From the Guidelines
Pulmonary embolism (PE) typically presents with symptoms such as unexplained shortness of breath, chest pain, tachycardia, apprehension or tachypnea, syncope, and hypoxemia, as reported in the most recent guidelines 1. The most common symptoms of PE include dyspnea, pain, and tachypnea, which were present in 85%, 40%, and 29% of patients with PE, respectively, according to the prospective multicenter MASTER registry cited in the NCCN Clinical Practice Guidelines in Oncology 1. Some key points to consider when evaluating symptoms of PE include:
- The International Cooperative Pulmonary Embolism Registry found that the most common symptoms at PE diagnosis were dyspnea (82%), chest pain (49%), cough (20%), syncope (14%), and hemoptysis (7%) 1.
- PE may also be an incidental finding, and some patients may have minimal or atypical symptoms, making diagnosis challenging.
- The severity of symptoms typically correlates with the size of the embolism and how much of the lung's blood supply is obstructed.
- It's essential to recognize that PE symptoms can mimic other conditions like heart attack or pneumonia, and a comprehensive medical history and physical examination, along with diagnostic imaging, are crucial for accurate diagnosis.
- The preferred imaging technique for the initial diagnosis of PE is CT angiography (CTA), which allows for indirect evaluation of pulmonary vessels and has several advantages, including accurate imaging of mediastinal and parenchymal structures and accurate visualization of emboli in many regions of the pulmonary vasculature 1.
From the Research
Symptoms of Pulmonary Embolism
- Pulmonary embolism (PE) presents with a variety of non-specific symptoms, including acute chest pain, shortness of breath, or syncope 2, 3
- The diagnosis of PE is determined by chest imaging 2
- Patients with a high probability of PE (ie, >40% probability) should undergo chest imaging, and D-dimer testing is not necessary 2
Clinical Characteristics
- The clinical probability of PE can be assessed using a structured score or using clinical gestalt 2
- In patients with a probability of PE that is less than 15%, the presence of 8 clinical characteristics (age <50 years, heart rate <100/min, an oxygen saturation level of > 94%, no recent surgery or trauma, no prior venous thromboembolism event, no hemoptysis, no unilateral leg swelling, and no estrogen use) identifies patients at very low risk of PE in whom no further testing is needed 2
Treatment
- First-line therapy consists of direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran, with thrombolysis reserved for patients with systolic blood pressure lower than 90 mm Hg 2, 3, 4
- Thrombolytic therapy is usually reserved for people with clinically serious or massive pulmonary embolism (PE) 5, 6
- Thrombolytic therapy may be helpful in reducing the recurrence of pulmonary emboli but may cause more major and minor haemorrhagic events, including haemorrhagic stroke 5, 6