Pulmonary embolism history & symptoms

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

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. The Prospective Investigation Of Pulmonary Embolism Diagnosis study (PIOPED) found the following symptoms in 97% of patients with angiographic proven PE. 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.
 * Dyspnea
 * Pleuritic chest pain
 * Tachypnea

History & Symptoms
Three major clinical presentations can exist: 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. Syncope is rare, but an important presentation of PE, since it may indicate a severely decreased haemodynamic reserve. Thus, the symptoms are highly variable, nonspecific, and common among patients with and without PE.
 * 1) Dyspnea with or without pleuritic chest pain (most frequent presentations of PE) and hemoptysis
 * 2) Hemodynamic instability and syncope (associated with massive pulmonary embolism)
 * 3) In the elderly, it may mimick as indolent pneumonia or heart failure.

Pulmonary embolism should be suspected 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. Furthermore the diagnostic workup should be changed depending upon the patient's clinical presentation and hemodynamic stability.