Medical definitions and information for the V.A.E.R.S. reports Symptoms are Blood clotting disorders

acute myocardial infarction. Cardiogenic shock is the largest cause of in-hospitalmortality.[30][73] Rupture of the ventricular dividing wall or left ventricular wall may occurwithin the initial weeks.[73] Dressler's syndrome, a reaction following larger infarcts and a causeof pericarditis is also possible.[73]Heart failure may develop as a long-term consequence, with an impaired ability of heart muscleto pump, scarring, and an increase in the size of the existing muscle. Aneurysm of the leftventricle myocardium develops in about 10% of MI and is itself a risk factor for heart failure,ventricular arrhythmia, and the development of clots.[16]Risk factors for complications and death include age, hemodynamic parameters (such as heartfailure, cardiac arrest on admission, systolic blood pressure, or Killip class of two or greater), ST-segment deviation, diabetes, serum creatinine, peripheral vascular disease, and elevation ofcardiac markers.[141][142][143]Myocardial infarction is a common presentation of coronary artery disease. The World HealthOrganization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heartdisease;[144] with it being the leading cause of death in high- or middle-income countries andsecond only to lower respiratory infections in lower-income countries.[144] Worldwide, morethan 3 million people have STEMIs and 4 million have NSTEMIs a year.[18] STEMIs occur abouttwice as often in men as women.[19]Rates of death from ischemic heart disease (IHD) have slowed or declined in most high-incomecountries, although cardiovascular disease still accounted for one in three of all deaths in the USin 2008.[145] For example, rates of death from cardiovascular disease have decreased almost athird between 2001 and 2011 in the United States.[146]In contrast, IHD is becoming a more common cause of death in the developing world. Forexample, in India, IHD had become the leading cause of death by 2004, accounting for 1.46million deaths (14% of total deaths) and deaths due to IHD were expected to double during1985–2015.[147] Globally, disability adjusted life years (DALYs) lost to ischemic heart disease arepredicted to account for 5.5% of total DALYs in 2030, making it the second-most-importantcause of disability (after unipolar depressive disorder), as well as the leading cause of death bythis date.[144]Social determinants such as neighborhood disadvantage, immigration status, lack of socialsupport, social isolation, access to health services play an important role in myocardial infarctionrisk and survival.[148][149][150][151] Studies have shown that low socioeconomic status isassociated with an increased risk of poorer survival. There are well-documented disparities inmyocardial infarction survival by socioeconomic status, race, education, and census-tract-levelpoverty.[152]Race: In the U.S. African Americans have a greater burden of myocardial infarction and othercardiovascular events. On a population level, there is a higher overall prevalence of risk factorsthat are unrecognized and therefore not treated, which places these individuals at a greaterlikelihood of experiencing adverse outcomes and therefore potentially higher morbidity andmortality.[153]EpidemiologySocial determinants of health

Socioeconomic status: Among individuals who live in the low-socioeconomic (SES) areas, whichis close to 25% of the US population, myocardial infarctions (MIs) occurred twice as oftencompared with people who lived in higher SES areas.[154]Immigration status: In 2018 many lawfully present immigrants who are eligible for coverageremain uninsured because immigrant families face a range of enrollment barriers, including fear,confusion about eligibility policies, difficulty navigating the enrollment process, and languageand literacy challenges. Uninsured undocumented immigrants are ineligible for coverage optionsdue to their immigration status.[155]Health care access: Lack of health insurance and financial concerns about accessing care wereassociated with delays in seeking emergency care for acute myocardial infarction which can havesignificant, adverse consequences on patient outcomes.[156]Education: Researchers found that compared to people with graduate degrees, those with lowereducational attainment appeared to have a higher risk of heart attack, dying from acardiovascular event, and overall death.[157]Depictions of heart attacks in popular media often include collapsing or loss of consciousnesswhich are not common symptoms; these depictions contribute to widespread misunderstandingabout the symptoms of myocardial infarctions, which in turn contributes to people not gettingcare when they should.[158]At common law, in general, a myocardial infarction is a disease, but may sometimes be an injury.This can create coverage issues in the administration of no-fault insurance schemes such asworkers' compensation. In general, a heart attack is not covered;[159] however, it may be a work-related injury if it results, for example, from unusual emotional stress or unusual exertion.[160]In addition, in some jurisdictions, heart attacks suffered by persons in particular occupationssuch as police officers may be classified as line-of-duty injuries by statute or policy. In somecountries or states, a person having suffered from an MI may be prevented from participating inactivity that puts other people's lives at risk, for example driving a car or flying an airplane.[161]1. \"What Are the Signs and Symptoms of Coronary Heart Disease?\" (https://web.archive.org/web/20150224034615/http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs).www.nhlbi.nih.gov. September 29, 2014. Archived from the original (http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs) on 24 February 2015. Retrieved 23 February 2015.2. \"Heart Attack Symptoms in Women\" (https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women). American Heart Association.3. \"What Is a Heart Attack?\" (http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/).www.nhlbi.nih.gov. December 17, 2013. Archived (https://web.archive.org/web/20150219152830/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/) from the original on 19February 2015. Retrieved 24 February 2015.Society and cultureLegal implicationsReferences

4. \"Heart Attack or Sudden Cardiac Arrest: How Are They Different?\" (http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp). www.heart.org. Jul 30, 2014. Archived (https://web.archive.org/web/20150224045054/http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp) from the original on 24 February 2015. Retrieved 24 February2015.5. Mehta PK, Wei J, Wenger NK (February 2015). \"Ischemic heart disease in women: a focuson risk factors\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336825). Trends inCardiovascular Medicine. 25 (2): 140–51. doi 10.1016/j.tcm.2014.10.005 (https://doi.org/10.1:016%2Fj.tcm.2014.10.005) PMC 4336825 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4. 336825) PMID 25453985 (https://pubmed.ncbi.nlm.nih.gov/25453985). .6. Mendis S, Puska P, Norrving B (2011). Global atlas on cardiovascular disease preventionand control (http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1)(PDF) (1st ed.). Geneva: World Health Organization in collaboration with the World HeartFederation and the World Stroke Organization. pp. 3–18. ISBN 978-92-4-156437-3 Archived. (https://web.archive.org/web/20140817123106/http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1) (PDF) from the original on 2014-08-17.7. \"How Is a Heart Attack Diagnosed?\" (http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/diagnosis). www.nhlbi.nih.gov. December 17, 2013. Archived (https://web.archive.org/web/20150224044949/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/diagnosis) from the original on 24 February 2015. Retrieved 24 February 2015.8. Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. (October2012). \"ESC Guidelines for the management of acute myocardial infarction in patientspresenting with ST-segment elevation\" (https://doi.org/10.1093%2Feurheartj%2Fehs215).European Heart Journal. 33 (20): 2569–619. doi 10.1093/eurheartj/ehs215 (https://doi.org/1:0.1093%2Feurheartj%2Fehs215) PMID 22922416 (https://pubmed.ncbi.nlm.nih.gov/229224. 16).9. O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. (November2010). \"Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines forCardiopulmonary Resuscitation and Emergency Cardiovascular Care\" (https://doi.org/10.1161%2FCIRCULATIONAHA.110.971028). Circulation. 122 (18 Suppl 3): S787–817.doi 10.1161/CIRCULATIONAHA.110.971028 (https://doi.org/10.1161%2FCIRCULATIONAH:A.110.971028) PMID 20956226 (https://pubmed.ncbi.nlm.nih.gov/20956226). .10. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease InjuryIncidence Prevalence Collaborators) (October 2016). \"Global, regional, and nationalincidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). Lancet. 388 (10053): 1545–1602.doi 10.1016/S0140-6736(16)31678-6 (https://doi.org/10.1016%2FS0140-6736%2816%2931:678-6) PMC 5055577 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). .PMID 27733282 (https://pubmed.ncbi.nlm.nih.gov/27733282).11. Coventry LL, Finn J, Bremner AP (2011). \"Sex differences in symptom presentation in acutemyocardial infarction: a systematic review and meta-analysis\". Heart & Lung. 40 (6): 477–91.doi 10.1016/j.hrtlng.2011.05.001 (https://doi.org/10.1016%2Fj.hrtlng.2011.05.001):.PMID 22000678 (https://pubmed.ncbi.nlm.nih.gov/22000678).12. Valensi P, Lorgis L, Cottin Y (March 2011). \"Prevalence, incidence, predictive factors andprognosis of silent myocardial infarction: a review of the literature\" (https://doi.org/10.1016%2Fj.acvd.2010.11.013). Archives of Cardiovascular Diseases. 104 (3): 178–88.doi 10.1016/j.acvd.2010.11.013 (https://doi.org/10.1016%2Fj.acvd.2010.11.013):.PMID 21497307 (https://pubmed.ncbi.nlm.nih.gov/21497307).

13. \"What Causes a Heart Attack?\" (http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/causes). www.nhlbi.nih.gov. December 17, 2013. Archived (https://web.archive.org/web/20150218075735/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/causes) fromthe original on 18 February 2015. Retrieved 24 February 2015.14. Devlin RJ, Henry JA (2008). \"Clinical review: Major consequences of illicit drug consumption\"(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374627). Critical Care. 12 (1): 202.doi 10.1186/cc6166 (https://doi.org/10.1186%2Fcc6166) PMC 2374627 (https://www.ncbi.nl:. m.nih.gov/pmc/articles/PMC2374627) PMID 18279535 (https://pubmed.ncbi.nlm.nih.gov/182. 79535).15. \"Electrocardiogram\" (https://www.nhlbi.nih.gov/health/health-topics/topics/ekg). NHLBI, NIH.9 December 2016. Archived (https://web.archive.org/web/20170411140634/https://www.nhlbi.nih.gov/health/health-topics/topics/ekg) from the original on 11 April 2017. Retrieved 10 April2017.16. Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). Davidson's principles andpractice of medicine (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 588–599.ISBN 978-0-7020-3085-7.17. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. (December 2011).\"ESC Guidelines for the management of acute coronary syndromes in patients presentingwithout persistent ST-segment elevation: The Task Force for the management of acutecoronary syndromes (ACS) in patients presenting without persistent ST-segment elevation ofthe European Society of Cardiology (ESC)\"(https://doi.org/10.1093%2Feurheartj%2Fehr236). European Heart Journal. 32 (23): 2999–3054. doi 10.1093/eurheartj/ehr236 (https://doi.org/10.1093%2Feurheartj%2Fehr236):.PMID 21873419 (https://pubmed.ncbi.nlm.nih.gov/21873419).18. White HD, Chew DP (August 2008). \"Acute myocardial infarction\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931354). Lancet. 372 (9638): 570–84. doi 10.1016/S0140-:6736(08)61237-4 (https://doi.org/10.1016%2FS0140-6736%2808%2961237-4).PMC 1931354 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931354) PMID 18707987 (ht. tps://pubmed.ncbi.nlm.nih.gov/18707987).19. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. (January2013). \"2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association TaskForce on Practice Guidelines\" (https://doi.org/10.1161%2FCIR.0b013e3182742cf6).Circulation. 127 (4): e362–425. doi 10.1161/CIR.0b013e3182742cf6 (https://doi.org/10.116:1%2FCIR.0b013e3182742cf6) PMID 23247304. (https://pubmed.ncbi.nlm.nih.gov/23247304).20. Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, et al. (April 2014).\"The global burden of ischemic heart disease in 1990 and 2010: the Global Burden ofDisease 2010 study\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181601). Circulation.129 (14): 1493–501. doi 10.1161/circulationaha.113.004046 (https://doi.org/10.1161%2Fcircu:lationaha.113.004046) PMC 4181601 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC41816. 01) PMID 24573351 (https://pubmed.ncbi.nlm.nih.gov/24573351). .21. Torio C (August 2013). \"National Inpatient Hospital Costs: The Most Expensive Conditions byPayer, 2011\" (https://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp). HCUP. Archived (https://web.archive.org/web/20170314171958/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp) from the original on 14 March 2017. Retrieved 1 May 2017.22. Morrow & Braunwald 2016, pp. 1–3; Dwight 2016, p. 41.23. Morrow & Braunwald 2016, pp. 1–3.24. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. (October2012). \"Third universal definition of myocardial infarction\" (https://doi.org/10.1161%2FCIR.0b013e31826e1058). Circulation. 126 (16): 2020–35. doi 10.1161/CIR.0b013e31826e1058 (htt:ps://doi.org/10.1161%2FCIR.0b013e31826e1058) PMID 22923432 (https://pubmed.ncbi.nl. m.nih.gov/22923432).25. Blumenthal & Margolis 2007, pp. 4–5.

26. Morrow & Bohula 2016, p. 295.27. Morrow 2016, pp. 59–61.28. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). Harrison'sprinciples of internal medicine. McGraw Hill Education. pp. 1593–1610. ISBN 978-0-07-180215-4 OCLC 923181481 (https://www.worldcat.org/oclc/923181481). .29. Morrow 2016, pp. 59–60.30. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). Harrison'sPrinciples of Internal Medicine. McGraw Hill Education. pp. 98–99. ISBN 978-0-07-180215-4.OCLC 923181481 (https://www.worldcat.org/oclc/923181481).31. Gupta R, Munoz R (August 2016). \"Evaluation and Management of Chest Pain in theElderly\". Emergency Medicine Clinics of North America. 34 (3): 523–42.doi 10.1016/j.emc.2016.04.006 (https://doi.org/10.1016%2Fj.emc.2016.04.006):.PMID 27475013 (https://pubmed.ncbi.nlm.nih.gov/27475013).32. Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, et al. (January 2007). \"Theutility of gestures in patients with chest discomfort\". The American Journal of Medicine. 120(1): 83–9. doi 10.1016/j.amjmed.2006.05.045 (https://doi.org/10.1016%2Fj.amjmed.2006.05.:045) PMID 17208083 (https://pubmed.ncbi.nlm.nih.gov/17208083). .33. Allison 2012, p. 197; Morrow 2016, p. 60.34. Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, Long T (December2007). \"Symptom presentation of women with acute coronary syndromes: myth vs reality\" (https://doi.org/10.1001%2Farchinte.167.22.2405). Archives of Internal Medicine. 167 (22):2405–13. doi 10.1001/archinte.167.22.2405 (https://doi.org/10.1001%2Farchinte.167.22.240:5) PMID 18071161 (https://pubmed.ncbi.nlm.nih.gov/18071161). .35. \"Heart Attack Symptoms, Risk, and Recovery\" (https://www.cdc.gov/heartdisease/heart_attack.htm). CDC.gov. U.S. Department of Health & Human Services. Retrieved July 20, 2021.36. Coventry, Linda L.; Finn, Judith; Bremner, Alexandra P. (November–December 2011). \"Sexdifferences in symptom presentation in acute myocardial infarction: A systematic review andmeta-analysis\" (https://www.sciencedirect.com/science/article/pii/S0147956311002706).Heart & Lung. 40 (6): 477–491. doi 10.1016/j.hrtlng.2011.05.001 (https://doi.org/10.1016%2F:j.hrtlng.2011.05.001) PMID 22000678 (https://pubmed.ncbi.nlm.nih.gov/22000678). .Retrieved July 20, 2021.37. Wan Chen; Woods, Susan L.; Puntillo, Kathleen A. (July–August 2005). \"Gender differencesin symptoms associated with acute myocardial infarction: A review of the research\" (https://www.sciencedirect.com/science/article/pii/S0147956305000087). Heart & Lung. 34 (4): 240–247. doi 10.1016/j.hrtlng.2004.12.004 (https://doi.org/10.1016%2Fj.hrtlng.2004.12.004):.PMID 16027643 (https://pubmed.ncbi.nlm.nih.gov/16027643). Retrieved July 20, 2021.38. DeVon, Holli A.; Johnson Zerwic, Julie (July–August 2002). \"Symptoms of acute coronarysyndromes: Are there gender differences? A review of the literature\" (https://www.sciencedirect.com/science/article/pii/S0147956302000006). Heart & Lung. 31 (4): 235–245.doi 10.1067/mhl.2002.126105 (https://doi.org/10.1067%2Fmhl.2002.126105):.PMID 12122387 (https://pubmed.ncbi.nlm.nih.gov/12122387). Retrieved July 20, 2021.39. Ashton R, Raman D. \"Dyspnea\" (http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/). www.clevelandclinicmeded.com. Cleveland Clinic.Archived (https://web.archive.org/web/20170711084207/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/) from the original on 11 July 2017.Retrieved 24 May 2017.40. Lilly LS (2012). Pathophysiology of Heart Disease: A Collaborative Project of MedicalStudents and Faculty (https://books.google.com/books?id=0lxSGJYeXikC&pg=PA172).Lippincott Williams & Wilkins. p. 172. ISBN 9781469816685 Archived (https://web.archive.or. g/web/20170728135942/https://books.google.com.au/books?id=0lxSGJYeXikC&pg=PA172&lpg=PA172) from the original on 2017-07-28.

41. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. (December2008). \"Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation AcuteMyocardial Infarction of the European Society of Cardiology\" (https://doi.org/10.1093%2Feurheartj%2Fehn416). European Heart Journal. 29 (23): 2909–45. doi 10.1093/eurheartj/ehn416:(https://doi.org/10.1093%2Feurheartj%2Fehn416) PMID 19004841 (https://pubmed.ncbi.nl. m.nih.gov/19004841).42. Davis TM, Fortun P, Mulder J, Davis WA, Bruce DG (March 2004). \"Silent myocardialinfarction and its prognosis in a community-based cohort of Type 2 diabetic patients: theFremantle Diabetes Study\". Diabetologia. 47 (3): 395–399. doi 10.1007/s00125-004-1344-4:(https://doi.org/10.1007%2Fs00125-004-1344-4) PMID 14963648 (https://pubmed.ncbi.nlm.. nih.gov/14963648) S2CID 12567614 (https://api.semanticscholar.org/CorpusID:12567614). .43. Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D (2001). Rubin's Pathology —Clinicopathological Foundations of Medicine. Maryland: Lippincott Williams & Wilkins. p. 549.ISBN 978-0-7817-4733-2.44. Gaziano & Gaziano 2016, p. 11-22.45. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. (July 2012).\"European Guidelines on cardiovascular disease prevention in clinical practice (version2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societieson Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives ofnine societies and by invited experts)\" (https://doi.org/10.1093%2Feurheartj%2Fehs092).European Heart Journal. 33 (13): 1635–701. doi 10.1093/eurheartj/ehs092 (https://doi.org/1:0.1093%2Feurheartj%2Fehs092) PMID 22555213 (https://pubmed.ncbi.nlm.nih.gov/225552. 13).46. Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. (May 2006).\"AHA/ACC guidelines for secondary prevention for patients with coronary and otheratherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, andBlood Institute\" (https://doi.org/10.1016%2Fj.jacc.2006.04.026). Journal of the AmericanCollege of Cardiology. 47 (10): 2130–9. doi 10.1016/j.jacc.2006.04.026 (https://doi.org/10.10:16%2Fj.jacc.2006.04.026) PMID 16697342 (https://pubmed.ncbi.nlm.nih.gov/16697342). .47. Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. (October2012). \"Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis ofindividual participant data\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486012). Lancet.380 (9852): 1491–7. doi 10.1016/S0140-6736(12)60994-5 (https://doi.org/10.1016%2FS0140:-6736%2812%2960994-5) PMC 3486012 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC34. 86012) PMID 22981903 (https://pubmed.ncbi.nlm.nih.gov/22981903). .48. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT (July 2012). \"Effect ofphysical inactivity on major non-communicable diseases worldwide: an analysis of burden ofdisease and life expectancy\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500).Lancet. 380 (9838): 219–29. doi 10.1016/S0140-6736(12)61031-9 (https://doi.org/10.1016%:2FS0140-6736%2812%2961031-9) PMC 3645500 (https://www.ncbi.nlm.nih.gov/pmc/article. s/PMC3645500) PMID 22818936 (https://pubmed.ncbi.nlm.nih.gov/22818936). .49. Steptoe A, Kivimäki M (April 2012). \"Stress and cardiovascular disease\". Nature Reviews.Cardiology. (6): 360–70. 9doi 10.1038/nrcardio.2012.45 (https://doi.org/10.1038%2Fnrcardi:o.2012.45) PMID 22473079 (https://pubmed.ncbi.nlm.nih.gov/22473079) S2CID 27925226. . (https://api.semanticscholar.org/CorpusID:27925226).50. Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS (August 2020). \"Reductionin saturated fat intake for cardiovascular disease\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457). The Cochrane Database of Systematic Reviews. : CD011737.8doi 10.1002/14651858.CD011737.pub3 (https://doi.org/10.1002%2F14651858.CD011737.pu:b3) PMC 8092457 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457). .PMID 32827219 (https://pubmed.ncbi.nlm.nih.gov/32827219).

51. Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. (March 2014).\"Association of dietary, circulating, and supplement fatty acids with coronary risk: asystematic review and meta-analysis\". Annals of Internal Medicine. 160 (6): 398–406.doi 10.7326/M13-1788 (https://doi.org/10.7326%2FM13-1788) PMID 24723079 (https://pub:. med.ncbi.nlm.nih.gov/24723079).52. de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. (August 2015).\"Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality,cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis ofobservational studies\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532752). BMJ. 351:h3978. doi 10.1136/bmj.h3978 (https://doi.org/10.1136%2Fbmj.h3978) PMC 4532752 (http:. s://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532752) PMID 26268692 (https://pubmed.ncbi.. nlm.nih.gov/26268692).53. \"Scientific Report of the 2015 Dietary Guidelines Advisory Committee\" (https://web.archive.org/web/20160503071439/http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf) (PDF). health.gov. Feb2015. p. 17. Archived from the original (https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf) (PDF)on 2016-05-03. Retrieved 2015-03-05.54. Krenz M, Korthuis RJ (January 2012). \"Moderate ethanol ingestion and cardiovascularprotection: from epidemiologic associations to cellular mechanisms\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246046). Journal of Molecular and Cellular Cardiology. 52 (1): 93–104. doi 10.1016/j.yjmcc.2011.10.011 (https://doi.org/10.1016%2Fj.yjmcc.2011.10.011):.PMC 3246046 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246046) PMID 22041278 (ht. tps://pubmed.ncbi.nlm.nih.gov/22041278).55. O'Donnell CJ, Nabel EG (December 2011). \"Genomics of cardiovascular disease\". The NewEngland Journal of Medicine. 365 (22): 2098–109. doi 10.1056/NEJMra1105239 (https://doi.o:rg/10.1056%2FNEJMra1105239) PMID 22129254 (https://pubmed.ncbi.nlm.nih.gov/221292. 54).56. Culić V (April 2007). \"Acute risk factors for myocardial infarction\". International Journal ofCardiology. 117 (2): 260–9. doi 10.1016/j.ijcard.2006.05.011 (https://doi.org/10.1016%2Fj.ijca:rd.2006.05.011) PMID 16860887 (https://pubmed.ncbi.nlm.nih.gov/16860887). .57. Shaw E, Tofler GH (July 2009). \"Circadian rhythm and cardiovascular disease\". CurrentAtherosclerosis Reports. 11 (4): 289–95. doi 10.1007/s11883-009-0044-4 (https://doi.org/10.:1007%2Fs11883-009-0044-4) PMID 19500492 (https://pubmed.ncbi.nlm.nih.gov/19500492). .S2CID 43626425 (https://api.semanticscholar.org/CorpusID:43626425).58. Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. (July 2012).\"Shift work and vascular events: systematic review and meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406223). BMJ. 345: e4800. doi 10.1136/bmj.e4800 (https://doi.or:g/10.1136%2Fbmj.e4800) PMC 3406223 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC34. 06223) PMID 22835925 (https://pubmed.ncbi.nlm.nih.gov/22835925). .59. Janszky I, Ljung R (October 2008). \"Shifts to and from daylight saving time and incidence ofmyocardial infarction\" (https://semanticscholar.org/paper/a5a499285580681257d918649a38ad805ed5670a). The New England Journal of Medicine. 359 (18): 1966–8.doi 10.1056/NEJMc0807104 (https://doi.org/10.1056%2FNEJMc0807104) PMID 18971502:. (https://pubmed.ncbi.nlm.nih.gov/18971502) S2CID 205040478 (https://api.semanticscholar.. org/CorpusID:205040478).60. Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM (August 2015).\"Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494192). The Cochrane Database of SystematicReviews (8): CD011054. doi 10.1002/14651858.CD011054.pub2 (https://doi.org/10.1002%2F:14651858.CD011054.pub2) hdl 1874/340787 (https://hdl.handle.net/1874%2F340787). :.PMC 6494192 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494192) PMID 26310586 (ht. tps://pubmed.ncbi.nlm.nih.gov/26310586).

61. Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, Brophy JM (May2017). \"Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423546).BMJ. 357: j1909. doi 10.1136/bmj.j1909 (https://doi.org/10.1136%2Fbmj.j1909):.PMC 5423546 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423546) PMID 28487435 (ht. tps://pubmed.ncbi.nlm.nih.gov/28487435).62. Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA (May 2016). \"Endometriosisand Risk of Coronary Heart Disease\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940126). Circulation: Cardiovascular Quality and Outcomes. (3): 257–64.9doi 10.1161/CIRCOUTCOMES.115.002224 (https://doi.org/10.1161%2FCIRCOUTCOMES.1:15.002224) PMC 4940126 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940126). .PMID 27025928 (https://pubmed.ncbi.nlm.nih.gov/27025928).63. Mustafic H, Jabre P, Caussin C, Murad MH, Escolano S, Tafflet M, et al. (February 2012).\"Main air pollutants and myocardial infarction: a systematic review and meta-analysis\" (https://doi.org/10.1001%2Fjama.2012.126). JAMA. 307 (7): 713–21. doi 10.1001/jama.2012.126:(https://doi.org/10.1001%2Fjama.2012.126) PMID 22337682 (https://pubmed.ncbi.nlm.nih.g. ov/22337682).64. Ho AF, Wah W, Earnest A, Ng YY, Xie Z, Shahidah N, et al. (November 2018). \"Healthimpacts of the Southeast Asian haze problem - A time-stratified case crossover study of therelationship between ambient air pollution and sudden cardiac deaths in Singapore\".International Journal of Cardiology. 271: 352–358. doi 10.1016/j.ijcard.2018.04.070 (https://d:oi.org/10.1016%2Fj.ijcard.2018.04.070) PMID 30223374 (https://pubmed.ncbi.nlm.nih.gov/3. 0223374).65. Sun Z, Chen C, Xu D, Li T (October 2018). \"Effects of ambient temperature on myocardialinfarction: A systematic review and meta-analysis\". Environmental Pollution. 241: 1106–1114.doi 10.1016/j.envpol.2018.06.045 (https://doi.org/10.1016%2Fj.envpol.2018.06.045):.PMID 30029319 (https://pubmed.ncbi.nlm.nih.gov/30029319).66. Chatzidimitriou D, Kirmizis D, Gavriilaki E, Chatzidimitriou M, Malisiovas N (October 2012).\"Atherosclerosis and infection: is the jury still not in?\". Future Microbiology. (10): 1217–30.7doi 10.2217/fmb.12.87 (https://doi.org/10.2217%2Ffmb.12.87) PMID 23030426 (https://pub:. med.ncbi.nlm.nih.gov/23030426).67. Charakida M, Tousoulis D (2013). \"Infections and atheromatous plaque: current therapeuticimplications\". Current Pharmaceutical Design. 19 (9): 1638–50.doi 10.2174/138161213805219658 (https://doi.org/10.2174%2F138161213805219658):.PMID 23016720 (https://pubmed.ncbi.nlm.nih.gov/23016720).68. Sánchez-Manubens J, Bou R, Anton J (February 2014). \"Diagnosis and classification ofKawasaki disease\". Journal of Autoimmunity. 48–49: 113–7. doi 10.1016/j.jaut.2014.01.010:(https://doi.org/10.1016%2Fj.jaut.2014.01.010) PMID 24485156 (https://pubmed.ncbi.nlm.ni. h.gov/24485156).69. Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (March 2011). \"Prognostic valueof cardiac computed tomography angiography: a systematic review and meta-analysis\" (https://doi.org/10.1016%2Fj.jacc.2010.10.011). Journal of the American College of Cardiology.57 (10): 1237–47. doi 10.1016/j.jacc.2010.10.011 (https://doi.org/10.1016%2Fj.jacc.2010.10.:011) PMID 21145688 (https://pubmed.ncbi.nlm.nih.gov/21145688). .70. Clarke R, Halsey J, Bennett D, Lewington S (February 2011). \"Homocysteine and vasculardisease: review of published results of the homocysteine-lowering trials\". Journal of InheritedMetabolic Disease. 34 (1): 83–91. doi 10.1007/s10545-010-9235-y (https://doi.org/10.1007%:2Fs10545-010-9235-y) PMID 21069462 (https://pubmed.ncbi.nlm.nih.gov/21069462). .S2CID 8714058 (https://api.semanticscholar.org/CorpusID:8714058).71. Lonn E (September 2007). \"Homocysteine in the prevention of ischemic heart disease,stroke and venous thromboembolism: therapeutic target or just another distraction?\". CurrentOpinion in Hematology. 14 (5): 481–7. doi 10.1097/MOH.0b013e3282c48bd8 (https://doi.org/:10.1097%2FMOH.0b013e3282c48bd8) PMID 17934354 (https://pubmed.ncbi.nlm.nih.gov/1. 7934354) S2CID 8734056 (https://api.semanticscholar.org/CorpusID:8734056). .

72. Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, et al. (January2017). \"ESC working group position paper on myocardial infarction with non-obstructivecoronary arteries\" (https://doi.org/10.1093%2Feurheartj%2Fehw149). European HeartJournal. 38 (3): 143–153. doi 10.1093/eurheartj/ehw149 (https://doi.org/10.1093%2Feurheart:j%2Fehw149) PMID 28158518 (https://pubmed.ncbi.nlm.nih.gov/28158518). .73. Reed GW, Rossi JE, Cannon CP (January 2017). \"Acute myocardial infarction\". Lancet. 389(10065): 197–210. doi 10.1016/S0140-6736(16)30677-8 (https://doi.org/10.1016%2FS0140-:6736%2816%2930677-8) PMID 27502078 (https://pubmed.ncbi.nlm.nih.gov/27502078). .S2CID 33523662 (https://api.semanticscholar.org/CorpusID:33523662).74. Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). Davidson's principles andpractice of medicine (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 577–9.ISBN 978-0-7020-3085-7.75. Woollard KJ, Geissmann F (February 2010). \"Monocytes in atherosclerosis: subsets andfunctions\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813241). Nature Reviews.Cardiology. (2): 77–86. 7doi 10.1038/nrcardio.2009.228 (https://doi.org/10.1038%2Fnrcardi:o.2009.228) PMC 2813241 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813241). .PMID 20065951 (https://pubmed.ncbi.nlm.nih.gov/20065951).76. Janoudi A, Shamoun FE, Kalavakunta JK, Abela GS (July 2016). \"Cholesterol crystalinduced arterial inflammation and destabilization of atherosclerotic plaque\" (https://doi.org/10.1093%2Feurheartj%2Fehv653). European Heart Journal. 37 (25): 1959–67.doi 10.1093/eurheartj/ehv653 (https://doi.org/10.1093%2Feurheartj%2Fehv653):.PMID 26705388 (https://pubmed.ncbi.nlm.nih.gov/26705388).77. Buja LM (July 2005). \"Myocardial ischemia and reperfusion injury\". CardiovascularPathology. 14 (4): 170–5. doi 10.1016/j.carpath.2005.03.006 (https://doi.org/10.1016%2Fj.car:path.2005.03.006) PMID 16009313 (https://pubmed.ncbi.nlm.nih.gov/16009313). .78. Algranati D, Kassab GS, Lanir Y (March 2011). \"Why is the subendocardium more vulnerableto ischemia? A new paradigm\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064294).American Journal of Physiology. Heart and Circulatory Physiology. 300 (3): H1090–100.doi 10.1152/ajpheart.00473.2010 (https://doi.org/10.1152%2Fajpheart.00473.2010):.PMC 3064294 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064294) PMID 21169398 (ht. tps://pubmed.ncbi.nlm.nih.gov/21169398).79. Bolooki HM, Askari A (August 2010). \"Acute Myocardial Infarction\" (http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/).www.clevelandclinicmeded.com. Archived (https://web.archive.org/web/20170428050921/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/) from the original on 28 April 2017. Retrieved 24 May 2017.80. Aaronson PI, Ward JP, Connolly MJ (2013). The cardiovascular system at a glance (4th ed.).Chichester, West Sussex: Wiley-Blackwell. pp. 88–89. ISBN 978-0-470-65594-8.81. Kutty RS, Jones N, Moorjani N (November 2013). \"Mechanical complications of acutemyocardial infarction\". Cardiology Clinics (Review). 31 (4): 519–31, vii–viii.doi 10.1016/j.ccl.2013.07.004 (https://doi.org/10.1016%2Fj.ccl.2013.07.004):.PMID 24188218 (https://pubmed.ncbi.nlm.nih.gov/24188218).82. Kloner R, Hale SL (15 September 2016). \"Reperfusion Injury: Prevention and Management\".In Morrow DA (ed.). Myocardial Infarction: A Companion to Braunwald's Heart Disease (https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 286–288. ISBN 978-0-323-35943-6.83. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD (January2019). \"Fourth universal definition of myocardial infarction (2018)\" (https://doi.org/10.1093%2Feurheartj%2Fehy462). European Heart Journal. 40 (3): 237–269.doi 10.1093/eurheartj/ehy462 (https://doi.org/10.1093%2Feurheartj%2Fehy462):.PMID 30165617 (https://pubmed.ncbi.nlm.nih.gov/30165617).

84. Pickering JW, Than MP, Cullen L, Aldous S, Ter Avest E, Body R, et al. (May 2017). \"RapidRule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin TMeasurement Below the Limit of Detection: A Collaborative Meta-analysis\" (https://www.research.manchester.ac.uk/portal/en/publications/rapid-ruleout-of-acute-myocardial-infarction-with-a-single-highsensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection(0e2cb8e0-229a-446b-9389-7fa319a649d4).html). Annals of Internal Medicine. 166 (10): 715–724.doi 10.7326/M16-2562 (https://doi.org/10.7326%2FM16-2562) PMID 28418520 (https://pub:. med.ncbi.nlm.nih.gov/28418520).85. Chapman AR, Lee KK, McAllister DA, Cullen L, Greenslade JH, Parsonage W, et al.(November 2017). \"Association of High-Sensitivity Cardiac Troponin I Concentration WithCardiac Outcomes in Patients With Suspected Acute Coronary Syndrome\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710293). JAMA. 318 (19): 1913–1924.doi 10.1001/jama.2017.17488 (https://doi.org/10.1001%2Fjama.2017.17488) PMC 5710293:. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710293) PMID 29127948 (https://pubmed.n. cbi.nlm.nih.gov/29127948).86. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al.(December 2014). \"2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College ofCardiology/American Heart Association Task Force on Practice Guidelines\" (https://doi.org/10.1161%2FCIR.0000000000000134). Circulation. 130 (25): e344–426.doi 10.1161/CIR.0000000000000134 (https://doi.org/10.1161%2FCIR.0000000000000134):.PMID 25249585 (https://pubmed.ncbi.nlm.nih.gov/25249585).87. Lipinski MJ, Escárcega RO, D'Ascenzo F, Magalhães MA, Baker NC, Torguson R, et al. (May2014). \"A systematic review and collaborative meta-analysis to determine the incrementalvalue of copeptin for rapid rule-out of acute myocardial infarction\". The American Journal ofCardiology. 113 (9): 1581–91. doi 10.1016/j.amjcard.2014.01.436 (https://doi.org/10.1016%2:Fj.amjcard.2014.01.436) PMID 24731654 (https://pubmed.ncbi.nlm.nih.gov/24731654). .88. Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). Davidson's principles andpractice of medicine (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 529–30.ISBN 978-0-7020-3085-7.89. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). Harrison'sprinciples of internal medicine. McGraw Hill Education. p. 1457. ISBN 978-0-07-180215-4.OCLC 923181481 (https://www.worldcat.org/oclc/923181481).90. \"American College of Cardiology\" (http://www.choosingwisely.org/societies/american-college-of-cardiology/). www.choosingwisely.org. Choosing Wisely. 28 February 2017. Archived (https://web.archive.org/web/20170728125746/http://www.choosingwisely.org/societies/american-college-of-cardiology/) from the original on 28 July 2017. Retrieved 24 May 2017.91. Schinkel AF, Valkema R, Geleijnse ML, Sijbrands EJ, Poldermans D (May 2010). \"Single-photon emission computed tomography for assessment of myocardial viability\".EuroIntervention. 6 Suppl G (Supplement G): G115–22. PMID 20542817 (https://pubmed.ncbi.nlm.nih.gov/20542817).92. National Institute for Health and Clinical Excellence. Clinical guideline cg94: Unstable anginaand NSTEMI (https://www.nice.org.uk/guidance/CGcg94). London, 2010.93. \"UOTW #36 - Ultrasound of the Week\" (https://www.ultrasoundoftheweek.com/uotw-36/).Ultrasound of the Week. 5 February 2015. Archived (https://web.archive.org/web/20170509115806/https://www.ultrasoundoftheweek.com/uotw-36/) from the original on 9 May 2017.Retrieved 27 May 2017.94. Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). Davidson's principles andpractice of medicine (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 535, 539.ISBN 978-0-7020-3085-7.95. Boie ET (November 2005). \"Initial evaluation of chest pain\". Emergency Medicine Clinics ofNorth America. 23 (4): 937–57. doi 10.1016/j.emc.2005.07.007 (https://doi.org/10.1016%2Fj.:emc.2005.07.007) PMID 16199332 (https://pubmed.ncbi.nlm.nih.gov/16199332). .

96. \"Assessment of fatigue\" (http://bestpractice.bmj.com/best-practice/monograph/571/diagnosis/differential-diagnosis.html). BMJ Best Practice. 17 August 2016. Retrieved 6 June 2017.97. MacIntyre CR, Mahimbo A, Moa AM, Barnes M (December 2016). \"Influenza vaccine as acoronary intervention for prevention of myocardial infarction\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256393). Heart. 102 (24): 1953–1956. doi 10.1136/heartjnl-2016-309983 (h:ttps://doi.org/10.1136%2Fheartjnl-2016-309983) PMC 5256393 (https://www.ncbi.nlm.nih.go. v/pmc/articles/PMC5256393) PMID 27686519 (https://pubmed.ncbi.nlm.nih.gov/27686519). .98. National Institute for Health and Clinical Excellence. Clinical guideline 181: Lipid modification:cardiovascular risk assessment and the modification of blood lipids for the primary andsecondary prevention of cardiovascular disease (https://www.nice.org.uk/guidance/CG181).London, 2014.99. Stradling C, Hamid M, Taheri S, Thomas GN (2014). \"A review of dietary influences oncardiovascular health: part 2: dietary patterns\". Cardiovascular & Hematological DisordersDrug Targets. 14 (1): 50–63. doi 10.2174/1871529x14666140701095426 (https://doi.org/10.2:174%2F1871529x14666140701095426) PMID 24993125 (https://pubmed.ncbi.nlm.nih.gov/. 24993125).100. Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP (December 2013). \"Vitamin andmineral supplements in the primary prevention of cardiovascular disease and cancer: Anupdated systematic evidence review for the U.S. Preventive Services Task Force\" (https://doi.org/10.7326%2F0003-4819-159-12-201312170-00729). Annals of Internal Medicine. 159(12): 824–34. doi 10.7326/0003-4819-159-12-201312170-00729 (https://doi.org/10.7326%2F:0003-4819-159-12-201312170-00729) PMID 24217421 (https://pubmed.ncbi.nlm.nih.gov/24. 217421).101. McPherson K, et al. (June 2010). \"Prevention of cardiovascular disease – NICE public healthguidance 25\" (http://guidance.nice.org.uk/ph25). London: National Institute for Health andCare Excellence Archived (https://web.archive.org/web/20140329171156/http://guidance.nic. e.org.uk/PH25) from the original on 2014-03-29.102. Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G (January 2011). \"Multiplerisk factor interventions for primary prevention of coronary heart disease\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160097). The Cochrane Database of Systematic Reviews (1):CD001561. doi 10.1002/14651858.cd001561.pub3 (https://doi.org/10.1002%2F14651858.cd:001561.pub3) PMC 4160097 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160097). .PMID 21249647 (https://pubmed.ncbi.nlm.nih.gov/21249647).103. Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. (January2013). \"Statins for the primary prevention of cardiovascular disease\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481400). The Cochrane Database of Systematic Reviews. (1):1CD004816. doi 10.1002/14651858.CD004816.pub5 (https://doi.org/10.1002%2F14651858.C:D004816.pub5) PMC 6481400 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481400). .PMID 23440795 (https://pubmed.ncbi.nlm.nih.gov/23440795).104. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. (May 2009). \"Aspirinin the primary and secondary prevention of vascular disease: collaborative meta-analysis ofindividual participant data from randomised trials\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715005). Lancet. 373 (9678): 1849–60. doi 10.1016/S0140-6736(09)60503-1 (https://d:oi.org/10.1016%2FS0140-6736%2809%2960503-1) PMC 2715005 (https://www.ncbi.nlm.ni. h.gov/pmc/articles/PMC2715005) PMID 19482214 (https://pubmed.ncbi.nlm.nih.gov/194822. 14).105. Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, et al. (September2013). \"Aspirin for prophylactic use in the primary prevention of cardiovascular disease andcancer: a systematic review and overview of reviews\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781046). Health Technology Assessment. 17 (43): 1–253. doi 10.3310/hta17430 (h:ttps://doi.org/10.3310%2Fhta17430) PMC 4781046 (https://www.ncbi.nlm.nih.gov/pmc/articl. es/PMC4781046) PMID 24074752 (https://pubmed.ncbi.nlm.nih.gov/24074752). .

