Pulmonary embolism physical examination: Difference between revisions
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*The patient may be [[hypotensive]] secondary to circulatory collapse in cases of massive PE.<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=2012-04-29}}</ref> The patient may progress to develop [[shock]] and [[sudden cardiac arrest]] in the absence of immediate management. Approximately 15% of all [[Sudden cardiac death|sudden cardiac arrest]] cases are attributed to PE.<ref>??</ref> | *The patient may be [[hypotensive]] secondary to circulatory collapse in cases of massive PE.<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=2012-04-29}}</ref> The patient may progress to develop [[shock]] and [[sudden cardiac arrest]] in the absence of immediate management. Approximately 15% of all [[Sudden cardiac death|sudden cardiac arrest]] cases are attributed to PE.<ref>??</ref> | ||
==Skin== | ===Skin=== | ||
*[[Cyanosis]] may be present, depending on severity of PE. | *[[Cyanosis]] may be present, depending on severity of PE. | ||
==Neck== | ===Neck=== | ||
*[[Jugular venous pressure#Assessment of Jugular Venous Distention|Jugular venous distension]] may be seen in cases of massive PE. | *[[Jugular venous pressure#Assessment of Jugular Venous Distention|Jugular venous distension]] may be seen in cases of massive PE. | ||
==Heart== | ===Heart=== | ||
====Inspection==== | |||
*[[Parasternal heave]] secondary to the development of [[right ventricular failure]] may be present in massive PE. | *[[Parasternal heave]] secondary to the development of [[right ventricular failure]] may be present in massive PE. | ||
===Auscultation=== | ====Auscultation==== | ||
*[[S2|Prominent P2 component of second heart sound]] may be present.<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=2012-04-29}}</ref> | *[[S2|Prominent P2 component of second heart sound]] may be present.<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=2012-04-29}}</ref> | ||
*[[Heart sounds#Third heart sound S3|Right sided S3]] may be present in cases of massive PE, secondary to the development of [[right ventricular failure]]. | *[[Heart sounds#Third heart sound S3|Right sided S3]] may be present in cases of massive PE, secondary to the development of [[right ventricular failure]]. | ||
* Murmur of [[tricuspid regurgitation]] may be heard on auscultation. | * Murmur of [[tricuspid regurgitation]] may be heard on auscultation. | ||
== | ===Lungs=== | ||
*Reduced [[breath sounds]] may be present. | *Reduced [[breath sounds]] may be present. | ||
*[[Rales]] may be present. | *[[Rales]] may be present. | ||
* Pulmonary hypertension and Rv overload are commonly seen at presentation and diagnosis. | * Pulmonary hypertension and Rv overload are commonly seen at presentation and diagnosis. | ||
==Extremities== | ===Extremities=== | ||
Signs of [[deep vein thrombosis]] ''(listed below)'' may be present in majority of patients with PE.<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=2012-04-29}}</ref> | Signs of [[deep vein thrombosis]] ''(listed below)'' may be present in majority of patients with PE.<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=2012-04-29}}</ref> | ||
:*[[Edema|Limb edema]] | :*[[Edema|Limb edema]] | ||
| Line 79: | Line 79: | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
[[Category:Physical Examination]] | [[Category:Physical Examination]] | ||
Revision as of 15:03, 9 October 2012
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Pulmonary Embolism Microchapters |
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Diagnosis |
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Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores |
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Treatment |
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Follow-Up |
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Special Scenario |
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Trials |
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Case Studies |
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Pulmonary embolism physical examination On the Web |
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Directions to Hospitals Treating Pulmonary embolism physical examination |
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Risk calculators and risk factors for Pulmonary embolism physical examination |
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]
Overview
Pulmonary emboli are associated with the presence of tachycardia and tachypnea. Signs of right ventricular failure include jugular venous distension, right sided S3, and parasternal lift. These are present in cases of massive pulmonary emboli.[1]
Physical Examination
Appearance of the Patient
The patient may appear anxious due to difficulty breathing. More severe cases may be associated with cyanosis.
Vital Signs
Temperature
- Patient is often afebrile.
Pulse
Rate
- Tachycardia may be present.[1]
Rhythm
- The pulse is regular.
Strength
- The pulse may be bounding and strong.
Symmetry
- The pulses are symmetric.
Respiratory Rate
Blood Pressure
- The patient may be hypotensive secondary to circulatory collapse in cases of massive PE.[1] The patient may progress to develop shock and sudden cardiac arrest in the absence of immediate management. Approximately 15% of all sudden cardiac arrest cases are attributed to PE.[2]
Skin
- Cyanosis may be present, depending on severity of PE.
Neck
- Jugular venous distension may be seen in cases of massive PE.
Heart
Inspection
- Parasternal heave secondary to the development of right ventricular failure may be present in massive PE.
Auscultation
- Prominent P2 component of second heart sound may be present.[1]
- Right sided S3 may be present in cases of massive PE, secondary to the development of right ventricular failure.
- Murmur of tricuspid regurgitation may be heard on auscultation.
Lungs
- Reduced breath sounds may be present.
- Rales may be present.
- Pulmonary hypertension and Rv overload are commonly seen at presentation and diagnosis.
Extremities
Signs of deep vein thrombosis (listed below) may be present in majority of patients with PE.[1]
- Limb edema
- Limb erythema
- Limb tenderness
- Palpable cords in the calf or thighs reflecting thrombosed veins.
Supportive trial data
The Prospective Investigation Of Pulmonary Embolism Diagnosis II (PIOPED II) study identified the following signs to be present in the majority of patients with proven pulmonary embolism proven by angiography.[1]
- Tachypnea (~54%),
- Signs of deep venous thrombosis (~47%),
- Tachycardia (~24%),
- Rales (~18),
- Reduced breath sounds (~17%),
- Prominent P2 component of second heart sound (~15%),
- Elevated jugular venous pressure (~14%).
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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 2012-04-29. Unknown parameter
|month=ignored (help) - ↑ ??