7.7 percent) patients even when patients with a history of coronary artery disease and/or ECG changes of infarction are excluded. Conversely, the diagnosis of pulmonary embolism should be considered in patients when right ventricular infarction is diagnosed.     

Long-term prognosis of treated acute massive pulmonary embolism.

Seventy-two patients surviving initial treatment by pulmonary embolectomy, streptokinase, or heparin for acute massive pulmonary embolism have been reviewed 1 to 9 years later. Of these patients, 17 had additional cardiorespiratory disease. There were 12 late deaths (41% of those patients with, and 9% of those patients without additional cardiorespiratory disease). No death was due to chronic pulmonary hypertension, and none to certain recurrence of pulmonary embolism. The causes of death were malignant disease (6 patients), cardiopulmonary disease other than pulmonary embolism (4 patients), and 'sudden' (2 patients). Though venous interruption surgery was not used, and long-term anticoagulation rare, the incidence of possible or probable recurrent embolism was low (6%). There was no definite evidence of persistence or subsequent development of pulmonary hypertension after treatment in any patient. Resolution of embolism as judged by symptoms, signs, electrocardiogram, and chest x-ray examination was almost always complete. Some pulmonary arteriograms 1 to 6 months after initial treatment showed minor abnormalities, but others at a later date were normal. Perfusion lung scans carried out 1 to 8 years after initial treatment often showed minor abnormalities.     

电子束CT诊断肺动脉栓塞

目的 ::评价电子束 CT（EBCT）对肺动脉栓塞的诊断价值与优势。方法 :对 2 0 0 2 - 0 5～ 2 0 0 3- 0 4经 EBCT确诊的 9例肺栓塞的 CT征象进行分析 ,探讨其诊断价值。结果 :左、右两侧段以上肺动脉发生栓塞的几率相近 ,右侧5 2 .6 % （71/ 135 ） ,左侧 4 9.6 % （6 7/ 135 ） ,右侧略高。但左侧闭塞的段以上肺动脉有 19支 ,右侧仅 4支。各叶段以上肺栓塞的发生率以下叶最高 ,达 6 1.1% （6 6 / 10 8） ,其次为上叶的 4 5 .8% （33/ 72 ）和中叶及舌叶的 4 0 .7% （2 2 / 5 4 ）。左、右中间肺动脉的栓塞率为 5 0 % （9/ 18）。 36 0支亚段肺动脉中有 115支栓塞 （31.9% ） ,其中明确的栓塞 76支 （包括 2 6支闭塞 ） ,可疑 39支。肺栓塞的 EBCT直接征象 :管腔内中心性或偏心性充盈缺损及“轨道征”、“漂浮征”和完全闭塞 （闭塞血管管径大于正常管径 ）。间接征象 :偶可见“马赛克征”和梗死灶 ,多数见局限性肺纹理稀疏。另外还有胸水、肺动脉及右心轻度扩张等。结论 :电子束 CT扫描速度快 ,运动伪影小 ,对段以上肺栓塞能清晰显像并准确诊断 ,可作为肺栓塞的首选无创性检查方法。局限性是空间分辨率低 ,对亚段以下肺动脉栓塞的评价并不十分可靠。     

Elevated cardiac troponin levels in patients with submassive pulmonary embolism.

BACKGROUND: Cardiac troponins are reliable markers of myocardial injury that are being used increasingly in patients presenting with undifferentiated chest pain or dyspnea to diagnose an acute coronary syndrome. If elevated cardiac troponin levels also occur in patients with pulmonary embolism because of right ventricular dilation and myocardial injury, such patients could be misdiagnosed. We performed a prospective cohort study to determine the prevalence of elevated cardiac troponin I (cTnI) levels in patients with submassive pulmonary embolism. METHODS: Consecutive patients with objectively confirmed submassive pulmonary embolism and no previous history of ischemic heart disease, other cardiac disease, or renal insufficiency were included. Creatine kinase and cTnI levels were measured within 24 hours of clinical presentation on 2 occasions 8 to 12 hours apart. RESULTS: Of 24 patients with submassive pulmonary embolism, 5 (20.8%) had elevated cTnI levels of 0.4 microg/L or higher (95% confidence interval, 7.1-42.2%). One of these patients had a cTnI level higher than 2.3 microg/L that was suggestive of myocardial infarction. CONCLUSION: Pulmonary embolism should be considered in the differential diagnosis of patients presenting with undifferentiated chest pain or dyspnea and an elevated cardiac troponin level.     

