syncope as the clinical presentation of pulmonary thromboembolism

pulmonary thromboembolism (pte) has a wide spectrum of presentations, and its c ardinal manifestations include chest pain, dyspnea, and syncope. syncope as an initial presentation of pte occurs in 10-14% of patients and is not restricted to massive ptes. it can also occur in the setting of non- massive cases probably due to a vasovagal mechanism or the occurrence of conduction disturbances in preexisting complete left bundle-branch block. the next point discussed here is the use of thrombolytic therapy for submassive pte with a normal blood pressure while marked right ventricular dyskinesia or dysfunction occurs.