PULMONARY EMBOLISM AS A CAUSE OF SYSTEMIC HYPOTENSION AND SHOCK,
LETTERMAN GENERAL HOSPITAL SAN FRANCISCO CALIF
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Experimental pulmonary thromboembolism in dogs supports the clinical observation that severe systemic arterial hypotension and death may result from a relatively small embolus. Severe systemic arterial hypotension, in contrast to pulmonary hypertension, is a variable acute hemodynamic alteration of pulmonary clot embolism. It is theorized that systemic arterial hypotension resulting from pulmonary embolism, exclusive of that caused by the massive pulmonary embolus, is initiated by a vasodepressor response mediated by the vagus and that recovery is dependent in part upon the ability of the peripheral vascular bed to react appropriately with reflex vasoconstriction. The value of the sympathomimetic amines, isoproterenol and metaraminol were assessed in the treatment of postembolic shock. The value of a pressor agent in contrast to one that decreases peripheral vascular resistance is emphasized.