A retrospective study of pulmonary infarction in patients with systemic lupus erythematosus from southern Taiwan

Since large-scale reports of pulmonary infarction in systemic lupus erythematosus (SLE) are limited, a retrospective study was performed for this manifestation in 773 hospitalized patients in southern Taiwan from 1999 to 2009. Pulmonary infarction was defined as the presence of pulmonary embolism, persistent pulmonary infiltrates, and characteristic clinical symptoms. Demographic, clinical, laboratory, and radiological images data were analyzed. There were 12 patients with pulmonary embolism and 9 of them had antiphospholipid syndrome (APS). Six patients (19 to 53 years, average 38.2?±?12.6) with 9 episodes of lung infarction were identified. All cases were APS and four episodes had coincidental venous thromboembolism. There were four episodes of bilateral infarction and seven episodes of larger central pulmonary artery embolism. Heparin therapy was routinely prescribed and thrombolytic agents were added in two episodes. Successful recovery was noted in all patients. In conclusion, there was a 0.8% incidence of pulmonary infarction in patients with SLE, all with the risk factor of APS. Differentiation between pulmonary infarction and pneumonia in lupus patients should be made; they have similar chest radiography with lung consolidation but require a different clinical approach in management. Although this report is a retrospective study with relatively small numbers of lupus patients with lung infarcts, our observation might provide beneficial information on the clinical features and radiological presentations during the disease evolution of pulmonary infarction in SLE with APS.     

Causes and presenting features of pulmonary infarctions in 43 cases identified by surgical lung biopsy

BACKGROUND: Although pulmonary infarction is usually associated with pulmonary thromboembolism, it can occur with other disorders such as vasculitis, angioinvasive infections, sickle-cell disease, tumor embolism, and pulmonary torsion. STUDY OBJECTIVE: To identify causes and presenting features of pulmonary infarctions diagnosed by surgical biopsy in a consecutive series of patients encountered at a single institution. DESIGN: Retrospective review. SETTING: Tertiary care, referral medical center. PATIENTS: Forty-three patients with pulmonary infarction identified on surgical lung biopsy over a period of 7 years, January 1996 through December 2002. RESULTS: The median age of these 43 patients was 55 years (range, 22 to 85 years); 17 patients (40%) were women, and 26 patients (60%) were men. Thirty-five patients (81%) had a smoking history. Twenty-eight patients (65%) presented with solitary or multiple lung nodules/masses of undetermined etiology. The underlying cause was identifiable in 31 cases (72%) based on a review of clinical, laboratory, radiologic, and histopathologic data. The two most common causes were pulmonary thromboembolism (18 cases, 42%) and pulmonary infections (5 cases, 12%). Thromboembolic pulmonary infarctions typically presented as solitary or multiple nodules located in the subpleural regions. Other causes included diffuse alveolar damage in two cases (5%), pulmonary torsion in two cases (5%), and one case each of lung cancer, amyloidosis, embolotherapy, and catheter embolism. In 12 cases (28%), the underlying cause was not directly identifiable but was probably due to previous pulmonary thromboembolism. CONCLUSION: We conclude that although pulmonary thromboembolism is the most common cause of pulmonary infarction identified by surgical lung biopsy, a variety of other causes are clinically encountered, including infections, inflammatory or infiltrative lung diseases, pulmonary torsion, malignancy, and nonthrombotic embolism. Pulmonary infarction should be considered in the differential diagnosis of peripheral lung nodules or masses.     