106. Matthys F, De Backer T, De Backer G, Stichele RV (March 2014). \"Review of guidelines onprimary prevention of cardiovascular disease with aspirin: how much evidence is needed toturn a tanker?\". European Journal of Preventive Cardiology. 21 (3): 354–65.doi 10.1177/2047487312472077 (https://doi.org/10.1177%2F2047487312472077):.PMID 23610452 (https://pubmed.ncbi.nlm.nih.gov/23610452) S2CID 28350632 (https://api.s. emanticscholar.org/CorpusID:28350632).107. Hodis HN, Mack WJ (July 2014). \"Hormone replacement therapy and the association withcoronary heart disease and overall mortality: clinical application of the timing hypothesis\".The Journal of Steroid Biochemistry and Molecular Biology. 142: 68–75.doi 10.1016/j.jsbmb.2013.06.011 (https://doi.org/10.1016%2Fj.jsbmb.2013.06.011):.PMID 23851166 (https://pubmed.ncbi.nlm.nih.gov/23851166) S2CID 30838065 (https://api.s. emanticscholar.org/CorpusID:30838065).108. National Institute for Health and Clinical Excellence. Clinical guideline 172: Secondaryprevention in primary and secondary care for patients following a myocardial infarction (https://www.nice.org.uk/guidance/CG172). London, 2013.109. Anderson L, Taylor RS (December 2014). \"Cardiac rehabilitation for people with heartdisease: an overview of Cochrane systematic reviews\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087435). The Cochrane Database of Systematic Reviews. 12 (12): CD011273.doi 10.1002/14651858.CD011273.pub2 (https://doi.org/10.1002%2F14651858.CD011273.pu:b2) hdl 10871/19152 (https://hdl.handle.net/10871%2F19152) PMC 7087435 (https://www.n. :. cbi.nlm.nih.gov/pmc/articles/PMC7087435) PMID 25503364 (https://pubmed.ncbi.nlm.nih.go. v/25503364).110. Perez MI, Musini VM, Wright JM (October 2009). \"Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascularevent\". The Cochrane Database of Systematic Reviews (4): CD006743.doi 10.1002/14651858.CD006743.pub2 (https://doi.org/10.1002%2F14651858.CD006743.pu:b2) PMID 19821384 (https://pubmed.ncbi.nlm.nih.gov/19821384). .111. Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, et al. (February 2015).\"Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386690). Lancet. 385 (9970):792–8. doi 10.1016/S0140-6736(14)62052-3 (https://doi.org/10.1016%2FS0140-6736%281:4%2962052-3) PMC 4386690 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386690). .PMID 25467565 (https://pubmed.ncbi.nlm.nih.gov/25467565).112. Bangalore S, Makani H, Radford M, Thakur K, Toklu B, Katz SD, et al. (October 2014).\"Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomizedtrials\". The American Journal of Medicine. 127 (10): 939–53.doi 10.1016/j.amjmed.2014.05.032 (https://doi.org/10.1016%2Fj.amjmed.2014.05.032):.PMID 24927909 (https://pubmed.ncbi.nlm.nih.gov/24927909).113. Newman D (19 August 2010). \"Beta Blockers for Acute Heart Attack (Myocardial Infarction)\"(http://www.thennt.com/nnt/beta-blockers-for-heart-attack/). TheNNT.com. Archived (https://web.archive.org/web/20151222092449/http://www.thennt.com/nnt/beta-blockers-for-heart-attack/) from the original on 22 December 2015. Retrieved 11 December 2015.114. Le HH, El-Khatib C, Mombled M, Guitarian F, Al-Gobari M, Fall M, et al. (2016). \"Impact ofAldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of RandomizedControlled Trials\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758660). PLOS ONE. 11(2): e0145958. Bibcode 2016PLoSO..1145958L (https://ui.adsabs.harvard.edu/abs/2016PLo:SO..1145958L) doi 10.1371/journal.pone.0145958 (https://doi.org/10.1371%2Fjournal.pone.. :0145958) PMC 4758660 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758660). .PMID 26891235 (https://pubmed.ncbi.nlm.nih.gov/26891235).

115. Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, et al. (October 2015). \"Part1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitationand Emergency Cardiovascular Care Science With Treatment Recommendations\" (https://doi.org/10.1161%2FCIR.0000000000000270). Circulation (Review). 132 (16 Suppl 1): S2–39.doi 10.1161/CIR.0000000000000270 (https://doi.org/10.1161%2FCIR.0000000000000270):.PMID 26472854 (https://pubmed.ncbi.nlm.nih.gov/26472854).116. Hess EP, Agarwal D, Chandra S, Murad MH, Erwin PJ, Hollander JE, et al. (July 2010).\"Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergencydepartment: a meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900327).CMAJ. 182 (10): 1039–44. doi 10.1503/cmaj.092119 (https://doi.org/10.1503%2Fcmaj.09211:9) PMC 2900327 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900327) PMID 20530163. . (https://pubmed.ncbi.nlm.nih.gov/20530163).117. Reeder G (27 December 2016). \"Nitrates in the management of acute coronary syndrome\" (https://www.uptodate.com/contents/nitrates-in-the-management-of-acute-coronary-syndrome).www.uptodate.com. Archived (https://web.archive.org/web/20170728135423/https://www.uptodate.com/contents/nitrates-in-the-management-of-acute-coronary-syndrome) from theoriginal on 28 July 2017. Retrieved 24 May 2017.118. Yadlapati A, Gajjar M, Schimmel DR, Ricciardi MJ, Flaherty JD (December 2016).\"Contemporary management of ST-segment elevation myocardial infarction\". Internal andEmergency Medicine. 11 (8): 1107–1113. doi 10.1007/s11739-016-1550-3 (https://doi.org/10.:1007%2Fs11739-016-1550-3) PMID 27714584 (https://pubmed.ncbi.nlm.nih.gov/27714584). .S2CID 23759756 (https://api.semanticscholar.org/CorpusID:23759756).119. McCarthy CP, Mullins KV, Sidhu SS, Schulman SP, McEvoy JW (June 2016). \"The on- andoff-target effects of morphine in acute coronary syndrome: A narrative review\". AmericanHeart Journal. 176: 114–21. doi 10.1016/j.ahj.2016.04.004 (https://doi.org/10.1016%2Fj.ahj.2:016.04.004) PMID 27264228 (https://pubmed.ncbi.nlm.nih.gov/27264228). .120. Bellemain-Appaix A, Kerneis M, O'Connor SA, Silvain J, Cucherat M, Beygui F, et al.(October 2014). \"Reappraisal of thienopyridine pretreatment in patients with non-STelevation acute coronary syndrome: a systematic review and meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208629). BMJ. 349: g6269. doi 10.1136/bmj.g6269 (https://d:oi.org/10.1136%2Fbmj.g6269) PMC 4208629 (https://www.ncbi.nlm.nih.gov/pmc/articles/PM. C4208629) PMID 25954988 (https://pubmed.ncbi.nlm.nih.gov/25954988). .121. Andrade-Castellanos CA, Colunga-Lozano LE, Delgado-Figueroa N, Magee K (June 2014).\"Heparin versus placebo for non-ST elevation acute coronary syndromes\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769062). The Cochrane Database of Systematic Reviews. 6(6): CD003462. doi 10.1002/14651858.CD003462.pub3 (https://doi.org/10.1002%2F1465185:8.CD003462.pub3) PMC 6769062. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769062) PMID 24972265 (https://pubmed.n. cbi.nlm.nih.gov/24972265).122. Bagai A, Dangas GD, Stone GW, Granger CB (June 2014). \"Reperfusion strategies in acutecoronary syndromes\" (https://doi.org/10.1161%2FCIRCRESAHA.114.302744). CirculationResearch. 114 (12): 1918–28. doi 10.1161/CIRCRESAHA.114.302744 (https://doi.org/10.116:1%2FCIRCRESAHA.114.302744) PMID 24902975 (https://pubmed.ncbi.nlm.nih.gov/249029. 75).123. Jobs A, Mehta SR, Montalescot G, Vicaut E, Van't Hof AW, Badings EA, et al. (August 2017).\"Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronarysyndrome: a meta-analysis of randomised trials\". Lancet. 390 (10096): 737–746.doi 10.1016/S0140-6736(17)31490-3 (https://doi.org/10.1016%2FS0140-6736%2817%2931:490-3) PMID 28778541 (https://pubmed.ncbi.nlm.nih.gov/28778541) S2CID 4489347 (http. . s://api.semanticscholar.org/CorpusID:4489347).

124. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. (October 2010).\"Guidelines on myocardial revascularization\" (https://doi.org/10.1093%2Feurheartj%2Fehq277). European Heart Journal. 31 (20): 2501–55. doi 10.1093/eurheartj/ehq277 (https://doi.org/:10.1093%2Feurheartj%2Fehq277) PMID 20802248 (https://pubmed.ncbi.nlm.nih.gov/20802. 248).125. Dalal F, Dalal HM, Voukalis C, Gandhi MM (July 2017). \"Management of patients afterprimary percutaneous coronary intervention for myocardial infarction\" (https://semanticscholar.org/paper/0ae24ba672e3ba8378deea704b0c5e584abbefb2). BMJ. 358: j3237.doi 10.1136/bmj.j3237 (https://doi.org/10.1136%2Fbmj.j3237) PMID 28729460 (https://pubm:. ed.ncbi.nlm.nih.gov/28729460) S2CID 46847680 (https://api.semanticscholar.org/CorpusID:. 46847680).126. Lassen JF, Bøtker HE, Terkelsen CJ (January 2013). \"Timely and optimal treatment ofpatients with STEMI\". Nature Reviews. Cardiology. 1. 10 (1): 41–8.doi 10.1038/nrcardio.2012.156 (https://doi.org/10.1038%2Fnrcardio.2012.156):.PMID 23165072 (https://pubmed.ncbi.nlm.nih.gov/23165072) S2CID 21955018 (https://api.s. emanticscholar.org/CorpusID:21955018).127. Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. (November2015). \"Part 1: Executive Summary: 2015 American Heart Association Guidelines Update forCardiopulmonary Resuscitation and Emergency Cardiovascular Care\" (https://doi.org/10.1161%2Fcir.0000000000000252). Circulation. 132 (18 Suppl 2): S315–67.doi 10.1161/cir.0000000000000252 (https://doi.org/10.1161%2Fcir.0000000000000252):.PMID 26472989 (https://pubmed.ncbi.nlm.nih.gov/26472989).128. McCaul M, Lourens A, Kredo T (September 2014). \"Pre-hospital versus in-hospitalthrombolysis for ST-elevation myocardial infarction\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823254). The Cochrane Database of Systematic Reviews. (9): CD010191.9doi 10.1002/14651858.CD010191.pub2 (https://doi.org/10.1002%2F14651858.CD010191.pu:b2) PMC 6823254 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823254). .PMID 25208209 (https://pubmed.ncbi.nlm.nih.gov/25208209).129. Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T (December 2016). \"Oxygen therapyfor acute myocardial infarction\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463792).The Cochrane Database of Systematic Reviews. 12: CD007160.doi 10.1002/14651858.CD007160.pub4 (https://doi.org/10.1002%2F14651858.CD007160.pu:b4) PMC 6463792 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463792). .PMID 27991651 (https://pubmed.ncbi.nlm.nih.gov/27991651).130. Hofmann R, James SK, Jernberg T, Lindahl B, Erlinge D, Witt N, et al. (September 2017).\"Oxygen Therapy in Suspected Acute Myocardial Infarction\" (https://doi.org/10.1056%2Fnejmoa1706222). The New England Journal of Medicine. 377 (13): 1240–1249.doi 10.1056/nejmoa1706222 (https://doi.org/10.1056%2Fnejmoa1706222) PMID 28844200:. (https://pubmed.ncbi.nlm.nih.gov/28844200).131. Abuzaid A, Fabrizio C, Felpel K, Al Ashry HS, Ranjan P, Elbadawi A, et al. (June 2018).\"Oxygen Therapy in Patients with Acute Myocardial Infarction: A Systemic Review and Meta-Analysis\" (https://doi.org/10.1016%2Fj.amjmed.2017.12.027). The American Journal ofMedicine. 131 (6): 693–701. doi 10.1016/j.amjmed.2017.12.027 (https://doi.org/10.1016%2F:j.amjmed.2017.12.027) PMID 29355510 (https://pubmed.ncbi.nlm.nih.gov/29355510). .132. Sepehrvand N, James SK, Stub D, Khoshnood A, Ezekowitz JA, Hofmann R (October 2018).\"Effects of supplemental oxygen therapy in patients with suspected acute myocardialinfarction: a meta-analysis of randomised clinical trials\". Heart. 104 (20): 1691–1698.doi 10.1136/heartjnl-2018-313089 (https://doi.org/10.1136%2Fheartjnl-2018-313089):.PMID 29599378 (https://pubmed.ncbi.nlm.nih.gov/29599378) S2CID 4472549 (https://api.se. manticscholar.org/CorpusID:4472549).133. Singh A, Hussain S, Antony B (2020). \"How Much Evidence Is Needed to Conclude againstthe Use of Oxygen Therapy in Acute Myocardial Infarction?\" (https://abstracts.isth.org/abstract/how-much-evidence-is-needed-to-conclude-against-the-use-of-oxygen-therapy-in-acute-myocardial-infarction/). Res Pract Thromb Haemost. (Suppl 1). Retrieved 28 July 2020.4

134. Ardehali R, Perez M, Wang P (2011). A practical approach to cardiovascular medicine (https://books.google.com/books?id=LZsoHMN8lM4C&pg=PA57). Chichester, West Sussex, UK:Wiley-Blackwell. p. 57. ISBN 978-1-4443-9387-3.135. Jindal SK, ed. (2011). Textbook of pulmonary and critical care medicine (https://books.google.com/books?id=rAT1bdnDakAC&pg=PA1758). New Delhi: Jaypee Brothers MedicalPublishers. p. 1758. ISBN 978-93-5025-073-0.136. Dahal K, Hendrani A, Sharma SP, Singireddy S, Mina G, Reddy P, et al. (July 2018).\"Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment ElevationMyocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145720). JAMA Internal Medicine. 178 (7): 913–920. doi 10.1001/jamainternmed.2018.0850 (https://doi.org/10.1001%2Fjamainternmed.201:8.0850) PMC 6145720 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145720). .PMID 29799995 (https://pubmed.ncbi.nlm.nih.gov/29799995).137. Rahim L, Allana S, Steinke EE, Ali F, Khan AH (November 2017). \"Level of knowledgeamong cardiac nurses regarding sexual counseling of post-MI patients in three tertiary carehospitals in Pakistan\". Heart & Lung. 46 (6): 412–416. doi 10.1016/j.hrtlng.2017.09.002 (http:s://doi.org/10.1016%2Fj.hrtlng.2017.09.002) PMID 28988654 (https://pubmed.ncbi.nlm.nih.g. ov/28988654) S2CID 4277993 (https://api.semanticscholar.org/CorpusID:4277993). .138. Jaarsma T, Steinke EE, Gianotten WL (2010). \"Sexual problems in cardiac patients: how toassess, when to refer\". The Journal of Cardiovascular Nursing. 25 (2): 159–64.doi 10.1097/JCN.0b013e3181c60e7c (https://doi.org/10.1097%2FJCN.0b013e3181c60e7c):.PMID 20168196 (https://pubmed.ncbi.nlm.nih.gov/20168196) S2CID 25806176 (https://api.s. emanticscholar.org/CorpusID:25806176).139. Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, Taylor RS (January2016). \"Exercise-based cardiac rehabilitation for coronary heart disease\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491180). The Cochrane Database of Systematic Reviews. 2016(1): CD001800. doi 10.1002/14651858.CD001800.pub3 (https://doi.org/10.1002%2F1465185:8.CD001800.pub3) PMC 6491180 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491180). .PMID 26730878 (https://pubmed.ncbi.nlm.nih.gov/26730878).140. Papneja K, Chan AK, Mondal TK, Paes B (March 2017). \"Myocardial Infarction in Neonates:A Review of an Entity with Significant Morbidity and Mortality\". Pediatric Cardiology. 38 (3):427–441. doi 10.1007/s00246-016-1556-7 (https://doi.org/10.1007%2Fs00246-016-1556-7):.PMID 28238152 (https://pubmed.ncbi.nlm.nih.gov/28238152) S2CID 20779415 (https://api.s. emanticscholar.org/CorpusID:20779415).141. López de Sá E, López-Sendón J, Anguera I, Bethencourt A, Bosch X (November 2002).\"Prognostic value of clinical variables at presentation in patients with non-ST-segmentelevation acute coronary syndromes: results of the Proyecto de Estudio del Pronóstico de laAngina (PEPA)\". Medicine. 81 (6): 434–42. doi 10.1097/00005792-200211000-00004 (https://:doi.org/10.1097%2F00005792-200211000-00004) PMID 12441900 (https://pubmed.ncbi.nl. m.nih.gov/12441900) S2CID 10268606 (https://api.semanticscholar.org/CorpusID:1026860. 6).142. Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. (November2006). \"Prediction of risk of death and myocardial infarction in the six months afterpresentation with acute coronary syndrome: prospective multinational observational study(GRACE)\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661748). BMJ. 333 (7578): 1091.doi 10.1136/bmj.38985.646481.55 (https://doi.org/10.1136%2Fbmj.38985.646481.55):.PMC 1661748 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661748) PMID 17032691 (ht. tps://pubmed.ncbi.nlm.nih.gov/17032691).143. Weir RA, McMurray JJ, Velazquez EJ (May 2006). \"Epidemiology of heart failure and leftventricular systolic dysfunction after acute myocardial infarction: prevalence, clinicalcharacteristics, and prognostic importance\". The American Journal of Cardiology. 97 (10A):13F–25F. doi 10.1016/j.amjcard.2006.03.005 (https://doi.org/10.1016%2Fj.amjcard.2006.03.:005) PMID 16698331 (https://pubmed.ncbi.nlm.nih.gov/16698331). .

