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/* Common Symptoms{{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 pulmo...
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The symptoms of pulmonary embolism (PE) depends on the severity of the disease. A pulmonary embolism may be an incidental finding in so far as many patients are asymptomatic.<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> The common symptoms of PE range from mild [[dyspnea]], [[chest pain]], and [[tachypnea]], to sustained [[hypotension]] and [[shock]].<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 a reduced clinical probability of pulmonary embolism, however it does not exclude the diagnosis of pulmonary embolism. The [[Deep vein thrombosis history and symptoms|symptoms]] of lower extremity [[Deep vein thrombosis|deep venous thrombosis]] may also be present.  [[Sudden death]] can also be the initial presentation of PE.
The symptoms of pulmonary embolism (PE) depends on the severity of the disease. A pulmonary embolism may be an incidental finding in so far as many patients are asymptomatic.<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> The common symptoms of PE range from mild [[dyspnea]], [[chest pain]], and [[tachypnea]], to sustained [[hypotension]] and [[shock]].<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 a reduced clinical probability of pulmonary embolism, however it does not exclude the diagnosis of pulmonary embolism. The [[Deep vein thrombosis history and symptoms|symptoms]] of lower extremity [[Deep vein thrombosis|deep venous thrombosis]] may also be present.  [[Sudden death]] can also be the initial presentation of PE.


== History and Symptoms ==
==History and Symptoms==
=== Typical 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> ===
As depicted in the image below, the majority of patients with venous thromboembolism (VTE), that is [[DVT]], [[PE]], or both, are asymptomatic.
*Acute onset of exertional dyspnea or [[dyspnea]] at rest.
*Pleuritic or substernal [[chest pain]].<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="pmid3355304">{{cite journal| author=Hull RD, Raskob GE, Carter CJ, Coates G, Gill GJ, Sackett DL et al.| title=Pulmonary embolism in outpatients with pleuritic chest pain. | journal=Arch Intern Med | year= 1988 | volume= 148 | issue= 4 | pages= 838-44 | pmid=3355304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3355304  }} </ref><ref name="pmid1909617">{{cite journal| author=Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT et al.| title=Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. | journal=Chest | year= 1991 | volume= 100 | issue= 3 | pages= 598-603 | pmid=1909617 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1909617  }} </ref>


*[[Hemoptysis]] secondary to distal vessel embolism with subsequent [[pulmonary infarction]] (alveolar hemorrhage).<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>
[[File:Challenge of Assessing VTE.JPG|300x400px|The challenge in diagnosis of VTE]]
 
*Circulatory collapse with subsequent [[syncope]], sustained [[hypotension]], and [[shock]] are associated with a massive pulmonary embolism.<ref name="pmid21422387">{{cite journal |author=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 |title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association |journal=[[Circulation]] |volume=123 |issue=16 |pages=1788–830 |year=2011 |month=April |pmid=21422387 |doi=10.1161/CIR.0b013e318214914f |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21422387 |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>


*Progressively worsening [[dyspnea]] can appear in patients with pre-existing [[pneumonia]] or [[heart failure]].
===Symptoms of PE===
Symptoms of PE include:
* [[Dyspnea]] (78–81%)<ref name="pmid24182642">{{cite journal| author=Cohen AT, Dobromirski M, Gurwith MM| title=Managing pulmonary embolism from presentation to extended treatment. | journal=Thromb Res | year= 2014 | volume= 133 | issue= 2 | pages= 139-48 | pmid=24182642 | doi=10.1016/j.thromres.2013.09.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24182642  }} </ref> <br>
* [[Pleuritic chest pain]] (39–56%)<ref name="pmid24182642">{{cite journal| author=Cohen AT, Dobromirski M, Gurwith MM| title=Managing pulmonary embolism from presentation to extended treatment. | journal=Thromb Res | year= 2014 | volume= 133 | issue= 2 | pages= 139-48 | pmid=24182642 | doi=10.1016/j.thromres.2013.09.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24182642  }} </ref>  <br>
* [[Fainting]] (22–26%)<ref name="pmid24182642">{{cite journal| author=Cohen AT, Dobromirski M, Gurwith MM| title=Managing pulmonary embolism from presentation to extended treatment. | journal=Thromb Res | year= 2014 | volume= 133 | issue= 2 | pages= 139-48 | pmid=24182642 | doi=10.1016/j.thromres.2013.09.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24182642  }} </ref> <br>
* [[Cough]] (20%)<ref name="pmid18757870">{{cite journal| author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al.| title=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). | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 18 | pages= 2276-315 | pmid=18757870 | doi=10.1093/eurheartj/ehn310 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757870  }} </ref><br>
* [[Substernal chest pain]] (12%)<ref name="pmid18757870">{{cite journal| author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al.| title=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). | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 18 | pages= 2276-315 | pmid=18757870 | doi=10.1093/eurheartj/ehn310 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757870  }} </ref><br>
* [[Hemoptysis]] (11%)<ref name="pmid18757870">{{cite journal| author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al.| title=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). | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 18 | pages= 2276-315 | pmid=18757870 | doi=10.1093/eurheartj/ehn310 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757870  }} </ref><br>
* [[Wheezing]] <br>
* [[Cyanosis]] (11%)<ref name="pmid24182642">{{cite journal| author=Cohen AT, Dobromirski M, Gurwith MM| title=Managing pulmonary embolism from presentation to extended treatment. | journal=Thromb Res | year= 2014 | volume= 133 | issue= 2 | pages= 139-48 | pmid=24182642 | doi=10.1016/j.thromres.2013.09.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24182642  }} </ref> <br>
* [[Fever]] (7%)<ref name="pmid24182642">{{cite journal| author=Cohen AT, Dobromirski M, Gurwith MM| title=Managing pulmonary embolism from presentation to extended treatment. | journal=Thromb Res | year= 2014 | volume= 133 | issue= 2 | pages= 139-48 | pmid=24182642 | doi=10.1016/j.thromres.2013.09.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24182642  }} </ref> <br>
* Symptoms suggestive of [[shock]] (in case of massive PE)
** [[Altered mental status]]
** [[Cold extremities]]
** [[Cyanosis]]
** [[Oliguria]]