The incidence of pulmonary embolism in unexplained sudden cardiac arrest with pulseless electrical activity

PURPOSE: The cause of many cases of sudden cardiac arrest from pulseless electrical activity is unknown. We hypothesized that pulmonary embolism was responsible for a substantial proportion of these cases and used transesophageal echocardiography to identify pulmonary embolism among patients with sudden cardiac arrest. SUBJECTS AND METHODS: We performed a prospective study at a tertiary care, university-operated county hospital, with a level 1 trauma center. Consecutive patients (n = 36) who were admitted with (n = 20) or unexpectedly developed (n = 16) sudden cardiac arrest of unknown cause were studied with transesophageal echocardiography during cardiopulmonary resuscitation. We determined the presence of central pulmonary embolism, right ventricular enlargement, and other causes of sudden cardiac arrest (such as myocardial infarction and aortic dissection) using prospectively defined criteria. RESULTS: Of the 25 patients with pulseless electrical activity as the initial event, 9 (36%) had pulmonary emboli (8 seen with transesophageal echocardiography and 1 diagnosed at autopsy) compared with none of the 11 patients with other rhythms, such as asystole or ventricular tachycardia or fibrillation (P = 0.02). Of the 8 patients who had pulmonary embolism diagnosed by transesophageal echocardiography, 2 survived to hospital discharge. CONCLUSIONS: Mortality from massive pulmonary embolism is high, particularly if patients present with sudden cardiac arrest. Earlier diagnosis of pulmonary embolus may permit wider use of thrombolytic agents or other interventions and may potentially increase survival.     

特发性肺血栓栓塞症33例临床回顾性分析

目的了解特发性肺栓塞的临床特点,提高特发性肺栓塞的诊治水平。方法对2010年7月至2012年2月于解放军总医院无获得性血栓形成高危因素的33例特发性肺栓塞住院患者的一般资料、临床表现、辅助检查、误诊情况及治疗进行统计学分析。结果本组特发性肺栓塞病例性别差异无统计学意义,平均年龄（57．6±14．1）岁,平均体质量指数（26．4±3．2）。临床表现以呼吸困难（97．0％）和胸痛（30．3％）为主。实验室检查中,D-二聚体〉0．5mg／L者30例（90．9％）,脑利钠肽〉150ng／L者15例（57．7％）,Pa02〈75mmI-Ig者15例（51．7％）。心电图主要以V1～V4ST-T改变（60．6％）为主,超声心动图主要表现为肺动脉压力升高,血管螺旋CT及肺动脉造影表现为不同程度的充盈缺损。首诊误诊以急性心肌梗死及肺炎多见,误诊率达69．7％。本组病例均采用抗凝治疗,部分患者行溶栓和（或）介入治疗。结论特发性肺栓塞因缺乏易感因素而易误诊,应综合临床表现、D-二聚体及影像学检查确定疑诊患者,并尽快行肺动脉造影检查确诊。     

Pulmonary embolism in medical patients: an autopsy-based study.

Pulmonary embolism, though treatable, is a devastating disease and an important cause of morbidity and mortality among hospitalized patients. In all, 1000 autopsies were reviewed in adult medical patients. The overall incidence of pulmonary embolism in adult medical autopsies was 15.9% (159/1000). The incidence of pulmonary embolism contributing significantly to the death of the patients (groups 1 and 2) is 126/1000 (12.6%). Thus, pulmonary embolism very significantly contributed to death in 126/159 (79.24%) of group 1 and 2 patients. Pulmonary embolism affected a younger population as 79.87% of the overall patients, 66.67% of the fatal cases (group 1) and 73% of combined group 1 and 2 cases were below the age of 50 years. Sepsis was the primary diagnosis in 32% of total and in 42% of fatal cases. Hence, pulmonary embolism is considered as an important cause of death in patients admitted to the medical wards. It affects a younger population in India and needs to be tackled appropriately.     

Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation

OBJECTIVE - To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS - Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS - Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions were more commonly related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction (10%). The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION - The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.     

老年肺动脉血栓栓塞误诊70例临床分析

目的分析老年肺动脉血栓栓塞(肺栓塞)的特点及误诊原因,以提高对老年肺栓塞的早期识别和处理。方法回顾性分析70例老年肺栓塞误诊患者的临床表现、超声心动图、心肌酶、肌钙蛋白Ⅰ、血气分析、D-二聚体、胸部X线及其他影像等临床资料,总结分析误诊的原因。结果 70例老年肺栓塞患者中,临床表现胸闷、呼吸困难57例(81.4%),胸痛27例(38.6%),咳嗽15例(21.4%),晕厥13例(18.6%),误诊疾病主要为冠心病46例(65.7%),心功能不全7例(10.0%),肺部感染5例(7.1%),慢性阻塞性肺病3例(4.3%),脑梗死3例(4.3%)。肺栓塞临床分类大面积1 9例,次大面积37例,小面积14例。结论老年肺栓塞多合并基础疾病,患者非特异性的临床症状、心电图的改变、肌钙蛋白I及心肌酶的升高、胸部X线浸润阴影为误诊主要原因。     

A structured clinical model for predicting the probability of pulmonary embolism

PURPOSE: To develop a structured model to predict the clinical probability of pulmonary embolism. METHODS: We studied 1,100 consecutive patients with suspected pulmonary embolism in whom a definite diagnosis had been established. We used logistic regression analysis to estimate the probability of pulmonary embolism based on patients' clinical characteristics; the probability was categorized as low (< or = 10%), intermediate (>10%, < or = 50%), moderately high (>50%, < or = 90%), or high (>90%). RESULTS: The overall prevalence of pulmonary embolism was 40% (n = 440). Ten characteristics were associated with an increased risk of pulmonary embolism (male sex, older age, history of thrombophlebitis, sudden-onset dyspnea, chest pain, hemoptysis, electrocardiographic signs of acute right ventricular overload, radiographic signs of oligemia, amputation of the hilar artery, and pulmonary consolidation suggestive of infarction), and five were associated with a decreased risk (prior cardiovascular or pulmonary disease, high fever, pulmonary consolidation other than infarction, and pulmonary edema on the chest radiograph). With this model, 432 patients (39%) were rated a low probability, of whom 19 (4%) had pulmonary embolism; 283 (26%) were rated an intermediate probability, of whom 62 (22%) had pulmonary embolism; 72 (7%) were rated a moderately high probability, of whom 53 (74%) had pulmonary embolism; and 313 (28%) were rated a high probability, of whom 306 (98%) had pulmonary embolism. CONCLUSION: This prediction model may be useful for estimating the probability of pulmonary embolism before obtaining definitive test results.     

Intraventricular thrombi in acute myocardial infarct. The Iberian Multicenter Study. Presentation of the study protocol and various preliminary results

