11), 12), 13), 14) Clinical presentation of PE varies from an asymptomatic small pulmonary embolus with low mortality to a massive PE resulting in failure of the right ventricular (RV) with shock, and/or death. However 30% of patients with PE have no detectable provoking factors and, as shown in the Emergency Medicine Pulmonary Embolism in the Real World Registry (EMPEROR), International Cooperative Pulmonary Embolism Registry (ICOPER), and Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registries, the mean age of PE patients ranges from 56 to 66 years, with older people and females having mild prevalence. PE risk factors include obesity, immobilization, cigarette use, cancer, surgery, trauma, pregnancy, oral contraceptives or hormone replacement therapies, and a prior history of PE or a known hype-coagulable disorder. 4), 5), 6) The correct annual number of VTE events is hard to obtain due to the difficult diagnosis based mostly on the following factors: 1) VTE is often clinically silent with the first sign of the disease being sudden fatal death (30–50% of cases) 7) 2) clinical presentation mimics the characteristics of several other conditions, resulting in mistaken diagnoses 8) 3) PE detection during autopsy is very difficult and requires close inspection of the pulmonary vascular tree in order to uncover small acute emboli or the residua of chronic thrombo-emboli 9) and 4) sensitivity and specificity of diagnostic tests for the disease remain weak. In 2001, the number of VTE-related deaths was estimated at 543,454 per annum across Europe, more than double comparing with the number of combined deaths due to acquired immune deficiency syndrome (AIDS) (5,860), breast cancer (86,831), prostate cancer (63,636), and road accidents (53,599). 1) PE is the third most frequent cardiovascular disease after acute myocardial infarction (AMI) and stroke, with an annual incidence of 1–2 per 1,000 people (100–200 per 100,000 inhabitants). In the United States PE affects about 500,000 to 600,000 people per year, with 200,000 to 300,000 deaths per year. Acute pulmonary embolism (APE) is the most serious clinical presentation of venous thrombo-embolism (VTE) with fatal pulmonary embolism (PE) being a common cause of sudden death (SD), usually resulting from a complication of deep venous thrombosis (DVT).
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