Pulmonary embolism history and symptoms
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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. 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[3]. Syncope is a rare but an important presentation of PE since it may indicate a severely decreased haemodynamic reserve[4]. Thus, the symptoms are highly variable, nonspecific, and common among patients with and without PE.
Pulmonary embolism should be suspected in all patients who present with the following symptoms, without an alternative obvious cause[1].
- Dyspnea (new or worsening)
- Chest pain
- Sustained Hypotension
However, the confirmed diagnosis is only possible in approximately 1/5th of the total patients.[5] 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.
- ↑ 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.
- ↑ 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