OBJECTIVE: To evaluate the incidence of left intraventricular thrombosis and systemic embolism after acute myocardial infarction, as well as to determine the risk factors of each one of them. To study the morphologic aspects of the thrombus and its relation with systemic embolism. CONCEPTION AND POPULATION: 1505 consecutive patients with acute myocardial infarction from six Iberian Hospital Coronary Care Units--five from Spain and one from Portugal--were studied. All protocols included a clinical evaluation and a M-mode and 2D echocardiographic study at days 1, 3, 7 at hospital discharge, as well as at months 1, 3, 6, 12, and 24 of the follow-up. In the intraventricular thrombus evaluation just the III and IV Asinger grades were considered. RESULTS: From the total studied patients an echocardiographic study of good quality for thrombus evaluation was found in 1360, and 305 (22.3%) of these had a left ventricular thrombus. In anterior infarctions the incidence of thrombus was 39.9%, and in the other localizations was 11.2%. In what concerns the thrombus morphologic aspects, we found a small thrombus (less than 4 cm2) in 71% of the cases, and a big one (greater than or equal to 4 cm2) in 29%; the shape was laminar in 53.6%, protuberant in 41.7% and pediculated in 4.6%; the outline was smooth in 56.7% and irregular in 43.3%; the echodensity was considered homogeneous in 60.1% heterogeneous in 37.6% and cavitated in 3.3%. Of the several parameters evaluated the following were correlated with left intraventricular thrombosis: anterior localization of the infarction, left ventricular failure, ventricular aneurysm, post infarction angina, bundle branche block and no thrombolytic therapy. The incidence of systemic embolism in a mean follow-up of 290 days was 3.96%, being maximum in the first month (3.4%), but an embolic episode still occurred in the following months in 3.02% of the cases. Systemic embolism correlated with left ventricular thrombus, the pediculated shape and the big size of it, as well as with the oldest patients. CONCLUSIONS: A high incidence of left intraventricular thrombosis after acute myocardial infarction correspond to a low incidence of systemic embolism. Some parameters correlated with intraventricular thrombus or with embolism, what allowed us to consider them as risk factors of these clinical entities.     

急性脑血管病后合并肺栓塞8例临床诊治分析

目的:总结急性脑血管病后合并肺栓塞的临床特点,诊治现状,提高对疾病的诊治水平和生存率。方法:对8例急性脑血管病后合并肺栓塞患者的易患因素、临床表现、辅助检查、治疗及转归进行临床分析。结果:8例患者中,急性脑梗死6例,急性脑出血2例,易患因素主要为长期卧床,高龄,肥胖,充血性心力衰竭,吸烟;临床表现不典型,主要为呼吸困难,咳嗽,不明原因烦躁,心悸,咳血;治疗方面仅2例给予抗凝治疗并且症状好转,4例未予抗凝治疗,症状无好转且其中2例出院1月内死亡,2例年轻患者发病1h内死亡。结论:急性脑血管病后合并肺栓塞易患因素多,临床症状不典型,早期诊断和治疗难度大,预后差,临床医师应充分重视提高早期诊断水平,以提高生存率。     

Incidence of embolic or thrombotic processes during the immediate convalescence from acute myocardial infarction

One hundred consecutive cases of acute coronary occlusion and myocardial infarction were studied, and the incidence of subsequent intravascular thrombosis or embolism during the immediate convalescent period has been tabulated.Complications of a thrombotic or embolic nature occurred in thirty-seven cases. In four cases the complication caused the death of the patients, in eight cases the complications were contributing factors in the death of the patients, and in seventeen other cases the complication was of considerable importance in the future health of the persons concerned.A second myocardial infarction occurred in fifteen cases, pulmonary embolism occurred in fourteen cases, cerebral thrombosis or embolism complicated eight cases, arterial occlusions were noted in four instances, and thrombophlebitis complicated seven cases.Forty-six of the patients were known to have had normal blood pressure prior to the coronary occlusion and myocardial infarction. Ten (22 per cent) had subsequent myocardial infarctions during the immediate convalescent period. Forty-two of the total group of one hundred patients had had hypertension prior to coronary occlusion, and two (5 per cent) had subsequent myocardial infarctions during the immediate convalescent period. In twelve cases, the blood pressure prior to coronary occlusion was not definitely known. Three of these patients had a second myocardial infarction during their residence in the hospital.Eighty-seven per cent of the cases of second myocardial infarction and 87 per cent of the instances of cerebral vascular accidents occurred between the fourth and the twentieth day, and 86 per cent of the cases of thrombophlebitis occurred between the tenth and the sixteenth day, periods when the blood pressure of patients who have acute myocardial infarctions has been demonstrated to be at the lowest levels.Thirteen of the patients died. Two of them died as a result of cerebral thrombosis, one from pulmonary embolism, and one from a second myocardial infarction. Two other patients died of congestive heart failure. In seven instances death was sudden, but the exact cause was not ascertained.     

