What are the symptoms of Pulmonary Embolism (PE)?

Symptoms of Pulmonary Embolism

The most common symptoms of PE are sudden-onset dyspnea (80% of cases), pleuritic chest pain (52%), and tachypnea with respiratory rate >20/min (70%), with at least one of these three symptoms present in 97% of patients. 1

Primary Symptom Patterns

Most Frequent Presentations

• Dyspnea (shortness of breath) occurs in approximately 80% of PE patients and represents the single most common symptom 1, 2
• Pleuritic chest pain (sharp, stabbing pain worsening with breathing) presents in 52% of cases, caused by pleural irritation from distal emboli 1, 3, 2
• Tachypnea (respiratory rate >20/min) is present in 70% of patients 1, 2
• Syncope or fainting occurs in 19% of cases and may indicate more severe PE 1, 2
• Tachycardia (heart rate >100/min) presents in 26% of patients 1, 2

Less Common but Important Symptoms

• Substernal chest pain (angina-like) occurs in 12% of cases, likely representing right ventricular ischemia 1, 3, 2
• Hemoptysis (coughing blood) presents in 11% of patients, resulting from alveolar hemorrhage 1, 2
• Cough occurs in 20% of cases 1, 2
• Signs of deep vein thrombosis (leg swelling, pain) are present in only 15% of patients 1, 2

Symptom Variation by PE Location

Central (Proximal) PE

• Acute, severe dyspnea of rapid onset is the hallmark presentation 1, 3, 2
• Substernal chest pain with anginal characteristics may occur, representing RV ischemia 1, 3
• Hemodynamic instability (hypotension, shock) indicates severely reduced cardiac reserve 1, 2
• Syncope is more frequent with central emboli 2

Peripheral (Distal) PE

• Mild, transient dyspnea that may come and go 1, 3, 4
• Pleuritic chest pain is the predominant feature 1, 3
• Hemoptysis is more common with peripheral emboli 2
• Symptoms may be subtle and easily missed 3, 4

Critical Clinical Pitfalls

PE Can Be Easily Missed In:

• Elderly patients where symptoms may be attributed to other conditions 1
• Patients with pre-existing heart failure or lung disease, where worsening dyspnea may be the only new symptom 1, 2
• Isolated dyspnea without chest pain or cough, which occurs frequently but is often dismissed 1

Common Diagnostic Errors

• Normal oxygen saturation does NOT exclude PE - up to 40% of PE patients have normal arterial oxygen saturation 1, 2
• Absence of chest pain does NOT rule out PE - approximately 48% of patients have no chest pain 3
• Transient symptoms should never be dismissed - small peripheral emboli can cause temporary symptoms that resolve, leading to delayed diagnosis 3, 4
• Only 3% of PE patients lack all three cardinal symptoms (dyspnea, tachypnea, chest pain), so their absence makes PE highly unlikely 1, 3

Physical Examination Findings

• Tachypnea (>20/min) in 70% 1, 2
• Tachycardia (>100/min) in 26% 1, 2
• Cyanosis in 11% 1, 2
• Fever (>38.5°C) in only 7% 1, 2
• Signs of DVT in 15% 1, 2
• Elevated jugular venous pressure with sudden collapse indicates massive PE 1

Life-Threatening Presentations

Sudden collapse with hypotension and/or shock represents central or extensive PE with severely reduced hemodynamic reserve and requires immediate intervention 1, 2. This presentation includes cold extremities, oliguria, and signs of acute right heart failure 1.

Asymptomatic Cases

PE can be completely asymptomatic and discovered incidentally during imaging for other conditions - only 1% of patients have no symptoms before diagnosis, but this emphasizes that PE should remain in differential diagnosis even without classic symptoms 2, 5.