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European and American guidelines on diagnosis and evaluation of patients with syncope barely mention pulmonary embolism (PE) as a diagnostic consideration (Eur Heart J 2009; 30:2631; Circulation 2006; 113:316). But a prospective study from Italy suggests that PE should receive more attention as a cause of syncope (NEJM JW Gen Med Nov 15 2016 and N Engl J Med 2016; 375:1524).
The study included 560 adults (mean age, 76) who were hospitalized for a first syncope episode. In addition to undergoing standard syncope evaluations, all patients had d-dimer testing and Wells score calculation. The 230 patients with either positive d-dimer levels or high-probability Wells scores underwent imaging with pulmonary computed tomography angiography (CTA) or…