144. World Health Organization (2008). The Global Burden of Disease: 2004 Update. Geneva:World Health Organization. ISBN 978-92-4-156371-0.145. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. (AmericanHeart Association Statistics Committee and Stroke Statistics Subcommittee) (January 2012).\"Executive summary: heart disease and stroke statistics--2012 update: a report from theAmerican Heart Association\" (https://doi.org/10.1161%2FCIR.0b013e3182456d46).Circulation. 125 (1): 188–97. doi 10.1161/CIR.0b013e3182456d46 (https://doi.org/10.1161%2:FCIR.0b013e3182456d46) PMID 22215894 (https://pubmed.ncbi.nlm.nih.gov/22215894). .146. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. (January2015). \"Heart disease and stroke statistics--2015 update: a report from the American HeartAssociation\" (https://doi.org/10.1161%2Fcir.0000000000000152). Circulation. 131 (4): e29–322. doi 10.1161/cir.0000000000000152 (https://doi.org/10.1161%2Fcir.0000000000000152):.PMID 25520374 (https://pubmed.ncbi.nlm.nih.gov/25520374). \"From 2001 to 2011, deathrates attributable to CVD declined 30.8%.\"147. Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S (January 2008). \"Epidemiology andcausation of coronary heart disease and stroke in India\". Heart. 94 (1): 16–26.doi 10.1136/hrt.2007.132951 (https://doi.org/10.1136%2Fhrt.2007.132951) PMID 18083949:. (https://pubmed.ncbi.nlm.nih.gov/18083949) S2CID 27117207 (https://api.semanticscholar.o. rg/CorpusID:27117207).148. Coady SA, Johnson NJ, Hakes JK, Sorlie PD (July 2014). \"Individual education, areaincome, and mortality and recurrence of myocardial infarction in a Medicare cohort: theNational Longitudinal Mortality Study\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227052). BMC Public Health. 14 (1): 705. doi 10.1186/1471-2458-14-705 (https://doi.org/10.118:6%2F1471-2458-14-705) PMC 4227052 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC422. 7052) PMID 25011538 (https://pubmed.ncbi.nlm.nih.gov/25011538). .149. Salomaa V, Miettinen H, Niemelä M, Ketonen M, Mähönen M, Immonen-Räihä P, et al. (July2001). \"Relation of socioeconomic position to the case fatality, prognosis and treatment ofmyocardial infarction events; the FINMONICA MI Register Study\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731938). Journal of Epidemiology and Community Health. 55 (7): 475–82. doi 10.1136/jech.55.7.475 (https://doi.org/10.1136%2Fjech.55.7.475) PMC 1731938 (htt:. ps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731938) PMID 11413176 (https://pubmed.ncbi.. nlm.nih.gov/11413176).150. Bucholz EM, Ma S, Normand SL, Krumholz HM (October 2015). \"Race, SocioeconomicStatus, and Life Expectancy After Acute Myocardial Infarction\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097251). Circulation. 132 (14): 1338–46.doi 10.1161/circulationaha.115.017009 (https://doi.org/10.1161%2Fcirculationaha.115.01700:9) PMC 5097251 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097251) PMID 26369354. . (https://pubmed.ncbi.nlm.nih.gov/26369354).151. Kilpi F, Silventoinen K, Konttinen H, Martikainen P (April 2016). \"Disentangling the relativeimportance of different socioeconomic resources for myocardial infarction incidence andsurvival: a longitudinal study of over 300,000 Finnish adults\" (https://doi.org/10.1093%2Feurpub%2Fckv202). European Journal of Public Health. 26 (2): 260–6.doi 10.1093/eurpub/ckv202 (https://doi.org/10.1093%2Feurpub%2Fckv202) PMID 26585783:. (https://pubmed.ncbi.nlm.nih.gov/26585783).152. Rosvall M, Gerward S, Engström G, Hedblad B (October 2008). \"Income and short-term casefatality after myocardial infarction in the whole middle-aged population of Malmö, Sweden\" (https://doi.org/10.1093%2Feurpub%2Fckn059). European Journal of Public Health. 18 (5):533–8. doi 10.1093/eurpub/ckn059 (https://doi.org/10.1093%2Feurpub%2Fckn059):.PMID 18621776 (https://pubmed.ncbi.nlm.nih.gov/18621776).153. Graham G (2015-05-14). \"Disparities in cardiovascular disease risk in the United States\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558355). Current Cardiology Reviews. 11 (3):238–45. doi 10.2174/1573403X11666141122220003 (https://doi.org/10.2174%2F1573403X1:1666141122220003) PMC 4558355 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC455835. 5) PMID 25418513 (https://pubmed.ncbi.nlm.nih.gov/25418513). .

Allison TG (6 December 2012). \"Stress Test Selection\". In Margaret A. Lloyd (ed.). MayoClinic Cardiology: Concise Textbook (https://books.google.com/books?id=WSCRAAAAQBAJ). Joseph G. Murphy. OUP USA. pp. 196–202. ISBN 978-0-19-991571-2.Blumenthal RS, Margolis S (2007). Heart Attack Prevention 2007 (https://books.google.com/books?id=mM3l59uTj04C&pg=PA10). Johns Hopkins Health. ISBN 978-1-933087-47-4.Dwight J (16 June 2016). \"Chest pain, breathlessness, fatigue\". In Timothy Cox (ed.). OxfordTextbook of Medicine: Cardiovascular Disorders (https://books.google.com/books?id=YqJHDAAAQBAJ). Jeremy Dwight. Oxford University Press. pp. 39–47. ISBN 978-0-19-871702-7.Gaziano TA, Gaziano JM (15 September 2016). \"Global Evolving Epidemiology, NaturalHistory, and Treatment Trends of Myocardial Infarction\". In Morrow DA (ed.). MyocardialInfarction: A Companion to Braunwald's Heart Disease (https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 11–21. ISBN 978-0-323-35943-6.Morrow DA, Bohula EA (15 September 2016). \"Heart Failure and Cardiogenic Shock AfterMyocardial Infarction\". In Morrow DA (ed.). Myocardial Infarction: A Companion to154. Hamad R, Penko J, Kazi DS, Coxson P, Guzman D, Wei PC, et al. (May 2020). \"Associationof Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254448). JAMA Cardiology. (8): 899–908.5doi 10.1001/jamacardio.2020.1458 (https://doi.org/10.1001%2Fjamacardio.2020.1458):.PMC 7254448 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254448) PMID 32459344 (ht. tps://pubmed.ncbi.nlm.nih.gov/32459344).155. \"Health Coverage of Immigrants\" (https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/). KFF. 2020-03-18. Retrieved 2021-04-09.156. Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. (April2010). \"Health care insurance, financial concerns in accessing care, and delays to hospitalpresentation in acute myocardial infarction\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020978). JAMA. 303 (14): 1392–400. doi 10.1001/jama.2010.409 (https://doi.org/10.1001%2:Fjama.2010.409) PMC 3020978 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020978). .PMID 20388895 (https://pubmed.ncbi.nlm.nih.gov/20388895).157. Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, et al. (September 2019). \"LowEducational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary ArteryDisease\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755831). Journal of the AmericanHeart Association. (17): e013165. 8doi 10.1161/JAHA.119.013165 (https://doi.org/10.1161%:2FJAHA.119.013165) PMC 6755831 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC675583. 1) PMID 31476920 (https://pubmed.ncbi.nlm.nih.gov/31476920). .158. Perry K, Petrie KJ, Ellis CJ, Horne R, Moss-Morris R (July 2001). \"Symptom expectationsand delay in acute myocardial infarction patients\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1729795). Heart. 86 (1): 91–3. doi 10.1136/heart.86.1.91 (https://doi.org/10.1136%2Fhe:art.86.1.91) PMC 1729795 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1729795). .PMID 11410572 (https://pubmed.ncbi.nlm.nih.gov/11410572).159. Workers' Compensation FAQ (http://www.pvamu.edu/pages/2026.asp) Archived (https://web.archive.org/web/20070711235600/http://www.pvamu.edu/pages/2026.asp) 2007-07-11 at theWayback Machine Prairie View A&M University. . Retrieved November 22, 2006.160. SIGNIFICANT DECISIONS Subject Index (http://www.biia.wa.gov/significantdecisions/contents.htm) Archived (https://web.archive.org/web/20061206115257/http://www.biia.wa.gov/SignificantDecisions/contents.htm) 2006-12-06 at the Wayback Machine. Board of IndustrialInsurance Appeals. Retrieved November 22, 2006.161. \"Classification of Drivers' Licenses Regulations\" (http://www.gov.ns.ca/just/regulations/regs/mvclasdl.htm). Nova Scotia Registry of Regulations. May 24, 2000. Archived (https://web.archive.org/web/20070420191108/http://www.gov.ns.ca/just/regulations/regs/mvclasdl.htm) fromthe original on April 20, 2007. Retrieved April 22, 2007.Sources

Classification ICD-10: I21 (https://icd.who.int/browse10/2019/en#/I21)-I22 (https://icd.who.int/browse10/2019/en#/I22) · ICD-9-CM:410 (http://www.icd9data.com/getICD9Code.ashx?icd9=410) · MeSH:D009203 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D009203) ·DiseasesDB: 8664(http://www.diseasesdatabase.com/ddb8664.htm)ExternalresourcesMedlinePlus:000195 (https://www.nlm.nih.gov/medlineplus/ency/article/000195.htm) ·Braunwald's Heart Disease (https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier.pp. 295–313. ISBN 978-0-323-35943-6.Morrow DA, Braunwald E (15 September 2016). \"Classification and Diagnosis of AcuteCoronary Syndromes\". In Morrow DA (ed.). Myocardial Infarction: A Companion toBraunwald's Heart Disease (https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier.pp. 1–10. ISBN 978-0-323-35943-6.Morrow DA (15 September 2016). \"Clinical Approach to Suspected Acute MyocardialInfarction\". In Morrow DA (ed.). Myocardial Infarction: A Companion to Braunwald's HeartDisease (https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 55–65.ISBN 978-0-323-35943-6.Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. (March 2016).\"2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention forPatients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAIGuideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for theManagement of ST-Elevation Myocardial Infarction: A Report of the American College ofCardiology/American Heart Association Task Force on Clinical Practice Guidelines and theSociety for Cardiovascular Angiography and Interventions\" (https://doi.org/10.1161%2FCIR.0000000000000336). Circulation. 133 (11): 1135–47. doi 10.1161/CIR.0000000000000336 (htt:ps://doi.org/10.1161%2FCIR.0000000000000336) PMID 26490017 (https://pubmed.ncbi.nl. m.nih.gov/26490017).Myocardial infarction (https://curlie.org/Health/Conditions_and_Diseases/Cardiovascular_Disorders/Heart_Disease) atCurlieAmerican Heart Association's Heart Attack web site (http://www.americanheart.org/heartattack) — Information andresources for preventing, recognizing, and treating a heartattack.TIMI Score for UA/NSTEMI (http://www.mdcalc.com/timi-risk-score-for-uanstemi/) and STEMI (http://www.mdcalc.com/timi-risk-score-for-stemi/)HEART Score for Major Cardiac Events (http://www.mdcalc.com/heart-score-for-major-cardiac-events/)\"Heart Attack\" (https://medlineplus.gov/heartattack.html).MedlinePlus. U.S. National Library of Medicine.Further readingExternal linksD

eMedicine:med/1567 (https://emedicine.medscape.com/med/1567-overview) emerg/327(http://www.emedicine.com/emerg/topic327.htm#)ped/2520 (http://www.emedicine.com/ped/topic2520.htm#)· Patient UK:Myocardialinfarction (https://patient.info/doctor/acute-myocardial-infarction)Retrieved from \"https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&oldid=1043418446\"This page was last edited on 10 September 2021, at 01:19 (UTC).Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By usingthis site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the WikimediaFoundation, Inc., a non-profit organization.

PetechiaOther namesPetechiaePetechia and purpura on the low limb due tomedication-induced vasculitisPronunciationpetechia /pɪˈtiːkiə/ petechiae/pɪˈtiːkiiː/SpecialtyRheumatologyPetechiaA petechia (pl. petechiae) is a small (1–2 mm)red or purple spot on the skin or conjunctiva,caused by a minor bleed from broken capillaryblood vessels. The word is derived from Latin[1]'petigo', meaning ‘scab' or 'eruption’.Petechia refers to one of the three descriptivetypes of hematoma differentiated by size, the othertwo being ecchymosis and purpura. Ecchymosis isdefined as hematomas larger than 1 centimetre[1]and purpura as 1–5 millimetres.[2]The term is almost always used in the plural(petechiae), since a single lesion is seldom noticedor significant.CausesPhysical traumaNon-infectious conditionsInfectious conditionsForensic scienceSee alsoReferencesExternal linksThe most common cause of petechiae is through physical trauma such as a hard bout ofcoughing, holding breath, vomiting, or crying, which can result in facial petechiae, especiallyaround the eyes. Such instances are harmless and usually disappear within a few days.Constriction, Asphyxiation – Petechiae, especially in the eyes, may also occur whenexcessive pressure is applied to tissue (e.g., when a tourniquet is applied to an extremity orwith excessive coughing or vomiting).Sunburn, childbirth, weightlifting[3]Gua Sha, a Chinese treatment that scrapes the skinHigh-G trainingHickeyContentsCausesPhysical trauma

AsphyxiationChoking gameOral sex[4]Vitamin C deficiency, scurvy[3]Vitamin K deficiency[3]Leukemia[3]Thrombocytopenia – Low platelet counts or diminished platelet function (e.g., as a side effectof medications or during certain infections) can give rise to petechial spots[1]clotting factor deficiencies – (Von Willebrand disease)HypocalcemiaIdiopathic thrombocytopenic purpuraCoeliac diseaseAplastic anaemiaLupusKwashiorkor or Marasmus – Childhood protein-energy malnutritionErythroblastosis fetalisHenoch–Schönlein purpuraKawasaki diseaseSchamberg diseaseEhlers–Danlos syndromeSjögren syndrome – Petechial spots could occur due to vasculitis, an inflammation of theblood vessels. In such a case immediate treatment is needed to prevent permanent damage.Some malignancies can also cause petechiae to appear.RadiationHavana syndromeBabesiosisBolivian hemorrhagic feverBoutonneuse feverChikungunyaCerebral malariaCongenital syphilisCrimean–Congo hemorrhagic feverCytomegalovirusDengue feverDukes' diseaseEbolaEndocarditisInfluenza A virus subtype H1N1HantavirusInfectious mononucleosisNon-infectious conditionsInfectious conditions

Palatal petechiae.Marburg virusNeisseria meningitidisRocky Mountain spotted feverScarlet feverTyphus[5]Streptococcal pharyngitis – Petechiae on the soft palateare mainly associated with streptococcal pharyngitis,[6]and as such it is an uncommon but highly specificfinding.[7]Petechiae on the face and conjunctiva (eyes) are unrelated toasphyxiation or hypoxia.[8]Despite this, petechiae are used by police investigators indetermining whether strangulation has been part of anattack. The documentation of the presence of petechiae on avictim can help police investigators prove the case.[9] Petechiae resulting from strangulation canbe relatively tiny and light in color to very bright and pronounced. Petechiae may be seen on theface, in the whites of the eyes or on the inside of the eyelids.Purpura, which is the mid-sized type of hematoma (3–10 mm)Ecchymoses, which is the large type of hematoma (>1 cm)1. Kumar, Vinay (2017). Robbins Basic Pathology. Abbas, Abul K.; Aster, Jon C.; Perkins,James A. (10th ed.). Philadelphia, PA. p. 101. ISBN 978-0323353175 OCLC 960844656 (htt. ps://www.worldcat.org/oclc/960844656).2. McKenzie, Shirlyn B. (2014). Clinical Laboratory Hematology. Williams, Joanne Lynne;Landis-Piwowar, Kristin (3rd ed.). Boston, MA. p. 665. ISBN 978-0133076011.OCLC 878098857 (https://www.worldcat.org/oclc/878098857).3. \"Causes\" (http://www.mayoclinic.org/symptoms/petechiae/basics/causes/sym-20050724).4. Schlesinger, SL; Borbotsina, J; O'Neill, L (September 1975). \"Petechial hemorrhages of thesoft palate secondary to fellatio\". Oral Surgery, Oral Medicine, and Oral Pathology. 40 (3):376–78. doi 10.1016/0030-4220(75)90422-3 (https://doi.org/10.1016%2F0030-4220%2875%:2990422-3) PMID 1080847 (https://pubmed.ncbi.nlm.nih.gov/1080847). .5. Grayson MD, Charlotte (2006-09-26). \"Typhus\" (https://www.nlm.nih.gov/medlineplus/ency/article/001363.htm). MedlinePlus Medical Encyclopedia. National Institutes of Health.Retrieved 2007-11-05.6. Fact Sheet: Tonsillitis (http://www.entnet.org/HealthInformation/tonsillitis.cfm) from AmericanAcademy of Otolaryngology. \"Updated 1/11\". Retrieved November 20117. Brook I, Dohar JE (December 2006). \"Management of group A beta-hemolytic streptococcalpharyngotonsillitis in children\". J Fam Pract. 55 (12): S1–11, quiz S12. PMID 17137534 (https://pubmed.ncbi.nlm.nih.gov/17137534).8. Ely, Susan F.; Charles S. Hirsch (2000). \"Asphyxial deaths and petechiae: a review\" (http://www.charlydmiller.com/LIB04/2000petechiaereview.pdf) (PDF). Journal of Forensic Sciences.Forensic scienceSee alsoReferences

Classification ICD-10: R23.3 (https://icd.who.int/browse10/2019/en#/R23.3) · ICD-9-CM:782.7 (http://www.icd9data.com/getICD9Code.ashx?icd9=782.7) · MeSH:D011693 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D011693)45 (6): 1274–1277. doi 10.1520/JFS14878J (https://doi.org/10.1520%2FJFS14878J):.Retrieved 2007-09-22.9. \"Investigating Domestic Violence Strangulation\" (http://www.bluesheepdog.com/2007/11/09/investigating-domestic-violence-strangulation-what-is-it-and-how-to-recognize-it/).BlueSheepdog.com. 2007-11-09. Retrieved 12 May 2011.Retrieved from \"https://en.wikipedia.org/w/index.php?title=Petechia&oldid=1043655153\"This page was last edited on 11 September 2021, at 07:29 (UTC).Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By usingthis site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the WikimediaFoundation, Inc., a non-profit organization.External linksD

Pulmonary embolismA lung illustration depicting a pulmonary embolismas a thrombus (blood clot) that has travelled fromanother region of the body, causes occlusion of thepulmonary bronchial artery, leading to arterialthrombosis of the superior and inferior lobes in theleft lungSpecialtyHematology, cardiology,pulmonologySymptomsShortness of breath, chest pain,coughing up blood[1]ComplicationsPassing out, abnormally low bloodpressure, sudden death[2]Usual onsetAdvanced age[3]Risk factorsCancer, prolonged bed rest,smoking, stroke, certain geneticconditions, estrogen-basedmedication, pregnancy, obesity,after surgery[3]DiagnosticmethodBased on symptoms, D-dimer, CTpulmonary angiography, lungventilation/perfusion scan[4]TreatmentAnticoagulants (heparin, warfarin,DOACs)[5]Frequency~450,000 per year (USA), 430,000(Europe)[6][7][8]Deaths>10–12,000 per year (US), >30–[9]40,000 per year (Europe)[10]Pulmonary embolismPulmonary embolism PE () is a blockage ofan artery in the lungs by a substance that hasmoved from elsewhere in the body through thebloodstream (embolism).[6] Symptoms of a PEmay include shortness of breath, chest painparticularly upon breathing in, and coughingup blood. Symptoms of a blood clot in the leg[1]may also be present, such as a red, warm,swollen, and painful leg. Signs of a PE[1]include low blood oxygen levels, rapidbreathing, rapid heart rate, and sometimes amild fever.[11] Severe cases can lead to passingout, abnormally low blood pressure, andsudden death.[2]PE usually results from a blood clot in the legthat travels to the lung.[6] The risk of bloodclots is increased by cancer, prolonged bedrest, smoking, stroke, certain geneticconditions, estrogen-based medication,pregnancy, obesity, and after some types ofsurgery.[3] A small proportion of cases are dueto the embolization of air, fat, or amnioticfluid.[12][13] Diagnosis is based on signs andsymptoms in combination with test results.[4]If the risk is low, a blood test known as a D-dimer may rule out the condition.[4]Otherwise, a CT pulmonary angiography, lungventilation/perfusion scan, or ultrasound ofthe legs may confirm the diagnosis.[4]Together, deep vein thrombosis and PE areknown as venous thromboembolism (VTE).[14]Efforts to prevent PE include beginning tomove as soon as possible after surgery, lowerleg exercises during periods of sitting, and theuse of blood thinners after some types ofsurgery.[15] Treatment is with anticoagulantssuch as heparin, warfarin or one of the direct-acting oral anticoagulants (DOACs).[5] Theseare recommended for at least three months.[5]Severe cases may require thrombolysis usingmedication such as tissue plasminogenactivator (tPA) given intravenously or througha catheter, and some may require surgery (a

pulmonary thrombectomy).[16] If blood thinners are not appropriate, a temporary vena cavafilter may be used.[16]Pulmonary emboli affect about 430,000 people each year in Europe.[8] In the United States,between 300,000 and 600,000 cases occur each year,[6][7] which contribute to at least 40,000deaths.[9] Rates are similar in males and females.[3] They become more common as people getolder.[3]Signs and symptomsRisk factorsUnderlying causesDiagnosisProbability testingBlood testsImagingElectrocardiogramEchocardiographyPreventionTreatmentAnticoagulationThrombolysisInferior vena cava filterSurgeryEpidemiologyPrognosisPredicting mortalityReferencesExternal linksSymptoms of pulmonary embolism are typically sudden in onset and may include one or many ofthe following: dyspnea (shortness of breath), tachypnea (rapid breathing), chest pain of a\"pleuritic\" nature (worsened by breathing), cough and hemoptysis (coughing up blood).[17] Moresevere cases can include signs such as cyanosis (blue discoloration, usually of the lips andfingers), collapse, and circulatory instability because of decreased blood flow through the lungsand into the left side of the heart. About 15% of all cases of sudden death are attributable toPE.[2] While PE may present with syncope, less than 1% of syncope cases are due to PE.[18]On physical examination, the lungs are usually normal. Occasionally, a pleural friction rub maybe audible over the affected area of the lung (mostly in PE with infarct). A pleural effusion issometimes present that is exudative, detectable by decreased percussion note, audible breathsounds, and vocal resonance. Strain on the right ventricle may be detected as a left parasternalContentsSigns and symptoms

