Pulmonary embolism physical examination
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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
Pulmonary embolism is associated with the presence of tachycardia, tachypnea and signs of right ventricular failure including jugular venous distension, right sided S3 and parasternal lift which is present in cases of massive PE.[1]
Appearance of the Patient
The patient may appear anxious because of difficulty in 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] In the absence of immediate management, the patient may progress to developing shock and sudden cardiac arrest. Approximately, 15% of all cases with sudden cardiac arrest are attributed to PE.[2]
Skin
- Cyanosis may be present depending on the severity of PE.
Neck
- Jugular venous pressure may be elevated in cases of massive PE.
Heart
Inspection
- Parasternal heave may be present in cases of massive PE, secondary to the development of right ventricular failure.
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.
Lung
- Reduced breath sounds may be present.
- Rales may be present.
Extremities
Signs of deep vein thrombosis (listed below) may be present in majority of patients with PE.[1]
- Limb edema,
- Erythema,
- Tender,
- Palpable cord 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 angiographically proven pulmonary embolism.[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
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