From the Guidelines
The mnemonic "PESTO" is commonly used to remember the main symptoms of pulmonary embolism (PE), which stands for Pain, Edema, Shortness of breath, Tachycardia, and Oxygen desaturation. This mnemonic is helpful in remembering the key symptoms of PE, as described in the 2020 ESC guidelines for the diagnosis and management of acute pulmonary embolism 1. The symptoms reflected in the "PESTO" mnemonic are consistent with the pathophysiology of PE, where a blood clot lodges in the pulmonary arteries, obstructing blood flow to the lungs, leading to ventilation-perfusion mismatch, causing hypoxemia and respiratory distress.
Some key points to consider when using this mnemonic include:
- Pain (chest pain that may be pleuritic or sharp) is a frequent symptom of PE, usually caused by pleural irritation due to distal emboli causing pulmonary infarction 1.
- Edema (swelling, usually in the legs due to associated deep vein thrombosis) may be present, although it is not a universal symptom.
- Shortness of breath (dyspnea, often sudden onset) is a common symptom, which may be acute and severe in central PE or mild and transient in small peripheral PE 1.
- Tachycardia (rapid heart rate) is a response to maintain cardiac output in the face of hypoxemia and respiratory distress.
- Oxygen desaturation (low blood oxygen levels) is a critical symptom, as PE can lead to hypoxemia, although up to 20% of patients with PE may have a normal arterial oxygen pressure (PaO2) and a normal alveolar-arterial oxygen gradient [D(A-a)O2] 1.
Recognizing these symptoms promptly is crucial, as PE is a medical emergency requiring immediate intervention, and some patients may not exhibit all symptoms, with presentation varying based on the size and location of the embolism 1.
From the Research
Mnemonic for Pulmonary Embolism Symptoms
There are no specific mnemonics mentioned in the provided studies to remember the main symptoms of pulmonary embolism (PE). However, common symptoms of PE include:
- Dyspnea (shortness of breath) 2, 3, 4
- Pleuritic chest pain (chest pain that worsens with deep breathing) 3
- Tachypnea (rapid breathing)
- Tachycardia (rapid heart rate)
Diagnosis and Management
Diagnosis of PE relies on a combination of clinical findings, laboratory tests, and radiological imaging 2, 5. Management of PE typically involves anticoagulation therapy, usually with a direct oral anticoagulant (DOAC) 2, 3.
Clinical Presentation
The clinical presentation of PE can vary, but common risk factors include recent surgery, trauma, malignancy, and estrogen exposure 2. The incidence of PE appears to be increasing worldwide 2.