The following symptoms and complaints may indicate pulmonary embolism:
The symptom pattern depends on the size of the thrombus! If a massive pulmonary embolism occurs (i.e., obstruction of more than 50% of the pulmonary circulation; in approximately 5-10 of all cases of pulmonary embolism), then the full clinical picture of pulmonary embolism described below is seen.
Note: The clinical picture of acute pulmonary embolism is often nonspecific; pulmonary embolism can be confirmed objectively in only about 20% of cases. Leading symptoms
- Acute onset of chest pain* (chest pain), sometimes felt as annihilation pain (70-80%).
- Dyspnea* (shortness of breath) and tachypnea (increased or excessive respiratory rate; typical: acute onset; but may also be slowly increasing) (80-90%)
- Fear, anxiety, vegetative symptoms (eg, sweating) (50%)
- Cough (40%)
- Syncope (brief loss of consciousness) (10-20%).
- Hypoxemia (lowered oxygen content in arterial blood) or hypocapnia (lowered partial pressure of carbon dioxide in arterial blood)
- Tachycardia (heartbeat too fast: > 100 beats per minute).
- Hemoptysis (coughing up blood) (10%)
- Palpitations (heart actions perceived by the affected individual as unusually rapid, forceful, or irregular) (10%)
- Angina-like pain (4%)
- Central cyanosis (bluish discoloration of skin and central mucous membranes).
- Hypotension (blood pressure below normal).
- Shock
* Atemsynchronous pain with resting dyspnea (onset of dyspnea at rest).
Other indications
- In approximately 20% of patients with pulmonary embolism is not found deep vein thrombosis (TBVT; leg pain, unilateral leg swelling).
- In about 20-30% of cases of pulmonary embolism is an idiopathic thromboembolic event (“without apparent cause”).
- Depending on the size of the blocked vessel, pulmonary embolism can be asymptomatic or lethal (fatal).
- Wells score to determine the clinical probability of pulmonary embolism (see “Physical examination” below).
PERC criteria (“pulmonary embolism rule-out”)
Immediate CT pulmonary angiography (CTPA) should be performed thereafter only if any of the following 8 PERC criteria are present:
- Medical history (history)
- Patient age > 50 years
- History of pulmonary embolism or deep vein thrombosis
- Hormone use (oral contraceptives, hormone replacement therapy, or intake of estrogens in male or female patients).
- Recent trauma or recent surgery
- Clinical findings/laboratory diagnostics.
- Unilateral leg swelling
- Hemoptysis (coughing up blood)
- Arterial oxygen saturation (SpO2): ≤ 94%.
- Pulse rate: ≥ 100 beats/minute.
Note: Use of PERC criteria results in less than 2% missed pulmonary emboli in the United States.
