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==Overview==
==Overview==
The symptoms of a pulmonary embolism (PE) depend on the severity of the disease. Majority of the patients may remain asymptomatic and pulmonary embolism may be an incidental finding.<ref name="pmid20592294">{{cite journal |author=Agnelli G, Becattini C |title=Acute pulmonary embolism |journal=[[The New England Journal of Medicine]] |volume=363 |issue=3 |pages=266–74 |year=2010 |month=July |pmid=20592294 |doi=10.1056/NEJMra0907731 |url=http://www.nejm.org/doi/abs/10.1056/NEJMra0907731?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-04-26}}</ref> However, the common symptoms of pulmonary embolism range from mild [[dyspnea]], [[chest pain|pleuritic chest pain]], [[tachypnea]] to severe circulatory collapse and sustained [[hypotension]].<ref name="pmid17904458">{{cite journal |author=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK |title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II |journal=[[The American Journal of Medicine]] |volume=120 |issue=10 |pages=871–9 |year=2007 |month=October |pmid=17904458 |pmc=2071924 |doi=10.1016/j.amjmed.2007.03.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(07)00463-9 |accessdate=2012-04-26}}</ref><ref name="pmid20592294">{{cite journal |author=Agnelli G, Becattini C |title=Acute pulmonary embolism |journal=[[The New England Journal of Medicine]] |volume=363 |issue=3 |pages=266–74 |year=2010 |month=July |pmid=20592294 |doi=10.1056/NEJMra0907731 |url=http://www.nejm.org/doi/abs/10.1056/NEJMra0907731?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-04-26}}</ref> The absence of these symptoms may be associated with reduced clinical probability of PE; however, does not exclude the diagnosis of idopathic PE. Additionally, the [[Deep vein thrombosis history and symptoms|symptoms]] of lower extremity [[Deep vein thrombosis history and symptoms|deep venous thrombosis]] may also be present.
The symptoms of a pulmonary embolism (PE) depend on the severity of the disease. Majority of the patients may remain asymptomatic and PE may be an incidental finding.<ref name="pmid20399319">{{cite journal |author=Stein PD, Matta F, Musani MH, Diaczok B |title=Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review |journal=[[The American Journal of Medicine]] |volume=123 |issue=5 |pages=426–31 |year=2010 |month=May |pmid=20399319 |doi=10.1016/j.amjmed.2009.09.037 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(09)01111-5 |accessdate=2012-04-26}}</ref><ref name="pmid20592294">{{cite journal |author=Agnelli G, Becattini C |title=Acute pulmonary embolism |journal=[[The New England Journal of Medicine]] |volume=363 |issue=3 |pages=266–74 |year=2010 |month=July |pmid=20592294 |doi=10.1056/NEJMra0907731 |url=http://www.nejm.org/doi/abs/10.1056/NEJMra0907731?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-04-26}}</ref> However, the common symptoms of PE range from mild [[dyspnea]], [[chest pain|pleuritic chest pain]], [[tachypnea]] to severe circulatory collapse and sustained [[hypotension]].<ref name="pmid17904458">{{cite journal |author=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK |title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II |journal=[[The American Journal of Medicine]] |volume=120 |issue=10 |pages=871–9 |year=2007 |month=October |pmid=17904458 |pmc=2071924 |doi=10.1016/j.amjmed.2007.03.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(07)00463-9 |accessdate=2012-04-26}}</ref><ref name="pmid20592294">{{cite journal |author=Agnelli G, Becattini C |title=Acute pulmonary embolism |journal=[[The New England Journal of Medicine]] |volume=363 |issue=3 |pages=266–74 |year=2010 |month=July |pmid=20592294 |doi=10.1056/NEJMra0907731 |url=http://www.nejm.org/doi/abs/10.1056/NEJMra0907731?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-04-26}}</ref> The absence of these symptoms may be associated with reduced clinical probability of PE; however, does not exclude the diagnosis of idopathic PE. Additionally, the [[Deep vein thrombosis history and symptoms|symptoms]] of lower extremity [[Deep vein thrombosis history and symptoms|deep venous thrombosis]] may also be present.


==Common symptoms<ref name="pmid9867786">{{cite journal |author=Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J |title=Use of a clinical model for safe management of patients with suspected pulmonary embolism |journal=[[Annals of Internal Medicine]] |volume=129 |issue=12 |pages=997–1005 |year=1998 |month=December |pmid=9867786 |doi= |url= |accessdate=2012-04-26}}</ref><ref name="pmid10051264">{{cite journal |author=Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, Allescia G, Pistolesi M |title=Accuracy of clinical assessment in the diagnosis of pulmonary embolism |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=159 |issue=3 |pages=864–71 |year=1999 |month=March |pmid=10051264 |doi= |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=10051264 |accessdate=2012-04-26}}</ref>==
==Common symptoms<ref name="pmid9867786">{{cite journal |author=Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J |title=Use of a clinical model for safe management of patients with suspected pulmonary embolism |journal=[[Annals of Internal Medicine]] |volume=129 |issue=12 |pages=997–1005 |year=1998 |month=December |pmid=9867786 |doi= |url= |accessdate=2012-04-26}}</ref><ref name="pmid10051264">{{cite journal |author=Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, Allescia G, Pistolesi M |title=Accuracy of clinical assessment in the diagnosis of pulmonary embolism |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=159 |issue=3 |pages=864–71 |year=1999 |month=March |pmid=10051264 |doi= |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=10051264 |accessdate=2012-04-26}}</ref>==
*[[Dyspnea]] with or without [[chest pain]] which may be pleuritic or substernal.
*Acute onset [[exertional dyspnea]] or dyspnea at rest; with or without [[chest pain]] which may be pleuritic or substernal.<ref name="pmid17904458">{{cite journal |author=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK |title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II |journal=[[The American Journal of Medicine]] |volume=120 |issue=10 |pages=871–9 |year=2007 |month=October |pmid=17904458 |pmc=2071924 |doi=10.1016/j.amjmed.2007.03.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(07)00463-9 |accessdate=2012-04-26}}</ref>