心肺疾病老年人并发肺栓塞的误诊分析(附23例临床分析)

目的:提高对患心、肺系统疾病老年人并发肺栓塞的认识,探讨及时确诊措施。方法:总结23例老年人肺栓塞的临床表现、实验室检查、影像检查等诊断资料。结果:78%患者表现突发性呼吸困难,以晕厥为首发症状者5例(21.7%),100%有低氧血症,10例行下肢静脉造影者中8例有下肢静脉血栓,14例核素肺扫描和18例肺动脉造影者均有PE诊断依据。误诊时间:<2周12例,6周至2年11例。最多是误诊为心绞痛或心肌梗塞者,共19例(82.6%)结论:晕厥、突发性呼吸困难、下肢静脉血栓为疑诊肺栓塞的主要征象,核素肺扫描、肺动脉造影为其诊断主要手段。     

Antithrombotic therapy practices in US hospitals in an era of practice guidelines

BACKGROUND: Antithrombotic therapy is efficacious for the prevention of thromboembolic disease, but it necessitates careful risk-benefit assessment. METHODS: Antithrombotic therapy data were retrospectively collected from inpatient medical records at 38 US hospitals. Patients treated for atrial fibrillation, acute myocardial infarction, deep vein thrombosis, or pulmonary embolism and patients given prophylaxis for total knee replacement, total hip replacement, or hip fracture surgery between July 1, 2000, and June 30, 2003, were randomly selected. RESULTS: The medical records of 3778 patients (53.3% men) were included. The mean patient age was 66.1 years. Of patients with atrial fibrillation at high risk for stroke, only 54.7% received warfarin sodium, and 20.6% received neither aspirin nor warfarin. Of patients with acute myocardial infarction, only 75.5% received aspirin on hospital arrival. After orthopedic surgery procedures, only 85.6% of patients received prophylaxis with a parenteral anticoagulant agent or warfarin. In 49.4% of patients with deep vein thrombosis, pulmonary embolism, or both, unfractionated or low-molecular-weight heparin use was discontinued before an international normalized ratio of 2.0 or greater was achieved for 2 consecutive days. Patients with deep vein thrombosis or pulmonary embolism were rarely discharged from the hospital with bridge therapy (an injectable anticoagulant agent plus warfarin), although the length of hospitalization was significantly shorter than if discharged taking warfarin alone (4.0 vs 8.1 days; P < .001). CONCLUSIONS: A significant percentage of hospitalized patients do not receive adequate antithrombotic therapy for the primary and secondary prevention of thromboembolic disease.     

Pulmonary embolism as a cause of death in patients with heart disease: an autopsy study

STUDY OBJECTIVE: To establish the prevalence of pulmonary embolism (PE) in autopsy material at a tertiary cardiac referral center and its importance as a cause of death in patients with heart disease (HD). DESIGN: Case series. SETTING: National Heart Institute, Mexico City. PATIENTS: One thousand thirty-two patients who died at our institution from 1985 to 1994 in whom an autopsy study was performed. MEASUREMENTS AND RESULTS: Of the 1,032 autopsies reviewed, 231 cases (24.4%) of PE were found; 100 of these patients had a diagnosis of massive PE. Massive PE (obstruction of either of the main pulmonary arteries or more than two lobar arteries) was found to be the third cause of death in this HD population. By age-group distribution, the global prevalence of massive events was higher in patients < 10 years old. Clinical suspicion (premortem) was raised in only 18% of the cases. CONCLUSIONS: PE was a frequent cause of morbidity and mortality in patients with HD who underwent autopsies. The incidence of massive PE was high in children.