Pulmonary embolism history and symptoms
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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]
Overview
The symptoms of a pulmonary embolism (PE) depends on the severity of the disease. A Pulmonary embolism may be an incidental finding because a majority of patients may be 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 PE, however it does not exclude the diagnosis of PE. The symptoms of lower extremity deep venous thrombosis may also be present.
Common symptoms[4][5]
- Acute onset of exertional dyspnea or dyspnea at rest.
- Pleuritic or substernal chest pain.[3]
- Hemoptysis secondary to distal vessel embolism with subsequent pulmonary infarction (alveolar hemorrhage).[6]
- Circulatory collapse with subsequent syncope, sustained hypotension, and shock are associated with a massive pulmonary embolism.[7][2]
- Progressively worsening dyspnea can appear in patients with pre-existing pneumonia or heart failure.
- Regarding chest pain, the pain may be pleuritic.[3][8][9] However, the reliability of assessing pleuritic may be low[10] and a meta-analysis concludes that assessing pleuritic pain is not helpful.[11]
Supportive trial data
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.[3][12]
ESC 2008 Guideline Recommendation- Suspected High-risk PE (DO NOT EDIT)
| Class I |
| "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) " |
Guideline Resources
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[13]
References
- ↑ 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) - ↑ 2.0 2.1 2.2 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) - ↑ 3.0 3.1 3.2 3.3 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) - ↑ Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (1998). "Use of a clinical model for safe management of patients with suspected pulmonary embolism". Annals of Internal Medicine. 129 (12): 997–1005. PMID 9867786. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, Allescia G, Pistolesi M (1999). "Accuracy of clinical assessment in the diagnosis of pulmonary embolism". American Journal of Respiratory and Critical Care Medicine. 159 (3): 864–71. PMID 10051264. Retrieved 2012-04-26. Unknown parameter
|month=ignored (help) - ↑ 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. Retrieved 2012-04-26. Unknown parameter
|month=ignored (help) - ↑ 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 (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. Retrieved 2012-04-26. Unknown parameter
|month=ignored (help) - ↑ Hull RD, Raskob GE, Carter CJ, Coates G, Gill GJ, Sackett DL; et al. (1988). "Pulmonary embolism in outpatients with pleuritic chest pain". Arch Intern Med. 148 (4): 838–44. PMID 3355304.
- ↑ Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT; et al. (1991). "Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease". Chest. 100 (3): 598–603. PMID 1909617.
- ↑ Kline JA, Nelson RD, Jackson RE, Courtney DM (2002). "Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study". Ann Emerg Med. 39 (2): 144–52. PMID 11823768.
- ↑ West J, Goodacre S, Sampson F (2007). "The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis". QJM. 100 (12): 763–9. doi:10.1093/qjmed/hcm113. PMID 18089542.
- ↑ 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 (2006). "Multidetector computed tomography for acute pulmonary embolism". The New England Journal of Medicine. 354 (22): 2317–27. doi:10.1056/NEJMoa052367. PMID 16738268. Retrieved 2012-04-26. Unknown parameter
|month=ignored (help) - ↑ 13.0 13.1 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 (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)". European Heart Journal. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870. Retrieved 2012-04-26. Unknown parameter
|month=ignored (help)