A deep vein thrombosis as seen inthe right leg is a risk factor for PEheave, a loud pulmonary component of the second heart sound, and/or raised jugular venouspressure.[2] A low-grade fever may be present, particularly if there is associated pulmonaryhemorrhage or infarction.[19]As smaller pulmonary emboli tend to lodge in more peripheral areas without collateralcirculation, they are more likely to cause lung infarction and small effusions (both of which arepainful), but not hypoxia, dyspnea, or hemodynamic instability such as tachycardia. Larger PEs,which tend to lodge centrally, typically cause dyspnea, hypoxia, low blood pressure, fast heartrate and fainting, but are often painless because there is no lung infarction due to collateralcirculation. The classic presentation for PE with pleuritic pain, dyspnea, and tachycardia is likelycaused by a large fragmented embolism causing both large and small PEs. Thus, small PEs areoften missed because they cause pleuritic pain alone without any other findings and large PEsare often missed because they are painless and mimic other conditions often causing ECGchanges and small rises in troponin and brain natriuretic peptide levels.[20]PEs are sometimes described as massive, submissive, and nonmassive depending on the clinicalsigns and symptoms. Although the exact definitions of these are unclear, an accepted definitionof massive PE is one in which there is hemodynamic instability such as sustained low bloodpressure, slowed heart rate, or pulselessness.[21]About 90% of emboli are from proximal leg deep veinthrombosis (DVTs) or pelvic vein thromboses.[22] DVTs areat risk for dislodging and migrating to the lung circulation.The conditions are generally regarded as a continuumtermed venous thromboembolism (VTE).VTE is much more common in immunocompromisedindividuals as well as individuals with comorbiditiesincluding:Those that undergo orthopedic surgery at or below thehip without prophylaxis.[23]This is due to immobility during or after the surgery,as well as venous damage during the surgery.[23]Pancreatic and colon cancer patients (other forms ofcancer also can be factors, but these are the mostcommon)[23]This is due to the release of procoagulants.[23]Risk of VTE is at its greatest during diagnosis andtreatment, but lowers in remission.[23]Patients with high-grade tumors[23]Pregnant individuals[23]As the body puts itself into what is known as a \"hypercoagulable state\" the risk of ahemorrhage during childbirth is decreased and is regulated by increased expression offactors VII, VIII, X, Von Willebrand, and fibrinogen.[23]Those on estrogen medication[23][24][25][26]Risk factors

The development of thrombosis is classically due to a group of causes named Virchow's triad(alterations in blood flow, factors in the vessel wall, and factors affecting the properties of theblood). Often, more than one risk factor is present.Alterations in blood flow: immobilization (after surgery, long-haul flight), injury, pregnancy(also procoagulant), obesity (also procoagulant), cancer (also procoagulant)Factors in the vessel wall: surgery, catheterizations causing direct injury (\"endothelial injury\")Factors affecting the properties of the blood (procoagulant state):Estrogen-containing medication (transgender hormone therapy, menopausal hormonetherapy and hormonal contraceptives)[25][24][26]Genetic thrombophilia (factor V Leiden, prothrombin mutation G20210A, protein Cdeficiency, protein S deficiency, antithrombin deficiency, hyperhomocysteinemia andplasminogen/fibrinolysis disorders)Acquired thrombophilia (antiphospholipid syndrome, nephrotic syndrome, paroxysmalnocturnal hemoglobinuria)Cancer (due to secretion of pro-coagulants)Although most pulmonary embolisms are the result of proximal leg deep vein thrombosis(DVTs), there are still many other risk factors that can also result in a pulmonary embolism.Risk Factors Include:Varicose veins caused by vascular damage[27]Pulmonary hypertension[27]Diabetes[27]Traumatic hip fractures that immobilize the patient[27]Joint fixation (primarily in the legs)[23]After a first PE, the search for secondary causes is usually brief. Only when a second PE occurs,and especially when this happens while still under anticoagulant therapy, a further search forunderlying conditions is undertaken. This will include testing (\"thrombophilia screen\") forFactor V Leiden mutation, antiphospholipid antibodies, protein C and S and antithrombin levels,and later prothrombin mutation, MTHFR mutation, Factor VIII concentration and rarerinherited coagulation abnormalities.[28]To diagnose a pulmonary embolism, a review of clinical criteria to determine the need for testingis recommended.[29] In those who have low risk, age less than 50, heart rate less than 100 beatsper minute, oxygen level more than 94% on room air, and no leg swelling, coughing up of blood,surgery or trauma in the last four weeks, previous blood clots, or estrogen use, further testing isnot typically needed.[30]In situations with more high risk individuals, further testing is needed. A CT pulmonaryangiogram (CTPA) is the preferred method for diagnosis of a pulmonary embolism due to itseasy administration and accuracy.[31] Although a CTPA is preferred, there are also other teststhat can be done. For example, a proximal lower limb compression ultrasound (CUS) can beused.[31] This is a test which is primarily used as a confirmatory test, meaning it confirms aUnderlying causesDiagnosis

A Hampton hump in a person with aright lower lobe pulmonaryembolismprevious analysis showing the presence or suspectedpresence of a pulmonary embolism.[31] According to a cross-sectional study, CUS tests have a sensitivity of 41% andspecificity of 96%.[31]If there are concerns this is followed by testing to determinea likelihood of being able to confirm a diagnosis by imaging,followed by imaging if other tests have shown that there is alikelihood of a PE diagnosis.[29][32][33]The diagnosis of PE is based primarily on validated clinicalcriteria combined with selective testing because the typicalclinical presentation (shortness of breath, chest pain) cannotbe definitively differentiated from other causes of chest painand shortness of breath. The decision to perform medicalimaging is based on clinical reasoning, that is, the medicalhistory, symptoms, and findings on physical examination,followed by an assessment of clinical probability.[2]The most commonly used method to predict clinical probability, the Wells score, is a clinicalprediction rule, whose use is complicated by multiple versions being available. In 1995, PhilipSteven Wells, initially developed a prediction rule (based on a literature search) to predict thelikelihood of PE, based on clinical criteria.[34] The prediction rule was revised in 1998[35] Thisprediction rule was further revised when simplified during a validation by Wells et al. in2000.[36] In the 2000 publication, Wells proposed two different scoring systems using cutoffs of2 or 4 with the same prediction rule.[36] In 2001, Wells published results using the moreconservative cutoff of 2 to create three categories.[37] An additional version, the \"modifiedextended version\", using the more recent cutoff of 2 but including findings from Wells's initialstudies[34][35] were proposed.[38] Most recently, a further study reverted to Wells's earlier use ofa cutoff of 4 points[36] to create only two categories.[39]There are additional prediction rules for PE, such as the Geneva rule. More importantly, the useof any rule is associated with reduction in recurrent thromboembolism.[40]The Wells score:[41]clinically suspected DVT – 3.0 pointsalternative diagnosis is less likely than PE – 3.0 pointstachycardia (heart rate > 100) – 1.5 pointsimmobilization (≥ 3d)/surgery in previous four weeks – 1.5 pointshistory of DVT or PE – 1.5 pointshemoptysis – 1.0 pointsmalignancy (with treatment within six months) or palliative – 1.0 pointsTraditional interpretation[36][37][42]Score >6.0 – High (probability 59% based on pooled data)[32]Score 2.0 to 6.0 – Moderate (probability 29% based on pooled data)[32]Score <2.0 – Low (probability 15% based on pooled data)[32]Probability testing

Alternative interpretation[36][39]Score > 4 – PE likely. Consider diagnostic imaging.Score 4 or less – PE unlikely. Consider D-dimer to rule out PE.Recommendations for a diagnostic algorithm were published by the PIOPED investigators;however, these recommendations do not reflect research using 64 slice MDCT.[32] Theseinvestigators recommended:Low clinical probability. If negative D-dimer, PE is excluded. If positive D-dimer, obtain MDCTand base treatment on results.Moderate clinical probability. If negative D-dimer, PE is excluded. However, the authors werenot concerned that a negative MDCT with negative D-dimer in this setting has a 5%probability of being false. Presumably, the 5% error rate will fall as 64 slice MDCT is morecommonly used. If positive D-dimer, obtain MDCT and base treatment on results.High clinical probability. Proceed to MDCT. If positive, treat, if negative, more tests areneeded to exclude PE. A D-dimer of less than 750 ug/L does not rule out PE in those whoare at high risk.[43]The pulmonary embolism rule-out criteria (PERC) helps assess people in whom pulmonaryembolism is suspected, but unlikely. Unlike the Wells score and Geneva score, which are clinicalprediction rules intended to risk stratify people with suspected PE, the PERC rule is designed torule out the risk of PE in people when the physician has already stratified them into a low-riskcategory.[44][42]People in this low risk category without any of these criteria may undergo no further testing forPE: low oxygen saturations – Sa <95%, unilateral leg swelling, coughing up blood, prior DVTO 2or PE, recent surgery or trauma, age >50, hormone use, fast heart rate. The rationale behind thisdecision is that further testing (specifically CT angiogram of the chest) may cause more harm(from radiation exposure and contrast dye) than the risk of PE.[45] The PERC rule has asensitivity of 97.4% and specificity of 21.9% with a false negative rate of 1.0% (16/1666).[44]In people with a low or moderate suspicion of PE, a normal D-dimer level (shown in a blood test)is enough to exclude the possibility of thrombotic PE, with a three-month risk ofthromboembolic events being 0.14%.[46] D-dimer is highly sensitive but not specific (specificityaround 50%). In other words, a positive D-dimer is not synonymous with PE, but a negative D-dimer is, with a good degree of certainty, an indication of absence of a PE.[47] A low pretestprobability is also valuable in ruling out PE.[48] The typical cut off is 500 μg/L, although thisvaries based on the assay.[49] However, in those over the age of 50, changing the cut-off value tothe person's age multiplied by 10 μg/L (accounting for assay which has been used) isrecommended as it decreases the number of falsely positive tests without missing any additionalcases of PE.[30][49][50]When a PE is being suspected, several blood tests are done in order to exclude importantsecondary causes of PE. This includes a full blood count, clotting status (PT, aPTT, TT), andsome screening tests (erythrocyte sedimentation rate, kidney function, liver enzymes,Pulmonary embolism rule-out criteriaBlood tests

electrolytes). If one of these is abnormal, further investigations might be warranted to theissue.[51]Troponin levels are increased in between 16 and 47% with pulmonary embolism.[52]In typical people who are not known to be at high risk of PE, imaging is helpful to confirm orexclude a diagnosis of PE after simpler first-line tests are used.[29][32][53] Medical societiesrecommend tests such as the D-dimer to first provide supporting evidence for the need forimaging, and imaging would be done if other tests confirmed a moderate or high probability offinding evidence to support a diagnosis of PE.[32][53]CT pulmonary angiography is the recommended first line diagnostic imaging test in mostpeople.[54]Ultrasound of the legs can confirm the presence of a PE but cannot rule it out.[55]CT pulmonary angiography (CTPA) is a pulmonary angiogram obtained using computedtomography (CT) with radiocontrast rather than right heart catheterization. Its advantages arethat it is accurate, it is non-invasive, it is more often available, and it may identifying other lungdisorders in case there is no pulmonary embolism. The accuracy and non-invasive nature ofCTPA also make it advantageous for people who are pregnant.[56]ImagingCT pulmonary angiography

On CT scan, pulmonary emboli Segmental and subsegmentalcan be classified according to pulmonary emboli on both sidesthe level along the arterial tree.CT pulmonary angiography Pulmonary embolism (whiteshowing a \"saddle embolus\" at arrow) that has been long-the bifurcation of the main standing and has caused a lungpulmonary artery and thrombus infarction (black arrow) seen asburden in the lobar arteries on a reverse halo sign.both sides.Assessing the accuracy of CT pulmonary angiography is hindered by the rapid changes in thenumber of rows of detectors available in multidetector CT (MDCT) machines.[57] According to acohort study, single-slice spiral CT may help diagnose detection among people with suspectedpulmonary embolism.[58] In this study, the sensitivity was 69% and specificity was 84%. In thisstudy which had a prevalence of detection was 32%, the positive predictive value of 67.0% andnegative predictive value of 85.2%. However, this study's results may be biased due to possibleincorporation bias, since the CT scan was the final diagnostic tool in people with pulmonaryembolism. The authors noted that a negative single slice CT scan is insufficient to rule outpulmonary embolism on its own. A separate study with a mixture of 4 slice and 16 slice scannersreported a sensitivity of 83% and a specificity of 96%, which means that it is a good test for rulingout a pulmonary embolism if it is not seen on imaging and that it is very good at confirming apulmonary embolism is present if it is seen. This study noted that additional testing is necessarywhen the clinical probability is inconsistent with the imaging results.[59] CTPA is non-inferior toVQ scanning, and identifies more emboli (without necessarily improving the outcome) comparedto VQ scanning.[60]Ventilation/perfusion scan

Ventilation-perfusion scintigraphy (A) After inhalation of 20 mCi ofXenon-133 gas, scintigraphicimages were obtained in theposterior projection, showinguniform ventilation to lungs. (B) After intravenous injection of 4mCi of Technetium-99m-labeledalbumin, scintigraphic imagesshown here in the posteriorprojection. This and other viewsshowed decreased activity inmultiple regions.A ventilation/perfusion scan (or V/Q scan or lungscintigraphy) shows that some areas of the lung are beingventilated but not perfused with blood (due to obstruction bya clot).[17] This type of examination is as accurate asmultislice CT, but is less used, due to the greater availabilityof CT technology. It is particularly useful in people who havean allergy to iodinated contrast, impaired kidney function, orare pregnant (due to its lower radiation exposure ascompared to CT).[61][62][63] The test can be performed withplanar two-dimensional imaging, or single photon emissioncomputed tomography (SPECT) which enables three-dimensional imaging.[54] Hybrid devices combining SPECTand CT (SPECT/CT) further enable anatomiccharacterization of any abnormality.[64]Tests that are frequently done that are not sensitive for PE,but can be diagnostic.Chest X-rays are often done on people with shortness of breath to help rule-out othercauses, such as congestive heart failure and rib fracture. Chest X-rays in PE are rarelynormal,[65] but usually lack signs that suggest the diagnosis of PE (for example, Westermarksign, Hampton's hump).Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis(DVT). The presence of DVT, as shown on ultrasonography of the legs, is in itself enough towarrant anticoagulation, without requiring the V/Q or spiral CT scans (because of the strongassociation between DVT and PE). This may be a valid approach in pregnancy, in which theother modalities would increase the risk of birth defects in the unborn child. However, anegative scan does not rule out PE, and low-radiation dose scanning may be required if themother is deemed at high risk of having a pulmonary embolism. The main use ofultrasonography of the legs is therefore in those with clinical symptoms suggestive of deepvein thrombosis.[63]Historically, the gold standard for diagnosis was pulmonary angiography by fluoroscopy, but thishas fallen into disuse with the increased availability of non-invasive techniques that offer similardiagnostic accuracy.[66]The primary use of the ECG is to rule out other causes of chest pain.[67] An electrocardiogram(ECG) is routinely done on people with chest pain to quickly diagnose myocardial infarctions(heart attacks), an important differential diagnosis in an individual with chest pain. Whilecertain ECG changes may occur with PE, none are specific enough to confirm or sensitive enoughto rule out the diagnosis.[67] An ECG may show signs of right heart strain or acute cor pulmonalein cases of large PEs – the classic signs are a large S wave in lead I, a large Q wave in lead III, andan inverted T wave in lead III (S1Q3T3), which occurs in 12–50% of people with the diagnosis,yet also occurs in 12% without the diagnosis.[68][69]Low probability diagnostic tests/non-diagnostic testsFluoroscopic pulmonary angiographyElectrocardiogram

Selective pulmonary angiogramrevealing clot (labeled A) causing acentral obstruction in the left mainpulmonary artery. ECG tracingshown at the bottom.Electrocardiogram of a person with pulmonaryembolism, showing sinus tachycardia ofapproximately 100 beats per minute, large Swave in Lead I, moderate Q wave in Lead III,inverted T wave in Lead III, and inverted T wavesin leads V1 and V3.This is occasionally present (occurring in up to 20% ofpeople), but may also occur in other acute lung conditions,and, therefore, has limited diagnostic value. The mostcommonly seen signs in the ECG are sinus tachycardia, rightaxis deviation, and right bundle branch block.[70] Sinustachycardia, however, is still only found in 8–69% of peoplewith PE.[71]ECG findings associated with pulmonary emboli may suggestworse prognosis since the six findings identified with RVstrain on ECG (heart rate > 100 beats per minute, S1Q3T3,inverted T waves in leads V1-V4, ST elevation in aVR,complete right bundle branch block, and atrial fibrillation)are associated with increased risk of circulatory shock anddeath.[72]Cases with inverted T in leads V1-3 are suspected with PE orinferior myocardial infarction. PE cases show inverted Twaves in leads II and aV , but inferior myocardial infarctionFcases do not show inverted T waves in II and aV .F[73]In massive and submassive PE, dysfunction ofthe right side of the heart may be seen onechocardiography, an indication that thepulmonary artery is severely obstructed and theright ventricle, a low-pressure pump, is unable tomatch the pressure. Some studies (see below)suggest that this finding may be an indication forthrombolysis. Not every person with a(suspected) pulmonary embolism requires anechocardiogram, but elevations in cardiactroponins or brain natriuretic peptide mayindicate heart strain and warrant an echocardiogram,[74] and be important in prognosis.[75]The specific appearance of the right ventricle on echocardiography is referred to as theMcConnell's sign. This is the finding of akinesia of the mid-free wall but a normal motion of theapex. This phenomenon has a 77% sensitivity and a 94% specificity for the diagnosis of acutepulmonary embolism in the setting of right ventricular dysfunction.[76]Echocardiography

