Pulmonary embolism history and symptoms: Difference between revisions
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#Hemodynamic instability and [[syncope]] (associated with massive pulmonary embolism) | #Hemodynamic instability and [[syncope]] (associated with massive pulmonary embolism) | ||
#In the elderly, it may mimick as indolent [[pneumonia]] or [[heart failure]]. | #In the elderly, it may mimick as indolent [[pneumonia]] or [[heart failure]]. | ||
Thus, the symptoms are highly variable, nonspecific, and common among patients with and without PE. [[Syncope]] is a rare but an important presentation of PE since it may indicate a severely decreased haemodynamic reserve<ref name="pmid21422387">{{cite journal| author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| 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 | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 | pmid=21422387 | doi=10.1161/CIR.0b013e318214914f | pmc=| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>. | Emboli in the distal vessel causes pleural irritation and produces chest pain, it appears like a pulmonary infarction (alveolar haemorrhage) and sometimes accompanied by haemoptysis. Thus, the symptoms are highly variable, nonspecific, and common among patients with and without PE. [[Syncope]] is a rare but an important presentation of PE since it may indicate a severely decreased haemodynamic reserve<ref name="pmid21422387">{{cite journal| author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| 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 | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 | pmid=21422387 | doi=10.1161/CIR.0b013e318214914f | pmc=| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>. | ||
Pulmonary embolism should be suspected<ref name="pmid20592294">{{cite journal| author=Agnelli G, Becattini C| title=Acute pulmonary embolism. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 3 | pages= 266-74 | pmid=20592294 | doi=10.1056/NEJMra0907731 |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20592294 }} </ref> in all patients who present with the following symptoms, without an alternative obvious cause. | Pulmonary embolism should be suspected<ref name="pmid20592294">{{cite journal| author=Agnelli G, Becattini C| title=Acute pulmonary embolism. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 3 | pages= 266-74 | pmid=20592294 | doi=10.1056/NEJMra0907731 |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20592294 }} </ref> in all patients who present with the following symptoms, without an alternative obvious cause. | ||
* [[Dyspnea]] (new or worsening) | * [[Dyspnea]] (new or worsening) | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Overview
The symptoms of a pulmonary embolism depend upon the severity of the disease. A pulmonary embolism can be symptomatic or asymptomatic and may even be diagnosed by imaging procedures performed for other diagnostic purposes.[1] The Prospective Investigation Of Pulmonary Embolism Diagnosis study (PIOPED) found the following symptoms in 97% of patients with angiographic proven PE.[2]
The absence of this triad reduces the clinical probability of PE. Symptoms or signs of lower extremity deep venous thrombosis (DVT) can also be present in the patient.
History & Symptoms
Three major clinical presentations can exist:
- Dyspnea with or without pleuritic chest pain (most frequent presentations of PE) and hemoptysis
- Hemodynamic instability and syncope (associated with massive pulmonary embolism)
- In the elderly, it may mimick as indolent pneumonia or heart failure.
Emboli in the distal vessel causes pleural irritation and produces chest pain, it appears like a pulmonary infarction (alveolar haemorrhage) and sometimes accompanied by haemoptysis. Thus, the symptoms are highly variable, nonspecific, and common among patients with and without PE. Syncope is a rare but an important presentation of PE since it may indicate a severely decreased haemodynamic reserve[3]. Pulmonary embolism should be suspected[1] in all patients who present with the following symptoms, without an alternative obvious cause.
- Dyspnea (new or worsening)
- Chest pain
- Sustained Hypotension
However, the confirmed diagnosis is only possible in approximately 1/5th of the total patients.[4] Furthermore the diagnostic workup should be changed depending upon the patient's clinical presentation and hemodynamic stability.
References
- ↑ 1.0 1.1 Agnelli G, Becattini C (2010). "Acute pulmonary embolism". N Engl J Med. 363 (3): 266–74. doi:10.1056/NEJMra0907731. PMID 20592294.
- ↑ Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA; et al. (2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". Am J Med. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458.
- ↑ Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (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.
- ↑ Righini M, Le Gal G, Aujesky D, Roy PM, Sanchez O, Verschuren F; et al. (2008). "Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial". Lancet. 371 (9621): 1343–52. doi:10.1016/S0140-6736(08)60594-2. PMID 18424324. Review in: ACP J Club. 2008 Sep 16;149(3):13