Pulmonary embolism, a blood clot that moves from the legs and prevents the smooth flow of blood in the lungs, is not high on the list of causes of fainting in the elderly – but it may have just risen higher.
Syncope, or fainting, in the elderly is common, and there are multiple possible causes, some more common than others. A curious Italian physician named Dr. Paolo Prandoni, along with several of his colleagues, asked doctors at 11 different hospitals to start screening patients who had suffered from syncope for pulmonary embolism, and the results showed that blood clots might be more to blame for fainting in the elderly than medical professionals originally thought.
Blood Clot Experiment Conditions
Each of the doctors performed the screening on their patients who had fainted. Tested patients with an average age of 76 totaled 560, and though the number is considerably small, a surprising 17 percent of them tested positive for a blood clot in their lungs.
That means that about one out of every six patients who suffered from syncope and had to go to the hospital wasn't getting the blood flow they needed in their lungs. Dr. Prandoni pointed out that because many physicians consider a pulmonary embolism to be a rarity among elderly patients who have fainted, and rarely consider it to be one of the possible signs of a blood clot. Therefore, doctors rarely test for or diagnose a pulmonary embolism in the lungs in these cases.
 |
| A pulmonary embolism will cause a lack of adequate blood flow in the lungs. Source: nih.gov |
What the Results Mean for Patients
The lack of diagnoses is not the fault of physicians. Medical science is a field that is far from perfect in its methodology, but the study could start turning the heads of those who author the guidelines for diagnosing and treating diseases. Inova Hospital cardiologist Dr. S. Adam Strickenberger, the co-author of the American Heart Association's guidelines for syncope evaluation in 2006, originally included only a small section of information about the possibility of pulmonary embolism as a cause of fainting in his text.
He agrees that blood clots should now be near the top of the list of possible causes for patients who enter hospitals with syncope. The results of Dr. Prandoni's experiment could change the way that elderly patients are tested at hospitals to identify causes of fainting.
Problems with Testing Patients
Testing for blood clots in Europe can be expensive and time-consuming. To rule out a blood clot, doctors can use a D-dimer assay, but when Italian medical professionals used it in Dr. Prandoni's study, it only eliminated about 60 percent of patients. The remaining patients needed a CT scan of the blood vessels (a CTA).
The price of CTAs is fairly high, which means that patients will need more than a single test to pinpoint the cause of their syncope. However, social media chats indicated that doctors recognize the possibility that CTA scans could profoundly increase in frequency if the medical community begins to embrace the results of Dr. Prandoni's study. It could mean higher medical bills for patients, but if the study is correct, it could also mean that doctors are better able to prevent fainting in the elderly in the future.