Ultrasound of the Ultrasound of theheart showing signs heart showing signsof PE[77]of PE[77]Pulmonary embolism may be preventable in those with risk factors. People admitted to hospitalmay receive preventative medication, including unfractionated heparin, low molecular weightheparin (LMWH), or fondaparinux, and anti-thrombosis stockings to reduce the risk of a DVT inthe leg that could dislodge and migrate to the lungs.[78]Following the completion of anticoagulation in those with prior PE, long-term aspirin is useful toprevent recurrence.[5]Anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments, such asoxygen or analgesia, may be required. People are often admitted to hospital in the early stages oftreatment, and tend to remain under inpatient care until the INR has reached therapeutic levels(if warfarin is used). Increasingly, however, low-risk cases are managed at home in a fashionalready common in the treatment of DVT.[5][79] Evidence to support one approach versus theother is weak.[80]Anticoagulant therapy is the mainstay of treatment. For many years, vitamin K antagonists(warfarin or less commonly acenocoumarol or phenprocoumon) have been the cornerstone. Asvitamin K antagonists do not act immediately, initial treatment is with rapidly acting injectableanticoagulants: unfractionated heparin (UFH), low molecular weight heparin (LMWH), orfondaparinux, while oral vitamin K antagonists are initiated and titrated (usually as part ofinpatient hospital care) to the international normalized ratio, a test that determines the dose.[5]In terms of injectable treatments, LMWH may reduce bleeding among people with pulmonaryembolism as compared to UFH.[81] According to the same review, LMWH reduced the incidenceof recurrent thrombotic complications and reduced thrombus size when compared to heparin.There was no difference in overall mortality between participants treated with LMWH and thosetreated with unfractionated heparin.[81] Vitamin K antagonists require frequent dose adjustmentand monitoring of the international normalized ratio (INR). In PE, INRs between 2.0 and 3.0 aregenerally considered ideal.[5] If another episode of PE occurs under warfarin treatment, the INRwindow may be increased to e.g. 2.5–3.5 (unless there are contraindications) or anticoagulationmay be changed to a different anticoagulant e.g. LMWH.[5]PreventionTreatmentAnticoagulation

Used inferior vena cava filter.In recent years, many anticoagulants have been introduced that offer similar to warfarin butwithout a need for titration to the INR. Known as the directly acting oral anticoagulants, thesetreatments are now preferred over vitamin K antagonists by American professional guidelines.[5]Two of these (rivaroxaban and apixaban) do not require initial heparin or fondaparinuxtreatment, whereas dabigatran and edoxaban do.[5] A Cochrane review found that there is noevidence of a difference between oral DTIs (dabigatran, rivaroxaban, edoxaban, apixaban) andstandard anticoagulation in the prevention of recurrent pulmonary embolism.[82]In people with cancer who develop pulmonary embolism, therapy with a course of LMWH isfavored over warfarin or other oral anticoagulants.[5][83] Similarly, pregnant women are treatedwith low molecular weight heparin until after delivery to avoid the known teratogenic effects ofwarfarin, especially in the early stages of pregnancy, but it can be used while breastfeeding.[63]Anticoagulation therapy is usually continued for 3–6 months, or \"lifelong\" if there have beenprevious DVTs or PEs, or none of the usual transient risk factors is present.[5][83] In thosewithout a known cause that can be reversed 2 years of treatment may be better than 6months.[84] For those with small PEs (known as subsegmental PEs) the effects of anticoagulationis unknown as it has not been properly studied as of 2020.[85]Massive PE causing hemodynamic instability (shock and/or low blood pressure, defined as asystolic blood pressure <90 mmHg or a pressure drop of 40 mmHg for >15 min if not caused bynew-onset arrhythmia, hypovolemia or sepsis) is an indication for thrombolysis, the enzymaticdestruction of the clot with medication. In this situation, it is the best available treatment inthose without contraindications and is supported by clinical guidelines.[33][83][86] It is alsorecommended in those in cardiac arrest with a known PE.[87] Catheter-directed thrombolysis(CDT) is a new technique found to be relatively safe and effective for massive PEs. This involvesaccessing the venous system by placing a catheter into a vein in the groin and guiding it throughthe veins by using fluoroscopic imaging until it is located next to the PE in the lung circulation.Medication that breaks up blood clots is released through the catheter so that its highestconcentration is directly next to the pulmonary embolus. CDT is performed by interventionalradiologists or vascular surgeons, and in medical centers that offer CDT, it may be offered as afirst-line treatment.[88]Catheter-based ultrasound-assisted thrombolysis is beinginvestigated.[89]The use of thrombolysis in non-massive PEs is still debated.[90][91] Some have found that thetreatment decreases the risk of death and increases the risk of bleeding including intracranialhemorrhage.[92] Others have found no decrease in the risk of death.[91]There are two situations when an inferior vena cava filter isconsidered advantageous, and those are if anticoagulanttherapy is contraindicated (e.g. shortly after a majoroperation), or a person has a pulmonary embolus in spite ofbeing anticoagulated.[83] In these instances, it may beimplanted to prevent new or existing DVTs from entering thepulmonary artery and combining with an existingblockage.[83] In spite of the device's theoretical advantage ofpreventing pulmonary emboli, there is a lack of evidenceThrombolysisInferior vena cava filter

supporting its effectiveness.[93]Inferior vena cava filters should be removed as soon as it becomes safe to start usinganticoagulation.[83] Although modern filters are meant to be retrievable, complications mayprevent some from being removed. The long-term safety profile of permanently leaving a filterinside the body is not known.[93]Surgical management of acute pulmonary embolism (pulmonary thrombectomy) is uncommonand has largely been abandoned because of poor long-term outcomes. However, recently, it hasgone through a resurgence with the revision of the surgical technique and is thought to benefitcertain people.[94] Chronic pulmonary embolism leading to pulmonary hypertension (known aschronic thromboembolic hypertension) is treated with a surgical procedure known as apulmonary thromboendarterectomy.[95]There are roughly 10 million cases of pulmonary embolisms per year.[23] In the United States,pulmonary embolisms are the primary cause of at least 10,000 to 12,000 deaths per year and acontributing cause in at least 30,000 to 40,000 deaths per year.[9] True incidence involvingpulmonary embolisms is unknown because they often go undiagnosed or unnoticed untilautopsy.[23] From 1993 to 2012, there have been an increased number of admissions in hospitalsdue to pulmonary embolisms, jumping from 23 cases per 100,000 people to 65 cases per100,000 people.[23] Despite this increase, there has been a decrease in mortality during thatsame time period due to medical advances that have occurred.[23]Venous thromboembolism (VTE), a common risk factor, is present at much higher rates in thoseover the age of 70 (three times higher compared to those aged 45 to 69).[23] This is likely due tothere being a generally lower level of activity among the elderly, resulting in higher rates ofimmobility and obesity.[23] VTE has a large, and continuously rising, case fatality rate.[23] Thisrate is roughly 10% after 30 days, 15% after three months and up to 20% after one year.[23]Pulmonary embolisms alone (when resulting in hospitalizations) have a case fatality rate ofabout 5% to 10% so VTE can play a large factor in the severity of the embolisms.[23]When looking at all cases, the rate of fatal pulmonary emboli has declined from 6% to 2% overthe last 25 years in the United States.[96] In Europe, an average of approximately 40,000 deathsper year with pulmonary embolism as the primary cause were reported between 2013 and 2015,a conservative estimate because of potential underdiagnosis.[10]Less than 5 to 10% of symptomatic PEs are fatal within the first hour of symptoms.[33][87]There are several markers used for risk stratification and these are also independent predictorsof adverse outcomes. These include hypotension, cardiogenic shock, syncope, evidence of rightheart dysfunction, and elevated cardiac enzymes.[33] Some ECG changes including S1Q3T3 alsocorrelate with a worse short-term prognosis.[21] There have been other patient-related factorssuch as COPD and chronic heart failure thought to also play a role in prognosis.[33]SurgeryEpidemiologyPrognosis

Large saddle embolus seen in thepulmonary artery (white arrows).Prognosis depends on the amount of lung that is affectedand on the co-existence of other medical conditions; chronicembolisation to the lung can lead to pulmonaryhypertension. After a massive PE, the embolus must beresolved somehow if the patient is to survive. In thromboticPE, the blood clot may be broken down by fibrinolysis, or itmay be organized and recanalized so that a new channelforms through the clot. Blood flow is restored most rapidlyin the first day or two after a PE.[97] Improvement slowsthereafter and some deficits may be permanent. There iscontroversy over whether small subsegmental PEs needtreatment at all[98] and some evidence exists that patientswith subsegmental PEs may do well without treatment.[59][99]Once anticoagulation is stopped, the risk of a fatal pulmonary embolism is 0.5% per year.[100]Mortality from untreated PEs was said to be 26%. This figure comes from a trial published in1960 by Barrit and Jordan, which compared anticoagulation against placebo for the managementof PE. Barritt and Jordan performed their study in the Bristol Royal Infirmary in 1957.[101] Thisstudy is the only placebo-controlled trial ever to examine the place of anticoagulants in thetreatment of PE, the results of which were so convincing that the trial has never been repeated asto do so would be considered unethical. That said, the reported mortality rate of 26% in theplacebo group is probably an overstatement, given that the technology of the day may havedetected only severe PEs.[102]The PESI and sPESI scoring tools can estimate mortality of patients. The Geneva prediction rulesand Wells criteria are used to calculate a pre-test probability of patients to predict who has apulmonary embolism. These scores are tools to be used with clinical judgment in decidingdiagnostic testing and types of therapy.[103] The PESI algorithm comprises 11 routinely availableclinical variables.[104] It puts the subjects into one of five classes (I–V), with 30-day mortalityranging from 1.1% to 24.5%. Those in classes I and II are low-risk and those in classes III–V arehigh-risk.[104]1. \"What Are the Signs and Symptoms of Pulmonary Embolism?\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe/signs). NHLBI. July 1, 2011. Archived (https://web.archive.org/web/20160309014739/https://www.nhlbi.nih.gov/health/health-topics/topics/pe/signs) from theoriginal on 9 March 2016. Retrieved 12 March 2016.2. Goldhaber SZ (2005). \"Pulmonary thromboembolism\". In Kasper DL, Braunwald E, Fauci AS,et al. (eds.). Harrison's Principles of Internal Medicine (16th ed.). New York: McGraw-Hill.pp. 1561–65. ISBN 978-0-07-139140-5.3. \"Who Is at Risk for Pulmonary Embolism?\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe/atrisk). NHLBI. July 1, 2011. Archived (https://web.archive.org/web/20160215115545/http://www.nhlbi.nih.gov/health/health-topics/topics/pe/atrisk) from the original on 15 February2016. Retrieved 12 March 2016.4. \"How Is Pulmonary Embolism Diagnosed?\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe/diagnosis). NHLBI. July 1, 2011. Archived (https://web.archive.org/web/20160407071108/http://www.nhlbi.nih.gov/health/health-topics/topics/pe/diagnosis) from the original on 7April 2016. Retrieved 12 March 2016.Predicting mortalityReferences

5. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. (February 2016).\"Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report\".Chest. 149 (2): 315–52. doi 10.1016/j.chest.2015.11.026 (https://doi.org/10.1016%2Fj.chest.:2015.11.026) PMID 26867832 (https://pubmed.ncbi.nlm.nih.gov/26867832). .6. \"What Is Pulmonary Embolism?\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe).NHLBI. July 1, 2011. Archived (https://web.archive.org/web/20160312125204/https://www.nhlbi.nih.gov/health/health-topics/topics/pe) from the original on 12 March 2016. Retrieved12 March 2016.7. Rahimtoola A, Bergin JD (February 2005). \"Acute pulmonary embolism: an update ondiagnosis and management\". Current Problems in Cardiology. 30 (2): 61–114.doi 10.1016/j.cpcardiol.2004.06.001 (https://doi.org/10.1016%2Fj.cpcardiol.2004.06.001):.PMID 15650680 (https://pubmed.ncbi.nlm.nih.gov/15650680).8. Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. (November2014). \"Thrombosis: a major contributor to global disease burden\" (https://doi.org/10.1161%2Fatvbaha.114.304488). Arteriosclerosis, Thrombosis, and Vascular Biology. 34 (11): 2363–71. doi 10.1161/atvbaha.114.304488 (https://doi.org/10.1161%2Fatvbaha.114.304488):.PMID 25304324 (https://pubmed.ncbi.nlm.nih.gov/25304324).9. Barco S, Valerio L, Ageno W, Cohen AT, Goldhaber SZ, Hunt BJ, et al. (October 2020). \"Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000-18: ananalysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database\"(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550106). The Lancet. Respiratory Medicine.9 (1): 33–42. doi 10.1016/S2213-2600(20)30417-3 (https://doi.org/10.1016%2FS2213-260:0%2820%2930417-3) PMC 7550106 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC75501. 06) PMID 33058771 (https://pubmed.ncbi.nlm.nih.gov/33058771). .10. Barco S, Mahmoudpour SH, Valerio L, Klok FA, Münzel T, Middeldorp S, et al. (March 2020).\"Trends in mortality related to pulmonary embolism in the European Region, 2000–15:analysis of vital registration data from the WHO Mortality Database\". The Lancet. RespiratoryMedicine. (3): 277–87. 8doi 10.1016/S2213-2600(19)30354-6 (https://doi.org/10.1016%2FS:2213-2600%2819%2930354-6) PMID 31615719 (https://pubmed.ncbi.nlm.nih.gov/3161571. 9).11. Tintinalli JE (2010). Emergency Medicine: A Comprehensive Study Guide (EmergencyMedicine (Tintinalli)) (7 ed.). New York: McGraw-Hill Companies. p. 432. ISBN 978-0-07-148480-0.12. \"What Causes Pulmonary Embolism?\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe/causes). NHLBI. July 1, 2011. Archived (https://web.archive.org/web/20160407071034/http://www.nhlbi.nih.gov/health/health-topics/topics/pe/causes) from the original on 7 April 2016.Retrieved 12 March 2016.13. Pantaleo G, Luigi N, Federica T, Paola S, Margherita N, Tahir M (2014). \"Amniotic fluidembolism: review\". Current Pharmaceutical Biotechnology. 14 (14): 1163–67.doi 10.2174/1389201015666140430161404 (https://doi.org/10.2174%2F1389201015666140:430161404) PMID 24804726 (https://pubmed.ncbi.nlm.nih.gov/24804726). .14. \"Other Names for Pulmonary Embolism\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe/names). July 1, 2011. Archived (https://web.archive.org/web/20160316025251/https://www.nhlbi.nih.gov/health/health-topics/topics/pe/names) from the original on 16 March 2016.Retrieved 12 March 2016.15. \"How Can Pulmonary Embolism Be Prevented?\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe/prevention). NHLBI. July 1, 2011. Archived (https://web.archive.org/web/20160407071129/http://www.nhlbi.nih.gov/health/health-topics/topics/pe/prevention) from the originalon 7 April 2016. Retrieved 12 March 2016.16. \"How Is Pulmonary Embolism Treated?\" (https://www.nhlbi.nih.gov/health/health-topics/topics/pe/treatment). NHLBI. July 1, 2011. Archived (https://web.archive.org/web/20160309014151/http://www.nhlbi.nih.gov/health/health-topics/topics/pe/treatment) from the original on 9March 2016. Retrieved 12 March 2016.

17. Lewis S, Dirksen S, Heitkemper M, Bucher L (2014). Medical-surgical nursing: Assessmentand management of clinical problems (9 ed.). St. Louis, MO: Elsevier Mosby. p. 552.ISBN 978-0-323-08678-3.18. Oqab Z, Ganshorn H, Sheldon R (April 2018). \"Prevalence of pulmonary embolism inpatients presenting with syncope. A systematic review and meta-analysis\". The AmericanJournal of Emergency Medicine. 36 (4): 551–55. doi 10.1016/j.ajem.2017.09.015 (https://doi.:org/10.1016%2Fj.ajem.2017.09.015) PMID 28947223 (https://pubmed.ncbi.nlm.nih.gov/289. 47223) S2CID 5012417 (https://api.semanticscholar.org/CorpusID:5012417). .19. Stein PD, Sostman HD, Hull RD, Goodman LR, Leeper KV, Gottschalk A, et al. (March2009). \"Diagnosis of pulmonary embolism in the coronary care unit\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717714). The American Journal of Cardiology. 103 (6): 881–86.doi 10.1016/j.amjcard.2008.11.040 (https://doi.org/10.1016%2Fj.amjcard.2008.11.040):.PMC 2717714 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717714) PMID 19268750 (ht. tps://pubmed.ncbi.nlm.nih.gov/19268750).20. Pregerson DB, Quick Essentials: Emergency Medicine, 4th edition. EMresource.org21. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. (April2011). American Heart Association Council on Cardiopulmonary, Critical Care, Perioperativeand Resuscitation, American Heart Association Council on Peripheral Vascular Disease,American Heart Association Council on Arteriosclerosis, Thrombosis, and Vascular Biology.\"Management of massive and submassive pulmonary embolism, iliofemoral deep veinthrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement fromthe American Heart Association\" (https://doi.org/10.1161%2FCIR.0b013e318214914f).Circulation. 123 (16): 1788–830. doi 10.1161/CIR.0b013e318214914f (https://doi.org/10.116:1%2FCIR.0b013e318214914f) PMID 21422387. (https://pubmed.ncbi.nlm.nih.gov/21422387).22. Ferri F (2012). Ferri's Clinical Advisor. St. Louis: Mosby's.23. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM (June 2018). \"Epidemiology,Pathophysiology, and Natural History of Pulmonary Embolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986574). Seminars in Interventional Radiology. 35 (2): 92–98.doi 10.1055/s-0038-1642036 (https://doi.org/10.1055%2Fs-0038-1642036) PMC 5986574 (h:. ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986574) PMID 29872243 (https://pubmed.nc. bi.nlm.nih.gov/29872243).24. Archer, D. F.; Oger, E. (June 2012). \"Estrogen and progestogen effect on venousthromboembolism in menopausal women\" (https://pubmed.ncbi.nlm.nih.gov/22612609/).Climacteric: The Journal of the International Menopause Society. 15 (3): 235–240.doi 10.3109/13697137.2012.664401 (https://doi.org/10.3109%2F13697137.2012.664401):.ISSN 1473-0804 (https://www.worldcat.org/issn/1473-0804) PMID 22612609 (https://pubme. d.ncbi.nlm.nih.gov/22612609) S2CID 43061502 (https://api.semanticscholar.org/CorpusID:4. 3061502).25. Tchaikovski, Svetlana N.; Rosing, Jan (July 2010). \"Mechanisms of estrogen-induced venousthromboembolism\" (https://pubmed.ncbi.nlm.nih.gov/20163835/). Thrombosis Research. 126(1): 5–11. doi 10.1016/j.thromres.2010.01.045 (https://doi.org/10.1016%2Fj.thromres.2010.0:1.045) ISSN 1879-2472 (https://www.worldcat.org/issn/1879-2472) PMID 20163835 (https://. . pubmed.ncbi.nlm.nih.gov/20163835).26. Nolan, Brendan J.; Cheung, Ada S. (September 2020). \"Estradiol Therapy in thePerioperative Period: Implications for Transgender People Undergoing Feminizing HormoneTherapy\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513447). The Yale Journal ofBiology and Medicine. 93 (4): 539–548. ISSN 1551-4056 (https://www.worldcat.org/issn/1551-4056) PMC 7513447 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513447). .PMID 33005118 (https://pubmed.ncbi.nlm.nih.gov/33005118).27. Toplis E, Mortimore G (January 2020). \"The diagnosis and management of pulmonaryembolism\". British Journal of Nursing. 29 (1): 22–26. doi 10.12968/bjon.2020.29.1.22 (https://:doi.org/10.12968%2Fbjon.2020.29.1.22) hdl 10545/624428 (https://hdl.handle.net/10545%2. :F624428) PMID 31917939 (https://pubmed.ncbi.nlm.nih.gov/31917939). .

