From the Guidelines
Pulmonary embolism (PE) typically presents with sudden onset of shortness of breath, chest pain, and rapid or irregular heartbeat, and can be life-threatening if not promptly diagnosed and treated. The signs and symptoms of PE can vary in severity depending on the size and location of the clot. Common symptoms include:
- Sudden shortness of breath that worsens with exertion
- Chest pain that may feel like a sharp stabbing sensation and often worsens with deep breathing or coughing
- Rapid or irregular heartbeat
- Coughing that may produce bloody sputum
- Lightheadedness, dizziness, excessive sweating, fever, leg pain or swelling (particularly in the calf), and a bluish discoloration of the lips and nails due to low oxygen levels
- In severe cases, patients can develop hypotension, syncope, or even cardiac arrest
These symptoms occur because the blood clot blocks blood flow to part of the lung, preventing normal oxygen exchange and increasing pressure in the pulmonary arteries and right side of the heart. Risk factors include prolonged immobility, recent surgery, cancer, pregnancy, hormonal birth control, and inherited clotting disorders. According to the most recent study 1, anyone experiencing these symptoms, especially those with risk factors, should seek immediate medical attention as PE can be life-threatening and requires prompt diagnosis and treatment. The use of clinical prediction scores, such as the Wells’ rule and the revised Geneva score, can help identify patients with a high likelihood of PE 1. Additionally, echocardiography can be a valuable tool in the diagnosis of PE, particularly in patients with haemodynamic compromise 1.
From the Research
Signs and Symptoms of Pulmonary Embolism
The signs and symptoms of pulmonary embolism (PE) can vary, but common presentations include:
- Sudden onset dyspnea (shortness of breath) 2
- Chest pain, often described as pleuritic (sharp pain that worsens with breathing) 3, 4, 2
- Fainting or syncope (loss of consciousness) 3, 2
- Hemoptysis (coughing up blood) 3, 4, 2
- Unexplained cough 4
- Symptoms of deep vein thrombosis, such as unilateral leg swelling 3, 2
Clinical Presentation
Most patients with PE present with at least one of the following symptoms: sudden onset dyspnea, chest pain, fainting or syncope, and hemoptysis 2. These symptoms should alert clinicians to consider PE in the differential diagnosis and order the appropriate objective tests. The clinical presentation of PE can be nonspecific, making diagnosis challenging 5, 4, 6.
Diagnostic Considerations
The diagnosis of PE is determined by chest imaging, and the clinical probability of PE can be assessed using a structured score or clinical gestalt 3. Serum D-dimer level, computed tomography pulmonary angiogram (CTPA), ventilation-perfusion scintigraphy, or echocardiography can help establish the clinical probability and severity of PE 4.
Risk Factors
Hereditary and acquired risk factors are associated with PE, and the incidence of PE is increasing, likely due to advances in diagnostic methods 4.