*[[Hemoptysis]] secondary to distal vessel embolism with subsequent [[pulmonary infarction]] ([[alveolar haemorrhage]]).<ref name="pmid9377961">{{cite journal |author=Stein PD, Henry JW |title=Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes |journal=[[Chest]] |volume=112 |issue=4 |pages=974–9 |year=1997 |month=October |pmid=9377961 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=9377961 |accessdate=2012-04-26}}</ref>
*[[Hemoptysis]] secondary to distal vessel embolism with subsequent [[pulmonary infarction]] ([[alveolar haemorrhage]]).<ref name="pmid9377961">{{cite journal |author=Stein PD, Henry JW |title=Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes |journal=[[Chest]] |volume=112 |issue=4 |pages=974–9 |year=1997 |month=October |pmid=9377961 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=9377961 |accessdate=2012-04-26}}</ref>
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==Supportive trial data==
==Supportive trial data==
The '''''Prospective Investigation Of Pulmonary Embolism Diagnosis (PIOPED) study''''' identified the following symptoms to be present in majority of with angiographically proven pulmonary embolism.<ref name="pmid17904458">{{cite journal| author=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA et al.| title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. | journal=Am J Med | year= 2007 | volume= 120 | issue= 10 | pages= 871-9 | pmid=17904458 | doi=10.1016/j.amjmed.2007.03.024 | pmc=PMC2071924 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17904458  }} </ref>
The '''''Prospective Investigation Of Pulmonary Embolism Diagnosis II (PIOPED II) study''''' identified the following triad of symptoms to be present in majority of with angiographically proven pulmonary embolism.<ref name="pmid17904458">{{cite journal |author=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK |title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II |journal=[[The American Journal of Medicine]] |volume=120 |issue=10 |pages=871–9 |year=2007 |month=October |pmid=17904458 |pmc=2071924 |doi=10.1016/j.amjmed.2007.03.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(07)00463-9 |accessdate=2012-04-26}}</ref><ref name="pmid16738268">{{cite journal |author=Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV, Popovich J, Quinn DA, Sos TA, Sostman HD, Tapson VF, Wakefield TW, Weg JG, Woodard PK |title=Multidetector computed tomography for acute pulmonary embolism |journal=[[The New England Journal of Medicine]] |volume=354 |issue=22 |pages=2317–27 |year=2006 |month=June |pmid=16738268 |doi=10.1056/NEJMoa052367 |url=http://dx.doi.org/10.1056/NEJMoa052367 |accessdate=2012-04-26}}</ref>
*[[Dyspnea]]
*[[Dyspnea]]
*[[Chest pain|Pleuritic chest pain]]
*[[Chest pain|Pleuritic chest pain]]

Revision as of 20:40, 26 April 2012

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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and Keywords: PE

Overview

The symptoms of a pulmonary embolism (PE) depend on the severity of the disease. Majority of the patients may remain asymptomatic and PE may be an incidental finding.[1][2] However, the common symptoms of PE range from mild dyspnea, pleuritic chest pain, tachypnea to severe circulatory collapse and sustained hypotension.[3][2] The absence of these symptoms may be associated with reduced clinical probability of PE; however, does not exclude the diagnosis of idopathic PE. Additionally, the symptoms of lower extremity deep venous thrombosis may also be present.

Common symptoms[4][5]

Supportive trial data

The Prospective Investigation Of Pulmonary Embolism Diagnosis II (PIOPED II) study identified the following triad of symptoms to be present in majority of with angiographically proven pulmonary embolism.[3][8]

ESC Guideline Recommendation- Suspected High-risk PE[9]

“

Class I

1. In high-risk PE, as indicated by the presence of shock or hypotension, emergency CT or bedside echocardiography (depending on availability and clinical circumstances) is recommended for diagnostic purposes. (Level of Evidence: C)

”

Guideline Resources

Guidelines on the diagnosis and management of acute pulmonary embolism. The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology[9]

References

  1. ↑ Stein PD, Matta F, Musani MH, Diaczok B (2010). "Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review". The American Journal of Medicine. 123 (5): 426–31. doi:10.1016/j.amjmed.2009.09.037. PMID 20399319. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 2.2 Agnelli G, Becattini C (2010). "Acute pulmonary embolism". The New England Journal of Medicine. 363 (3): 266–74. doi:10.1056/NEJMra0907731. PMID 20592294. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 3.2 Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". The American Journal of Medicine. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)
  4. ↑ Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (1998). "Use of a clinical model for safe management of patients with suspected pulmonary embolism". Annals of Internal Medicine. 129 (12): 997–1005. PMID 9867786. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. ↑ Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, Allescia G, Pistolesi M (1999). "Accuracy of clinical assessment in the diagnosis of pulmonary embolism". American Journal of Respiratory and Critical Care Medicine. 159 (3): 864–71. PMID 10051264. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)
  6. ↑ Stein PD, Henry JW (1997). "Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes". Chest. 112 (4): 974–9. PMID 9377961. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)
  7. ↑ Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)
  8. ↑ Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV, Popovich J, Quinn DA, Sos TA, Sostman HD, Tapson VF, Wakefield TW, Weg JG, Woodard PK (2006). "Multidetector computed tomography for acute pulmonary embolism". The New England Journal of Medicine. 354 (22): 2317–27. doi:10.1056/NEJMoa052367. PMID 16738268. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". European Heart Journal. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870. Retrieved 2012-04-26. Unknown parameter |month= ignored (help)

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