Brown A K, Newton P, Hamilton E A, Anderson V
Thorax. 1979 Jun;34(3):380-3. doi: 10.1136/thx.34.3.380.
Pulmonary emboli seldom recur, and when recurrence does occur it is not associated with permanent sequelae unless there is progressive pulmonary arterial hypertension. Five patients with clinical and perfusion lung scan evidence of recurrent pulmonary embolism presented with abnormal cardiac rhythms without evidence of progressive pulmonary hypertension. Twenty-four-hour ambulatory electrocardiographic monitoring was valuable in diagnosis and in assessing the effectiveness of treatment. Although palpitation was the main complaint, other symptoms included tiredness, mild exertional dyspnoea, and chest discomfort unrelated to effort. Symptomatic improvement coincided with objective evidence of improvement from repeat lung scans and 24-hour ECG records. Antiarrhythmic agents controlled the arrhythmias but were subsequently withdrawn without the return of symptoms. Four of the five patients continued to take anticoagulants for two years. We believe that these five patients represent a group of patients with recurrent pulmonary emboli and a recognisable clinical picture dominated by arrhythmias unrelated to progressive pulmonary arterial hypertension. Long-term anticoagulant treatment was associated with clinical improvement.
肺栓塞很少复发，即便复发，若不存在进行性肺动脉高压，也不会导致永久性后遗症。五例经临床及肺灌注扫描证实为复发性肺栓塞的患者出现心律失常，且无进行性肺动脉高压的证据。24小时动态心电图监测对诊断及评估治疗效果很有价值。虽然心悸是主要主诉，但其他症状包括疲倦、轻度劳力性呼吸困难以及与活动无关的胸部不适。症状改善与重复肺扫描及24小时心电图记录显示的客观改善证据相符。抗心律失常药物可控制心律失常，但随后停药且症状未复发。五名患者中有四名继续服用抗凝剂两年。我们认为这五名患者代表了一组复发性肺栓塞患者，其具有以与进行性肺动脉高压无关的心律失常为主导的可识别临床表现。长期抗凝治疗与临床改善相关。