===Atypical Symptoms===
===Symptoms of DVT===
* [[Cough]]
* [[Cyanosis]]
* [[Low grade fever]]
* [[Wheezing]]<ref name="pmid10051264">{{cite journal| author=Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L et al.| title=Accuracy of clinical assessment in the diagnosis of pulmonary embolism. | journal=Am J Respir Crit Care Med | year= 1999 | volume= 159 | issue= 3 | pages= 864-71 | pmid=10051264 | doi=10.1164/ajrccm.159.3.9806130 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10051264  }} </ref><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>


=== Supportive Trial Data ===
Since VTE involves both [[DVT]] and PE, the patient can present with complaints of either of the diseases. Therefore it is important to inquire about the symptoms of both diseases.
The Prospective Investigation Of Pulmonary Embolism Diagnosis II (PIOPED II) study identified the following triad of symptoms present in a majority of patients with a confirmed 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]]
====Common Symptoms of DVT====
*[[Pleuritic chest pain|Chest pain]]
The classical symptoms of DVT include:
*[[Tachypnea]]
* [[Pain and nociception|Pain]] in the affected area
* [[Swelling]] of the affected area
* [[Erythema]] around the affected area
* [[Dilation]] of the surface veins and [[erythema]] of the overlying area
 
However, sometimes there may be no symptoms referable to the location of the DVT.
 
<gallery>
Image:Extremities dvt.jpg|Front View:Edematous Right Leg
Image:Extremities dvt2.jpg|Rear View:Left limb edema localized to calf.
Image:Extremities dvt3.jpg|Front View:Left limb edema localized to calf. 
</gallery>
 
====Less Common Symptoms of DVT====
* In [[phlegmasia alba dolens]], the leg is pale and cold with a diminished [[arterial pulse]].
 
* In [[phlegmasia cerulea dolens]], there is an acute and near-total venous occlusion of the entire extremity outflow, including the [[iliac vein|iliac]] and [[femoral vein]]s. The leg is usually painful, [[cyanosis|cyanosed]] and [[edema|edematous]].
 