28. \"Pulmonary embolus\" (http://pacificschoolserver.org/med/ency/article/000132.htm).MedlinePlus Medical Encyclopedia. Archived (https://web.archive.org/web/20170425030617/http://pacificschoolserver.org/med/ency/article/000132.htm) from the original on 25 April2017. Retrieved 24 April 2017.29. American College of Radiology \"Five Things Physicians and Patients Should Question\" (htt. p://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Coll_Radiology.pdf) (PDF). Choosing Wisely: an initiative of the ABIM Foundation. American College ofRadiology Archived (https://web.archive.org/web/20120416220509/http://choosingwisely.org/. wp-content/uploads/2012/04/5things_12_factsheet_Amer_Coll_Radiology.pdf) (PDF) fromthe original on April 16, 2012. Retrieved August 17, 2012.30. Raja AS, Greenberg JO, Qaseem A, Denberg TD, Fitterman N, Schuur JD (November 2015).\"Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice AdviceFrom the Clinical Guidelines Committee of the American College of Physicians\" (https://doi.org/10.7326%2FM14-1772). Annals of Internal Medicine. 163 (9): 701–11. doi 10.7326/M14-:1772 (https://doi.org/10.7326%2FM14-1772) PMID 26414967 (https://pubmed.ncbi.nlm.nih.g. ov/26414967).31. Ullah S, Jan SU, Rehman HU, Butt NI, Rauf MA, Shah S, Jan MY (March 2019). \"Researchproductivity in Pakistan heart journal from 2005 to 2018: a scientometric study\". PakistanHeart Journal. 52 (2). doi 10.47144/phj.v52i2.1763 (https://doi.org/10.47144%2Fphj.v52i2.17:63) (inactive 31 May 2021).32. Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, et al. (January2007). \"Diagnostic pathways in acute pulmonary embolism: recommendations of thePIOPED II Investigators\". Radiology. 242 (1): 15–21. doi 10.1148/radiol.2421060971 (https://:doi.org/10.1148%2Fradiol.2421060971) PMID 17185658 (https://pubmed.ncbi.nlm.nih.gov/1. 7185658).33. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al.(November 2014). \"2014 ESC guidelines on the diagnosis and management of acutepulmonary embolism\" (https://doi.org/10.1093%2Feurheartj%2Fehu283). European HeartJournal. 35 (43): 3033–69, 3069a–69k. doi 10.1093/eurheartj/ehu283 (https://doi.org/10.109:3%2Feurheartj%2Fehu283) PMID 25173341 (https://pubmed.ncbi.nlm.nih.gov/25173341). .34. Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, et al. (May 1995).\"Accuracy of clinical assessment of deep-vein thrombosis\". Lancet. 345 (8961): 1326–30.doi 10.1016/S0140-6736(95)92535-X (https://doi.org/10.1016%2FS0140-6736%2895%2992:535-X) PMID 7752753 (https://pubmed.ncbi.nlm.nih.gov/7752753) S2CID 23107192 (http. . s://api.semanticscholar.org/CorpusID:23107192).35. Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. (December1998). \"Use of a clinical model for safe management of patients with suspected pulmonaryembolism\". Annals of Internal Medicine. 129 (12): 997–1005. doi 10.7326/0003-4819-129-12-:199812150-00002 (https://doi.org/10.7326%2F0003-4819-129-12-199812150-00002).PMID 9867786 (https://pubmed.ncbi.nlm.nih.gov/9867786) S2CID 41389736 (https://api.se. manticscholar.org/CorpusID:41389736).36. Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. (March 2000).\"Derivation of a simple clinical model to categorize patients probability of pulmonaryembolism: increasing the models utility with the SimpliRED D-dimer\". Thrombosis andHaemostasis. 83 (3): 416–20. doi 10.1055/s-0037-1613830 (https://doi.org/10.1055%2Fs-00:37-1613830) PMID 10744147 (https://pubmed.ncbi.nlm.nih.gov/10744147). .37. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. (July 2001).\"Excluding pulmonary embolism at the bedside without diagnostic imaging: management ofpatients with suspected pulmonary embolism presenting to the emergency department byusing a simple clinical model and d-dimer\". Annals of Internal Medicine. 135 (2): 98–107.doi 10.7326/0003-4819-135-2-200107170-00010 (https://doi.org/10.7326%2F0003-4819-135:-2-200107170-00010) PMID 11453709 (https://pubmed.ncbi.nlm.nih.gov/11453709). .S2CID 2708155 (https://api.semanticscholar.org/CorpusID:2708155).

38. Sanson BJ, Lijmer JG, Mac Gillavry MR, Turkstra F, Prins MH, Büller HR (February 2000).\"Comparison of a clinical probability estimate and two clinical models in patients withsuspected pulmonary embolism. ANTELOPE-Study Group\". Thrombosis and Haemostasis.83 (2): 199–203. doi 10.1055/s-0037-1613785 (https://doi.org/10.1055%2Fs-0037-1613785):.PMID 10739372 (https://pubmed.ncbi.nlm.nih.gov/10739372).39. van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al.(January 2006). \"Effectiveness of managing suspected pulmonary embolism using analgorithm combining clinical probability, D-dimer testing, and computed tomography\" (https://doi.org/10.1001%2Fjama.295.2.172). JAMA. 295 (2): 172–79. doi 10.1001/jama.295.2.172 (h:ttps://doi.org/10.1001%2Fjama.295.2.172) PMID 16403929 (https://pubmed.ncbi.nlm.nih.go. v/16403929).40. Roy PM, Meyer G, Vielle B, Le Gall C, Verschuren F, Carpentier F, et al. (February 2006).\"Appropriateness of diagnostic management and outcomes of suspected pulmonaryembolism\". Annals of Internal Medicine. 144 (3): 157–64. CiteSeerX 10.1.1.1032.7193 (https://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.1032.7193) doi 10.7326/0003-4819-. :144-3-200602070-00003 (https://doi.org/10.7326%2F0003-4819-144-3-200602070-00003).PMID 16461959 (https://pubmed.ncbi.nlm.nih.gov/16461959) S2CID 38894349 (https://api.s. emanticscholar.org/CorpusID:38894349).41. Neff MJ (August 2003). \"ACEP releases clinical policy on evaluation and management ofpulmonary embolism\" (http://www.aafp.org/afp/20030815/practice.html). American FamilyPhysician. 68 (4): 759–60. PMID 12952389 (https://pubmed.ncbi.nlm.nih.gov/12952389).Archived (https://web.archive.org/web/20070926230609/http://www.aafp.org/afp/20030815/practice.html) from the original on 2007-09-26.42. Yap KS, Kalff V, Turlakow A, Kelly MJ (September 2007). \"A prospective reassessment of theutility of the Wells score in identifying pulmonary embolism\". The Medical Journal ofAustralia. 187 (6): 333–6. doi 10.5694/j.1326-5377.2007.tb01274.x (https://doi.org/10.5694%:2Fj.1326-5377.2007.tb01274.x) PMID 17874979 (https://pubmed.ncbi.nlm.nih.gov/1787497. 9) S2CID 17476982 (https://api.semanticscholar.org/CorpusID:17476982). .43. van Es N, van der Hulle T, Büller HR, Klok FA, Huisman MV, Galipienzo J, Di Nisio M(February 2017). \"Is stand-alone D-dimer testing safe to rule out acute pulmonaryembolism?\" (https://doi.org/10.1111%2Fjth.13574). Journal of Thrombosis and Haemostasis.15 (2): 323–28. doi 10.1111/jth.13574 (https://doi.org/10.1111%2Fjth.13574) PMID 27873439:. (https://pubmed.ncbi.nlm.nih.gov/27873439).44. Kline JA, Courtney DM, Kabrhel C, Moore CL, Smithline HA, Plewa MC, et al. (May 2008).\"Prospective multicenter evaluation of the pulmonary embolism rule-out criteria\". Journal ofThrombosis and Haemostasis. (5): 772–80. 6doi 10.1111/j.1538-7836.2008.02944.x (https://:doi.org/10.1111%2Fj.1538-7836.2008.02944.x) PMID 18318689 (https://pubmed.ncbi.nlm.ni. h.gov/18318689) S2CID 25488146 (https://api.semanticscholar.org/CorpusID:25488146). .45. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM (August 2004). \"Clinical criteriato prevent unnecessary diagnostic testing in emergency department patients with suspectedpulmonary embolism\". Journal of Thrombosis and Haemostasis. (8): 1247–55.2doi 10.1111/j.1538-7836.2004.00790.x (https://doi.org/10.1111%2Fj.1538-7836.2004.00790.:x) PMID 15304025 (https://pubmed.ncbi.nlm.nih.gov/15304025) S2CID 19311896 (https://a. . pi.semanticscholar.org/CorpusID:19311896).46. Carrier M, Righini M, Djurabi RK, Huisman MV, Perrier A, Wells PS, et al. (May 2009).\"VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonaryembolism. A systematic review of management outcome studies\". Thrombosis andHaemostasis. 101 (5): 886–92. doi 10.1160/TH-08-10-0689 (https://doi.org/10.1160%2FTH-0:8-10-0689) PMID 19404542 (https://pubmed.ncbi.nlm.nih.gov/19404542). .

47. Schrecengost JE, LeGallo RD, Boyd JC, Moons KG, Gonias SL, Rose CE, Bruns DE(September 2003). \"Comparison of diagnostic accuracies in outpatients and hospitalizedpatients of D-dimer testing for the evaluation of suspected pulmonary embolism\" (https://doi.org/10.1373%2F49.9.1483). Clinical Chemistry. 49 (9): 1483–90. doi 10.1373/49.9.1483 (http:s://doi.org/10.1373%2F49.9.1483) PMID 12928229 (https://pubmed.ncbi.nlm.nih.gov/12928. 229).48. Crawford F, Andras A, Welch K, Sheares K, Keeling D, Chappell FM, et al. (CochraneVascular Group) (August 2016). \"D-dimer test for excluding the diagnosis of pulmonaryembolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457638). The CochraneDatabase of Systematic Reviews (8): CD010864. doi 10.1002/14651858.CD010864.pub2 (ht:tps://doi.org/10.1002%2F14651858.CD010864.pub2) PMC 6457638 (https://www.ncbi.nlm.n. ih.gov/pmc/articles/PMC6457638) PMID 27494075 (https://pubmed.ncbi.nlm.nih.gov/274940. 75).49. Schouten HJ, Geersing GJ, Koek HL, Zuithoff NP, Janssen KJ, Douma RA, et al. (May 2013).\"Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patientswith suspected venous thromboembolism: systematic review and meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643284). BMJ. 346: f2492. doi 10.1136/bmj.f2492 (http:s://doi.org/10.1136%2Fbmj.f2492) PMC 3643284 (https://www.ncbi.nlm.nih.gov/pmc/articles/. PMC3643284) PMID 23645857 (https://pubmed.ncbi.nlm.nih.gov/23645857). .50. van Es N, van der Hulle T, van Es J, den Exter PL, Douma RA, Goekoop RJ, et al. (August2016). \"Wells Rule and d-Dimer Testing to Rule Out Pulmonary Embolism: A SystematicReview and Individual-Patient Data Meta-analysis\". Annals of Internal Medicine. 165 (4):253–61. doi 10.7326/m16-0031 (https://doi.org/10.7326%2Fm16-0031) PMID 27182696 (htt:. ps://pubmed.ncbi.nlm.nih.gov/27182696) S2CID 207538572 (https://api.semanticscholar.or. g/CorpusID:207538572).51. Werman HA, Karren K, Mistovich J (2014). \"Other Conditions That Cause RespiratoryDistress: Pulmonary Embolism\". In Howard WA, Mistovich J, Karren K (eds.). PrehospitalEmergency Care, 10e. Pearson Education, Inc. p. 456.52. Söhne M, Ten Wolde M, Büller HR (November 2004). \"Biomarkers in pulmonary embolism\".Current Opinion in Cardiology. 19 (6): 558–62. doi 10.1097/01.hco.0000138991.82347.0e (ht:tps://doi.org/10.1097%2F01.hco.0000138991.82347.0e) PMID 15502498 (https://pubmed.nc. bi.nlm.nih.gov/15502498) S2CID 39899682 (https://api.semanticscholar.org/CorpusID:39899. 682).53. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. (September2008). \"Guidelines on the diagnosis and management of acute pulmonary embolism: theTask Force for the Diagnosis and Management of Acute Pulmonary Embolism of theEuropean Society of Cardiology (ESC)\" (https://doi.org/10.1093%2Feurheartj%2Fehn310).European Heart Journal. 29 (18): 2276–315. doi 10.1093/eurheartj/ehn310 (https://doi.org/1:0.1093%2Feurheartj%2Fehn310) PMID 18757870 (https://pubmed.ncbi.nlm.nih.gov/187578. 70).54. Stein PD, Freeman LM, Sostman HD, Goodman LR, Woodard PK, Naidich DP, et al.(December 2009). \"SPECT in acute pulmonary embolism\" (https://doi.org/10.2967%2Fjnumed.109.063958). Journal of Nuclear Medicine (Review). 50 (12): 1999–2007.doi 10.2967/jnumed.109.063958 (https://doi.org/10.2967%2Fjnumed.109.063958):.PMID 19949025 (https://pubmed.ncbi.nlm.nih.gov/19949025).55. Da Costa Rodrigues J, Alzuphar S, Combescure C, Le Gal G, Perrier A (September 2016).\"Diagnostic characteristics of lower limb venous compression ultrasonography in suspectedpulmonary embolism: a meta-analysis\" (https://doi.org/10.1111%2Fjth.13407). Journal ofThrombosis and Haemostasis. 14 (9): 1765–72. doi 10.1111/jth.13407 (https://doi.org/10.111:1%2Fjth.13407) PMID 27377039 (https://pubmed.ncbi.nlm.nih.gov/27377039). .

56. van Mens TE, Scheres LJ, de Jong PG, Leeflang MM, Nijkeuter M, Middeldorp S, et al.(Cochrane Vascular Group) (January 2017). \"Imaging for the exclusion of pulmonaryembolism in pregnancy\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464730). TheCochrane Database of Systematic Reviews. : CD011053.1doi 10.1002/14651858.CD011053.pub2 (https://doi.org/10.1002%2F14651858.CD011053.pu:b2) PMC 6464730 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464730). .PMID 28124411 (https://pubmed.ncbi.nlm.nih.gov/28124411).57. Schaefer-Prokop C, Prokop M (November 2005). \"MDCT for the diagnosis of acutepulmonary embolism\". European Radiology. 15 Suppl 4 (Suppl 4): D37–41.doi 10.1007/s10406-005-0144-3 (https://doi.org/10.1007%2Fs10406-005-0144-3):.PMID 16479644 (https://pubmed.ncbi.nlm.nih.gov/16479644) S2CID 6074 (https://api.sema. nticscholar.org/CorpusID:6074).58. Van Strijen MJ, De Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MV (January2005). \"Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: aprospective multicenter cohort study of consecutive patients with abnormal perfusionscintigraphy\". Journal of Thrombosis and Haemostasis. (1): 17–25. 3doi 10.1111/j.1538-:7836.2004.01064.x (https://doi.org/10.1111%2Fj.1538-7836.2004.01064.x) PMID 15634261. (https://pubmed.ncbi.nlm.nih.gov/15634261) S2CID 38746246 (https://api.semanticscholar.o. rg/CorpusID:38746246).59. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al. (June 2006).\"Multidetector computed tomography for acute pulmonary embolism\". The New EnglandJournal of Medicine. 354 (22): 2317–27. doi 10.1056/NEJMoa052367 (https://doi.org/10.105:6%2FNEJMoa052367) PMID 16738268 (https://pubmed.ncbi.nlm.nih.gov/16738268). .60. Anderson DR, Kahn SR, Rodger MA, Kovacs MJ, Morris T, Hirsch A, et al. (December 2007).\"Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning inpatients with suspected pulmonary embolism: a randomized controlled trial\" (https://doi.org/10.1001%2Fjama.298.23.2743). JAMA. 298 (23): 2743–53. doi 10.1001/jama.298.23.2743 (htt:ps://doi.org/10.1001%2Fjama.298.23.2743) PMID 18165667 (https://pubmed.ncbi.nlm.nih.g. ov/18165667).61. Scarsbrook AF, Gleeson FV (February 2007). \"Investigating suspected pulmonary embolismin pregnancy\" (http://www.bmj.com/cgi/content/full/334/7590/418). BMJ. 334 (7590): 418–19.doi 10.1136/bmj.39071.617257.80 (https://doi.org/10.1136%2Fbmj.39071.617257.80):.PMC 1804186 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804186) PMID 17322258 (ht. tps://pubmed.ncbi.nlm.nih.gov/17322258) Archived (https://web.archive.org/web/200709040. 32200/http://www.bmj.com/cgi/content/full/334/7590/418) from the original on 2007-09-04.62. Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, et al. (November2011). \"An official American Thoracic Society/Society of Thoracic Radiology clinical practiceguideline: evaluation of suspected pulmonary embolism in pregnancy\". American Journal ofRespiratory and Critical Care Medicine. 184 (10): 1200–08. doi 10.1164/rccm.201108-:1575ST (https://doi.org/10.1164%2Frccm.201108-1575ST) PMID 22086989 (https://pubmed.. ncbi.nlm.nih.gov/22086989).63. Thomson AJ, Greer IA (April 2015). \"Thrombosis and Embolism during Pregnancy and thePuerperium, the Acute Management of (Green-top Guideline No. 37b)\" (https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37b/). Royal College of Obstetricians &Gynaecologists. Retrieved 4 June 2018.64. Mortensen, Jann; Gutte, Henrik (May 2014). \"SPECT/CT and pulmonary embolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003400). European Journal of Nuclear Medicineand Molecular Imaging. 41 Suppl 1: S81–90. doi 10.1007/s00259-013-2614-5 (https://doi.org/:10.1007%2Fs00259-013-2614-5) ISSN 1619-7089 (https://www.worldcat.org/issn/1619-708. 9) PMC 4003400 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003400) PMID 24213621. . (https://pubmed.ncbi.nlm.nih.gov/24213621).

65. Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE (October 1993).\"Chest radiographic findings in patients with acute pulmonary embolism: observations fromthe PIOPED Study\". Radiology. 189 (1): 133–36. doi 10.1148/radiology.189.1.8372182 (http:s://doi.org/10.1148%2Fradiology.189.1.8372182) PMID 8372182 (https://pubmed.ncbi.nlm.ni. h.gov/8372182).66. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al.(November 2014). \"2014 ESC guidelines on the diagnosis and management of acutepulmonary embolism\" (https://doi.org/10.1093%2Feurheartj%2Fehu283). European HeartJournal. 35 (43): 3033–69, 3069a–69k. doi 10.1093/eurheartj/ehu283 (https://doi.org/10.109:3%2Feurheartj%2Fehu283) PMID 25173341 (https://pubmed.ncbi.nlm.nih.gov/25173341). .\"Pulmonary angiography has for decades remained the ‘gold standard' for the diagnosis orexclusion of PE but is rarely performed now as less-invasive CT angiography offers similardiagnostic accuracy.\"67. Brown G, Hogg K (October 2005). \"Best evidence topic report. Diagnostic utility ofelectrocardiogram for diagnosing pulmonary embolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726554). Emergency Medicine Journal. 22 (10): 729–30.doi 10.1136/emj.2005.029041 (https://doi.org/10.1136%2Femj.2005.029041) PMC 1726554:. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726554) PMID 16189038 (https://pubmed.n. cbi.nlm.nih.gov/16189038).68. Mattu A, Goyal D, eds. (2007). Emergency medicine avoiding the pitfalls and improving theoutcomes (https://books.google.com/books?id=QzaKkqAwuWYC&pg=PA9). Malden, Mass.:Blackwell Pub./BMJ Books. p. 9. ISBN 978-0470755174 Archived (https://web.archive.org/w. eb/20170908190516/https://books.google.com/books?id=QzaKkqAwuWYC&pg=PA9) fromthe original on 2017-09-08.69. McGinn S, White PD (1935). \"Acute cor pulmonale resulting from pulmonary embolism\". JAm Med Assoc. 104 (17): 1473–80. doi 10.1001/jama.1935.02760170011004 (https://doi.org/:10.1001%2Fjama.1935.02760170011004).70. Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P, Wells PS (October2000). \"Diagnostic value of the electrocardiogram in suspected pulmonary embolism\". TheAmerican Journal of Cardiology. 86 (7): 807–09, A10. doi 10.1016/S0002-9149(00)01090-0:(https://doi.org/10.1016%2FS0002-9149%2800%2901090-0) PMID 11018210 (https://pubm. ed.ncbi.nlm.nih.gov/11018210).71. Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; PeterDeblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey(2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden,Mass: Blackwell Pub./BMJ Books. p. 10. ISBN 978-1-4051-4166-6.72. Shopp JD, Stewart LK, Emmett TW, Kline JA (October 2015). \"Findings From 12-leadElectrocardiography That Predict Circulatory Shock From Pulmonary Embolism: SystematicReview and Meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306533).Academic Emergency Medicine. 22 (10): 1127–37. doi 10.1111/acem.12769 (https://doi.org/1:0.1111%2Facem.12769) PMC 5306533 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC530. 6533) PMID 26394330 (https://pubmed.ncbi.nlm.nih.gov/26394330). .73. Kosuge M, Ebina T, Hibi K, Tsukahara K, Iwahashi N, Gohbara M, et al. (December 2012).\"Differences in negative T waves among acute coronary syndrome, acute pulmonaryembolism, and Takotsubo cardiomyopathy\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760560). European Heart Journal - Acute Cardiovascular Care. (4): 349–57.1doi 10.1177/2048872612466790 (https://doi.org/10.1177%2F2048872612466790):.PMC 3760560 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760560) PMID 24062927 (ht. tps://pubmed.ncbi.nlm.nih.gov/24062927).74. Kucher N, Goldhaber SZ (November 2003). \"Cardiac biomarkers for risk stratification ofpatients with acute pulmonary embolism\" (https://doi.org/10.1161%2F01.CIR.0000100687.99687.CE). Circulation. 108 (18): 2191–94. doi 10.1161/01.CIR.0000100687.99687.CE (https://:doi.org/10.1161%2F01.CIR.0000100687.99687.CE) PMID 14597581 (https://pubmed.ncbi.nl. m.nih.gov/14597581).

