Can a pulmonary embolism (PE) cause inspiratory chest pain?

From the Guidelines

Yes, a pulmonary embolism (PE) can cause inspiratory chest pain, as the most recent and highest quality study suggests that pleuritic chest pain is one of the most frequent presentations of PE 1. This pain typically worsens with deep breathing or inspiration because the movement of the inflamed pleura surrounding the lung tissue affected by the embolism creates friction and discomfort. The chest pain from a PE is often described as sharp, stabbing, or pleuritic in nature and may be accompanied by other symptoms such as sudden shortness of breath, rapid heart rate, cough (sometimes with bloody sputum), lightheadedness, and anxiety.

Key Points to Consider

• The pain occurs because when a blood clot lodges in a pulmonary artery, it can cause tissue damage, inflammation, and sometimes infarction of lung tissue, which irritates the pleural lining 1.
• This irritation becomes more pronounced during inspiration as the lungs expand.
• If you experience sudden inspiratory chest pain, especially with shortness of breath or risk factors for blood clots (such as recent surgery, prolonged immobility, pregnancy, or certain medications), seek immediate medical attention as PE is a potentially life-threatening condition requiring prompt diagnosis with imaging tests like CT pulmonary angiography and treatment with anticoagulants or thrombolytics depending on severity 1.
• Clinical decision trees, such as the Wells criteria, have been developed and validated to estimate the pretest probability of PE, and D-dimer testing can be used to rule out PE in patients with a low pretest probability 1.

Importance of Prompt Medical Attention

Given the potentially life-threatening nature of PE, it is crucial to seek medical attention immediately if symptoms suggestive of PE occur. The use of clinical prediction rules, D-dimer measurements, and imaging studies like CT pulmonary angiography can help in the diagnosis of PE, and treatment should be initiated promptly based on the severity of the condition 1.

From the Research

Symptoms of Pulmonary Embolism

• Pulmonary embolism (PE) is characterized by occlusion of blood flow in a pulmonary artery, typically due to a thrombus that travels from a vein in a lower limb 2
• Patients with PE often present with acute chest pain, shortness of breath, or syncope 2
• The clinical probability of PE can be assessed using a structured score or using clinical gestalt 2

Relationship between PE and Inspiratory Chest Pain

• Pulmonary embolism can cause pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed 3
• Pleuritic chest pain is a type of chest pain that worsens with inspiration, which is consistent with the user's question about inspiratory chest pain
• While the exact term "inspiratory chest pain" is not used in the studies, the description of pleuritic chest pain as a symptom of PE suggests a connection between PE and chest pain that worsens with inspiration 3

Diagnosis and Treatment of PE

• The diagnosis of PE is determined by chest imaging, and the treatment typically involves anticoagulant therapy 2, 4, 5, 3, 6
• The use of low-molecular-weight heparin (LMWH) is recommended for the treatment of PE, and it offers more predictable pharmacokinetics and anticoagulant effects compared to unfractionated heparin (UFH) 4, 5, 6
• Direct oral anticoagulants (DOACs) are also becoming the agents of first choice for the initial treatment of PE due to their practicability and non-inferiority to standard therapy 5