How we do it: evaluation of dyspnea and exercise intolerance after acute pulmonary embolism

Chest. 2022 Jul 2:S0012-3692(22)01215-6. doi: 10.1016/j.chest.2022.06.036. Online ahead of print.ABSTRACTLong-term dyspnea and exercise intolerance are common clinical problems after acute PE. Unfortunately, no single test can distinguish among the range of potential pathological outcomes after PE. We illustrate a stepwise approach to post-PE evaluation that uses a hierarchical series of clinically validated diagnostic tests. The algorithm is represented by the acronym SEARCH, which stands for symptom screening, exercise testing, arterial perfusion, resting echocardiography, confirmatory chest imaging and (right) heart catheterization. We illustrate the algorithm with a patient whom we saw in our pulmonary embolism follow up clinic. Patients are asked at least six months after PE whether they have returned to their baseline level of respiratory comfort and exercise tolerance. Dyspneic and exercise intolerant patients undergo non-invasive cardiopulmonary exercise testing to identify elevated ventilatory dead space ratios, decreased stroke volume augmentation with exercise and other physiological abnormalities during exertion. Ventilation-perfusion scanning is performed on those with exercise-related physiological findings to confirm the presence of residual pulmonary arterial obstruction or to suggest alternative diagnoses. Resting echocardiography may provide evidence of pulmonary hypertension, while confirmatory imaging with pulmonary angiography or CT angiography may disclo...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research