75. Lankeit M, Jiménez D, Kostrubiec M, Dellas C, Hasenfuss G, Pruszczyk P, Konstantinides S(December 2011). \"Predictive value of the high-sensitivity troponin T assay and the simplifiedPulmonary Embolism Severity Index in hemodynamically stable patients with acutepulmonary embolism: a prospective validation study\" (https://doi.org/10.1161%2FCIRCULATIONAHA.111.051177). Circulation. 124 (24): 2716–24.doi 10.1161/CIRCULATIONAHA.111.051177 (https://doi.org/10.1161%2FCIRCULATIONAHA.:111.051177) PMID 22082681 (https://pubmed.ncbi.nlm.nih.gov/22082681). .76. McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT (August 1996).\"Regional right ventricular dysfunction detected by echocardiography in acute pulmonaryembolism\". The American Journal of Cardiology. 78 (4): 469–73. doi 10.1016/S0002-:9149(96)00339-6 (https://doi.org/10.1016%2FS0002-9149%2896%2900339-6).PMID 8752195 (https://pubmed.ncbi.nlm.nih.gov/8752195).77. \"UOTW #2 Answer - Ultrasound of the Week\" (https://www.ultrasoundoftheweek.com/uotw-2-answer/). Ultrasound of the Week. Archived (https://web.archive.org/web/20170112213201/http://www.ultrasoundoftheweek.com/uotw-2-answer/) from the original on 12 January 2017.Retrieved 27 May 2017.78. National Institute for Health and Clinical Excellence. Clinical guideline 92: Venousthromboembolism: reducing the risk: Reducing the risk of venous thromboembolism (deepvein thrombosis and pulmonary embolism) in patients admitted to hospital (https://www.nice.org.uk/guidance/CG92). London, January 2010.79. Vinson DR, Zehtabchi S, Yealy DM (November 2012). \"Can selected patients with newlydiagnosed pulmonary embolism be safely treated without hospitalization? A systematicreview\". Annals of Emergency Medicine. 60 (5): 651–662.e4.doi 10.1016/j.annemergmed.2012.05.041 (https://doi.org/10.1016%2Fj.annemergmed.2012.0:5.041) PMID 22944455 (https://pubmed.ncbi.nlm.nih.gov/22944455). .80. Yoo HH, Queluz TH, El Dib R (January 2016). \"Anticoagulant treatment for subsegmentalpulmonary embolism\". The Cochrane Database of Systematic Reviews (1): CD010222.doi 10.1002/14651858.CD010222.pub3 (https://doi.org/10.1002%2F14651858.CD010222.pu:b3) PMID 26756331 (https://pubmed.ncbi.nlm.nih.gov/26756331). .81. Robertson L, Jones LE (February 2017). \"Fixed dose subcutaneous low molecular weightheparins versus adjusted dose unfractionated heparin for the initial treatment of venousthromboembolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464611). The CochraneDatabase of Systematic Reviews. 2017 (2): CD001100.doi 10.1002/14651858.CD001100.pub4 (https://doi.org/10.1002%2F14651858.CD001100.pu:b4) PMC 6464611 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464611). .PMID 28182249 (https://pubmed.ncbi.nlm.nih.gov/28182249).82. Robertson L, Kesteven P, McCaslin JE, et al. (Cochrane Vascular Group) (December 2015).\"Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of pulmonaryembolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463831). The CochraneDatabase of Systematic Reviews (12): CD010957. doi 10.1002/14651858.CD010957.pub2:(https://doi.org/10.1002%2F14651858.CD010957.pub2) PMC 6463831 (https://www.ncbi.nl. m.nih.gov/pmc/articles/PMC6463831) PMID 26636644 (https://pubmed.ncbi.nlm.nih.gov/266. 36644).83. National Institute for Health and Clinical Excellence. Clinical guideline 144: Venousthromboembolic diseases: the management of venous thromboembolic diseases and the roleof thrombophilia testing (https://www.nice.org.uk/guidance/CG144). London, 2012.84. Mai V, Guay CA, Perreault L, Bonnet S, Bertoletti L, Lacasse Y, et al. (June 2019). \"ExtendedAnticoagulation for VTE: A Systematic Review and Meta-Analysis\". Chest. 155 (6): 1199–1216. doi 10.1016/j.chest.2019.02.402 (https://doi.org/10.1016%2Fj.chest.2019.02.402):.PMID 31174635 (https://pubmed.ncbi.nlm.nih.gov/31174635).

85. Yoo HH, Nunes-Nogueira VS, Fortes Villas Boas PJ (February 2020). \"Anticoagulanttreatment for subsegmental pulmonary embolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004894). The Cochrane Database of Systematic Reviews. : CD010222.2doi 10.1002/14651858.CD010222.pub4 (https://doi.org/10.1002%2F14651858.CD010222.pu:b4) PMC 7004894 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004894). .PMID 32030721 (https://pubmed.ncbi.nlm.nih.gov/32030721).86. Ucar, Elif Yilmazel (June 2019). \"Update on Thrombolytic Therapy in Acute PulmonaryThromboembolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592452). The EurasianJournal of Medicine. 51 (2): 186–190. doi 10.5152/eurasianjmed.2019.19291 (https://doi.org/:10.5152%2Feurasianjmed.2019.19291) PMC 6592452 (https://www.ncbi.nlm.nih.gov/pmc/ar. ticles/PMC6592452) PMID 31258361 (https://pubmed.ncbi.nlm.nih.gov/31258361). .87. Lavonas EJ, Drennan IR, Gabrielli A, Heffner AC, Hoyte CO, Orkin AM, et al. (November2015). \"Part 10: Special Circumstances of Resuscitation: 2015 American Heart AssociationGuidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care\".Circulation. 132 (18 Suppl 2): S501–18. doi 10.1161/cir.0000000000000264 (https://doi.org/1:0.1161%2Fcir.0000000000000264) PMID 26472998 (https://pubmed.ncbi.nlm.nih.gov/26472. 998).88. Kuo WT, Gould MK, Louie JD, Rosenberg JK, Sze DY, Hofmann LV (November 2009).\"Catheter-directed therapy for the treatment of massive pulmonary embolism: systematicreview and meta-analysis of modern techniques\". Journal of Vascular and InterventionalRadiology. 20 (11): 1431–40. doi 10.1016/j.jvir.2009.08.002 (https://doi.org/10.1016%2Fj.jvir.:2009.08.002) PMID 19875060 (https://pubmed.ncbi.nlm.nih.gov/19875060). .89. Engelberger RP, Kucher N (March 2014). \"Ultrasound-assisted thrombolysis for acutepulmonary embolism: a systematic review\"(https://doi.org/10.1093%2Feurheartj%2Fehu029). European Heart Journal. 35 (12): 758–64.doi 10.1093/eurheartj/ehu029 (https://doi.org/10.1093%2Feurheartj%2Fehu029):.PMID 24497337 (https://pubmed.ncbi.nlm.nih.gov/24497337).90. Zuo, Zhiliang; Yue, Jirong; Dong, Bi Rong; Wu, Taixiang; Liu, Guan J.; Hao, Qiukui (2021-04-15). \"Thrombolytic therapy for pulmonary embolism\". The Cochrane Database of SystematicReviews. 2021 (4): CD004437. doi 10.1002/14651858.CD004437.pub6 (https://doi.org/10.10:02%2F14651858.CD004437.pub6) ISSN 1469-493X (https://www.worldcat.org/issn/1469-49. 3X) PMC. 8092433. PMID 33857326 (https://pubmed.ncbi.nlm.nih.gov/33857326).91. Nakamura S, Takano H, Kubota Y, Asai K, Shimizu W (July 2014). \"Impact of the efficacy ofthrombolytic therapy on the mortality of patients with acute submassive pulmonary embolism:a meta-analysis\". Journal of Thrombosis and Haemostasis. 12 (7): 1086–95.doi 10.1111/jth.12608 (https://doi.org/10.1111%2Fjth.12608) PMID 24829097 (https://pubme:. d.ncbi.nlm.nih.gov/24829097) S2CID 21881585 (https://api.semanticscholar.org/CorpusID:2. 1881585).92. Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. (June2014). \"Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding,and intracranial hemorrhage: a meta-analysis\" (https://doi.org/10.1001%2Fjama.2014.5990).JAMA. 311 (23): 2414–21. doi 10.1001/jama.2014.5990 (https://doi.org/10.1001%2Fjama.20:14.5990) PMID 24938564 (https://pubmed.ncbi.nlm.nih.gov/24938564). .93. Young T, Sriram KB (October 2020). \"Vena caval filters for the prevention of pulmonaryembolism\". The Cochrane Database of Systematic Reviews. 10: CD006212.doi 10.1002/14651858.CD006212.pub5 (https://doi.org/10.1002%2F14651858.CD006212.pu:b5) PMID 33027844 (https://pubmed.ncbi.nlm.nih.gov/33027844). .94. Augustinos P, Ouriel K (August 2004). \"Invasive approaches to treatment of venousthromboembolism\" (https://doi.org/10.1161%2F01.CIR.0000140900.64198.f4). Circulation.110 (9 Suppl 1): I27–34. doi 10.1161/01.CIR.0000140900.64198.f4 (https://doi.org/10.1161%:2F01.CIR.0000140900.64198.f4) PMID 15339878 (https://pubmed.ncbi.nlm.nih.gov/153398. 78).

Classification ICD-10: I26 (https://icd.who.int/browse10/2019/en#/I26)· ICD-9-CM: 415.1Pulmonary embolism (https://curlie.org/Health/Conditions_and_Diseases/Cardiovascular_Disorders/Vascular_Disorders/Thrombosis/) at CurlieWells criteria for pulmonary embolism online calculator (http://www.mdcalc.com/wells-criteria-pulmonary-embolism-p95. Madani, Michael M. (2016). \"50. Pulmonary Thromboendarterectomy\" (https://books.google.com/books?id=pgzYCwAAQBAJ&q=Pulmonary+thromboendarterectomy+pte+pea&pg=PA541). In Peacock, Andrew J.; Naeije, Robert; Rubin, Lewis J. (eds.). Pulmonary Circulation:Diseases and Their Treatment, Fourth Edition. CRC Press. p. 541. ISBN 978-1-4987-1991-9.96. Kumar V, Abbas AK, Fausto N, Mitchell RN (2010). Basic Pathology. New Delhi: Elsevier.p. 98. ISBN 978-81-312-1036-9.97. Walker RH, Goodwin J, Jackson JA (October 1970). \"Resolution of pulmonary embolism\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819885). British Medical Journal. (5728):4135–39. doi 10.1136/bmj.4.5728.135 (https://doi.org/10.1136%2Fbmj.4.5728.135):.PMC 1819885 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819885) PMID 5475816 (htt. ps://pubmed.ncbi.nlm.nih.gov/5475816).98. Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F (April 2006). \"Diagnosis andmanagement of subsegmental pulmonary embolism\". Journal of Thrombosis andHaemostasis. (4): 724–31. 4doi 10.1111/j.1538-7836.2006.01819.x (https://doi.org/10.1111%:2Fj.1538-7836.2006.01819.x) PMID 16634736 (https://pubmed.ncbi.nlm.nih.gov/16634736). .S2CID 20515117 (https://api.semanticscholar.org/CorpusID:20515117).99. Perrier A, Bounameaux H (June 2006). \"Accuracy or outcome in suspected pulmonaryembolism\". The New England Journal of Medicine. 354 (22): 2383–85.doi 10.1056/NEJMe068076 (https://doi.org/10.1056%2FNEJMe068076) PMID 16738276 (htt:. ps://pubmed.ncbi.nlm.nih.gov/16738276).100. White RH (October 2008). \"Risk of fatal pulmonary embolism was 0.49 per 100 person-yearsafter discontinuing anticoagulant therapy for venous thromboembolism\". Evidence-BasedMedicine. 13 (5): 154. doi 10.1136/ebm.13.5.154 (https://doi.org/10.1136%2Febm.13.5.154):.PMID 18836122 (https://pubmed.ncbi.nlm.nih.gov/18836122) S2CID 29062377 (https://api.s. emanticscholar.org/CorpusID:29062377).101. Barritt DW, Jordan SC (June 1960). \"Anticoagulant drugs in the treatment of pulmonaryembolism. A controlled trial\". Lancet. (7138): 1309–12. 1doi 10.1016/S0140-6736(60)92299-:6 (https://doi.org/10.1016%2FS0140-6736%2860%2992299-6) PMID 13797091 (https://pub. med.ncbi.nlm.nih.gov/13797091).102. Cugell, D. W.; Buckingham, W. B.; Webster, J. R.; Kettel, L. J. (January 1967). \"Thelimitations of laboratory methods in the diagnosis of pulmonary embolism\" (https://pubmed.ncbi.nlm.nih.gov/4869238/). The Medical Clinics of North America. 51 (1): 175–184.doi 10.1016/s0025-7125(16)33092-9 (https://doi.org/10.1016%2Fs0025-7125%2816%29330:92-9) ISSN 0025-7125 (https://www.worldcat.org/issn/0025-7125) PMID 4869238 (https://pu. . bmed.ncbi.nlm.nih.gov/4869238).103. Jiménez D, Yusen RD, Otero R, Uresandi F, Nauffal D, Laserna E, et al. (July 2007).\"Prognostic models for selecting patients with acute pulmonary embolism for initial outpatienttherapy\". Chest. 132 (1): 24–30. doi 10.1378/chest.06-2921 (https://doi.org/10.1378%2Fches:t.06-2921) PMID 17625081 (https://pubmed.ncbi.nlm.nih.gov/17625081). .104. Zhou XY, Ben SQ, Chen HL, Ni SS (December 2012). \"The prognostic value of pulmonaryembolism severity index in acute pulmonary embolism: a meta-analysis\" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571977). Respiratory Research. 13 (1): 111. doi 10.1186/1465-:9921-13-111 (https://doi.org/10.1186%2F1465-9921-13-111) PMC 3571977 (https://www.ncb. i.nlm.nih.gov/pmc/articles/PMC3571977) PMID 23210843 (https://pubmed.ncbi.nlm.nih.gov/. 23210843).External linksD

(http://www.icd9data.com/getICD9Code.ashx?icd9=415.1)· MeSH: D011655(https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D011655) ·DiseasesDB:10956 (http://www.diseasesdatabase.com/ddb10956.htm)ExternalresourcesMedlinePlus:000132 (https://www.nlm.nih.gov/medlineplus/ency/article/000132.htm) ·eMedicine:med/1958 (https://emedicine.medscape.com/med/1958-overview) emerg/490(http://www.emedicine.com/emerg/topic490.htm#)radio/582 (http://www.emedicine.com/radio/topic582.htm#) ·Patient UK:Pulmonaryembolism (https://patient.info/doctor/pulmonary-embolism)e/)Clinical prediction website – Wells criteria for pulmonaryembolism (http://www.clinicalprediction.com/wells-score-for-pe/) Media related to Pulmonary embolism at WikimediaCommons\"Pulmonary Embolism\" (https://medlineplus.gov/pulmonaryembolism.html). MedlinePlus. U.S. National Library ofMedicine.Retrieved from \"https://en.wikipedia.org/w/index.php?title=Pulmonary_embolism&oldid=1042054027\"This page was last edited on 3 September 2021, at 00:14 (UTC).Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By usingthis site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the WikimediaFoundation, Inc., a non-profit organization.

PurpuraPetechiae and purpura on the lower limb due tomedication-induced vasculitisSpecialtyDermatology, hematologyPurpuraPurpura (/ p rpj r / ) is a condition of red orˈ ɜːʊə ə[1]purple discolored spots on the skin that do notblanch on applying pressure. The spots are causedby bleeding underneath the skin secondary toplatelet disorders, vascular disorders, coagulationdisorders, or other causes.[2] They measure 3–10 mm,[3] whereas petechiae measure less than3 mm, and ecchymoses greater than 1 cm.[4]Purpura is common with typhus and can bepresent with meningitis caused by meningococcior septicaemia. In particular, meningococcus(Neisseria meningitidis), a Gram-negativediplococcus organism, releases endotoxin when itlyses. Endotoxin activates the Hageman factor(clotting factor XII), which causes disseminatedintravascular coagulation (DIC). The DIC is whatappears as a rash on the affected individual.ClassificationEtymology and pronunciationSee alsoReferencesExternal linksPurpura are a common and nonspecific medical sign; however, the underlying mechanismcommonly involves one of:Platelet disorders (thrombocytopenic purpura)Primary thrombocytopenic purpuraSecondary thrombocytopenic purpuraPost-transfusion purpuraVascular disorders (nonthrombocytopenic purpura)Microvascular injury, as seen in senile (old age) purpura, when blood vessels are moreeasily damagedHypertensive statesDeficient vascular supportVasculitis, as in the case of Henoch–Schönlein purpuraContentsClassification

Coagulation disordersDisseminated intravascular coagulation (DIC)Scurvy (vitamin C deficiency) – defect in collagen synthesis due to lack of hydroxylationof procollagen results in weakened capillary walls and cellsMeningococcemiaClumping fibrillary protein deposits caused by AmyloidosisCocaine use with concomitant use of the one-time chemotherapy drug and now veterinarydeworming agent levamisole can cause purpura of the ears, face, trunk, or extremities,sometimes needing reconstructive surgery. Levamisole is purportedly a common cutting[5]agent.Decomposition of blood vessels including purpura is a symptom of acute radiation poisoningin excess of 2 Grays of radiation exposure. This is an uncommon cause in general, but iscommonly seen in victims of nuclear disaster.Cases of psychogenic purpura are also described in the medical literature,[6] some claimed to bedue to \"autoerythrocyte sensitization\". Other studies[7] suggest the local (cutaneous) activity oftissue plasminogen activator can be increased in psychogenic purpura, leading to substantialamounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding.Petechial rash is also characteristic of a rickettsial infection.The word purpura (/ p rp r /) comes from Latin ˈ ɜː ɜː əpurpura, \"purple\", which came from ancientGreek πορφύρα. Purpura is a mass noun naming the condition or state, not the name of anindividual spot (thus there is no *pupurum, *purpura or *purpura, *purpurae countdeclension).Bruise, which is a hematoma caused by traumaPetechia, which is a small type of hematoma (<3 mm)Ecchymosis, which is a large type of hematoma (>1 cm)Purpura secondary to clotting disordersPurpura hemorrhagica in horsesPigmented purpuric dermatosisSchamberg disease (progressive pigmentary purpura)1. https://www.lexico.com/en/definition/purpura2. \"UCSF Purpura Module\" (https://web.archive.org/web/20131002064433/http://www.dermatology.ucsf.edu/education_training/140.01ClinicalDermatology/Module.8.Purpura%20Module%20REVISED2.pdf) (PDF). Archived from the original (http://www.dermatology.ucsf.edu/education_training/140.01ClinicalDermatology/Module.8.Purpura%20Module%20REVISED2.pdf)(PDF) on 2013-10-02.3. McKenzie, Shirlyn B. (2014). Clinical Laboratory Hematology. Williams, Joanne Lynne;Landis-Piwowar, Kristin (3rd ed.). Boston. p. 665. ISBN 978-0133076011 OCLC 878098857. (https://www.worldcat.org/oclc/878098857).4. Robbins basic pathology. Kumar, Vinay; Abbas, Abul K.; Aster, Jon C.; Perkins, James A.(10th ed.). Philadelphia, Pennsylvania. 2017-03-28. p. 101. ISBN 978-0323353175.Etymology and pronunciationSee alsoReferences