===Complete History===
If VTE is suspected or diagnosed, a complete history should be undertaken, including the following:
* '''Risk factors'''
** [[Chemotherapy]]<br>
** [[Chronic heart failure]]<br>
** [[Respiratory failure]]<br>
** [[Hormone replacement therapy]]<br>
** [[Cancer]]<br>
** [[Oral contraceptive pills]] <br>
** [[Stroke]] <br>
** [[Pregnancy]] <br>
** [[Postpartum]] <br>
** Prior history of [[VTE]] <br>
** [[Thrombophilia]] <br>
** Advanced [[age]] <br>
** [[Laparoscopic surgery]] <br>
** Prepartum <br>
** [[Obesity]] <br>
** [[Varicose veins]]
* '''Triggers'''
** [[Bone fracture]] ([[hip]] or [[leg]]) <br>
** [[Hip replacement surgery]]<br>
** Knee replacement surgery<br>
** [[General surgery|Major general surgery]]<br>
** [[Trauma|Significant trauma]]<br>
** [[Spinal cord injury]]<br>
** Athroscopic knee surgery<br>
** [[Central venous line]]s<br>
** [[Chemotherapy]]<br>
** Bed rest for more than 3 days <br>
** Prolonged car or air travel <br>
** [[Laparoscopic surgery]] <br>
** Prepartum <br>
* '''Previous episode of [[VTE]]'''
** Age
** Location
* '''Past medical history of diseases associated with hyperviscosity'''
** [[Atherosclerosis]]
** [[Collagen vascular disease]]
** [[Heart failure]]
** [[Myeloproliferative disease]]
** [[Nephrotic syndrome]]
** [[Autoimmune diseases]]
**[[Polycythemia vera]]
** [[Hyperhomocysteinemia]]
** [[Paroxysmal nocturnal hemoglobinuria]]
** [[Waldenstrom macroglobulinemia]]
** [[Multiple myeloma]]
* '''History of [[thrombophilia]]'''
** [[Factor V Leiden mutation]]
** [[Prothrombin gene mutation G20210A]]
** [[Protein C]] or [[Protein S]] deficiency
** [[Antithrombin]] (AT) deficiency
** [[Antiphospholipid syndrome]] (APS)
* '''Abortion'''
** [[Abortion]] at second or third trimester of [[pregnancy]] (suggestive of an inherited [[thrombophilia]] or APS)
* '''Drugs that may induce APS'''
** [[Hydralazine]]
** [[Phenothiazine]]
** [[Procainamide]]
** [[Tamoxifen]]
** [[Bevacizumab]]
** [[Glucocorticoids]]
* Family history (suggestive of [[inherited thrombophilia]])
** Deep vein thrombosis
** Pulmonary embolism
** Recurrent [[miscarriage]]
* Social history (increased risk in females)
** Heavy [[cigarette smoking]] (>25 cigarettes per day)
** [[Intravenous drug use]] (if injected directly in [[femoral vein]])
** [[Alcohol]]


==ESC 2008 Guideline Recommendation- Suspected High-risk PE (DO NOT EDIT)<ref name="pmid18757870">{{cite journal |author=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 |title=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) |journal=[[European Heart Journal]] |volume=29 |issue=18 |pages=2276–315 |year=2008 |month=September|pmid=18757870 |doi=10.1093/eurheartj/ehn310 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870|accessdate=2012-04-26}}</ref>==
==ESC 2008 Guideline Recommendation- Suspected High-risk PE (DO NOT EDIT)<ref name="pmid18757870">{{cite journal |author=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 |title=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) |journal=[[European Heart Journal]] |volume=29 |issue=18 |pages=2276–315 |year=2008 |month=September|pmid=18757870 |doi=10.1093/eurheartj/ehn310 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18757870|accessdate=2012-04-26}}</ref>==

Revision as of 13:45, 5 June 2014

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

Overview

The symptoms of pulmonary embolism (PE) depends on the severity of the disease. A pulmonary embolism may be an incidental finding in so far as many patients are asymptomatic.[1][2] The common symptoms of PE range from mild dyspnea, chest pain, and tachypnea, to sustained hypotension and shock.[3][2] The absence of these symptoms may be associated with a reduced clinical probability of pulmonary embolism, however it does not exclude the diagnosis of pulmonary embolism. The symptoms of lower extremity deep venous thrombosis may also be present. Sudden death can also be the initial presentation of PE.

History and Symptoms

As depicted in the image below, the majority of patients with venous thromboembolism (VTE), that is DVT, PE, or both, are asymptomatic.

The challenge in diagnosis of VTE

Symptoms of PE

Symptoms of PE include:

Symptoms of DVT

Since VTE involves both DVT and PE, the patient can present with complaints of either of the diseases. Therefore it is important to inquire about the symptoms of both diseases.

Common Symptoms of DVT

The classical symptoms of DVT include:

However, sometimes there may be no symptoms referable to the location of the DVT.

Less Common Symptoms of DVT

Complete History

If VTE is suspected or diagnosed, a complete history should be undertaken, including the following:

ESC 2008 Guideline Recommendation- Suspected High-risk PE (DO NOT EDIT)[5]

Class I
"1. In high-risk PE, as indicated by the presence of shock or hypotension, emergency CT or bedside echocardiography is recommended for diagnostic purposes. (Level of Evidence: C) "

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 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. ↑ 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. ↑ 4.0 4.1 4.2 4.3 4.4 Cohen AT, Dobromirski M, Gurwith MM (2014). "Managing pulmonary embolism from presentation to extended treatment". Thromb Res. 133 (2): 139–48. doi:10.1016/j.thromres.2013.09.040. PMID 24182642.
  5. ↑ 5.0 5.1 5.2 5.3 Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P; et al. (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)". Eur Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870.

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