From the Guidelines
Pulmonary embolism (PE) symptoms include unexplained shortness of breath, chest pain, tachycardia, apprehension or tachypnea, syncope, and hypoxemia, with the most common presenting symptoms being dyspnea, pain, and tachypnea, as reported in the prospective multicenter MASTER registry 1. The severity of symptoms depends on the size of the embolism, how much of the lung is affected, and the patient's underlying cardiopulmonary health. Some key symptoms to look out for include:
- Sudden shortness of breath
- Chest pain that worsens with deep breathing or coughing
- Rapid or irregular heartbeat
- Lightheadedness
- Coughing up blood These symptoms may develop suddenly or gradually over days. It's essential to note that PE can be a medical emergency requiring immediate attention as it can be life-threatening, and the symptoms result from blocked blood vessels in the lungs that prevent normal oxygen exchange and increase pressure in the pulmonary circulation, potentially straining the right side of the heart. According to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Associated Venous Thromboembolic Disease, Version 2.2024, the most common symptoms at PE diagnosis were dyspnea (82%), chest pain (49%), cough (20%), syncope (14%), and hemoptysis (7%) 1. In some cases, PE may also be an incidental finding, and patients older than 70 years of age are more likely to be diagnosed with an intermediate-probability VQ scan result, which lacks diagnostic utility and should be considered indeterminate 1. The diagnosis of PE is often evoked by the absence of other classic causes of progressive dyspnoea, and a high-probability VQ scan is diagnostic in the setting of high clinical suspicion for PE 1. Overall, it's crucial to prioritize the diagnosis and treatment of PE to prevent morbidity, mortality, and reduce the impact on quality of life.
From the Research
Symptoms of Pulmonary Embolism (PE)
The symptoms of Pulmonary Embolism (PE) can vary, but common symptoms include:
- Sudden onset dyspnea (shortness of breath) 2, 3, 4, 5
- Chest pain 2, 3, 4, 5
- Syncope (fainting) 2, 4, 5
- Hemoptysis (coughing up blood) 2, 3, 4, 5
- Limb swelling 4
Clinical Presentation
The clinical presentation of PE can range from asymptomatic cases to life-threatening events 4. The presentation can vary based on factors such as thrombus burden, demographics, and time to presentation 4.
Diagnostic Evaluation
Diagnostic evaluation involves assessing symptoms, physical examination findings, and utilizing laboratory tests, including D-dimer 4. Imaging tests such as lung ultrasound and echocardiography may also be indicated in some patients 5.
Risk Stratification
Risk stratification using tools like the Wells score, Pulmonary Embolism Severity Index, and Hestia criteria can aid in determining the severity of PE 4, 5. This is crucial in guiding treatment decisions and management strategies, particularly for elderly and comorbid individuals who are at higher risk 4.