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European Heart Journal 1984 5(7):602-605;
Copyright © 1984 by the European Society of Cardiology.
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© 1984 The European Society of Cardiology

Floating pulmonary embolus: unusual cause of recurrent syncope

U. BUSCH, U. RENNER, A. WIRTZFELD, H. SEBENING, G. KLEIN and S. HAGL

I. Medizinische Klinik rechts der Isar der Technischen Universität and Deutsches Herzzentrum München, München, D-8000 München, F.R.G.

Received 13 February 1984; revised 27 March 1984; .

Requests for reprints to U Busch, 1. Medizinische Klink rechts der Isar der Technischen Universität, Ismaningerstr, 22, 8000 München 80, F.R.G.

Abstract

A 69-year old woman was admitted because of recurrent syncopal episodes. In hospital, she had repeated attacks of near fainting or syncope when she was turned into the left decubitus position. Continuous arterial pressure monitoring revealed that severe hypotension initiated these events. Secondarily, the heart rate dropped markedly. The symptoms quickly reversed when the patient was turned back into the supine or right decubitus position. Angiography revealed a large, riding and partly floating pulmonary embolus that obstructed the pulmonary circulation to a variable degree, apparently influenced by the patient's body position. During subsequent emergency surgery the angiographic findings were confirmed. It appears that the severe hypotensive episodes were caused by intermittent high degree obstruction of the pulmonary circulation by the floating pulmonary embolus, a mechanism that, to our knowledge, has not previously been described as a cause of recurrent syncope.

Key Words: Syncope • pulmonary embolism • pulmonary angiography • pulmonary embolectomy


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