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Pulmonary embolism symptoms and signs

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Pulmonary embolism symptoms and signs can vary from none to sudden death.  The determinants are the pulmonary embolism symptoms and signssize and number of emboli as well as the state of cardiopulmonary function of the victim prior to the event.   

Some of the symptoms and signs of pulmonary embolism depend upon whether or not the event is massive or submassive. A massive pulmonary embolism is one which causes instability of the blood pressure and heart rate.  A submassive pulmonary embolism is one that causes dysfunction of the right ventricle but does not cause a drop in the blood pressure.

Symptoms of pulmonary embolism

Frequent symptoms are:

  • Acute dyspnea – shortness of breath that comes on suddenly
  • Pleuritic chest pain – sharp pain in the chest made worse by breathing, particularly taking a deep breath

Pleuritic chest pain occurs most commonly as a result of pulmonary infarction due to smaller emboli in the periphery of the lung(s).  

Less common symptoms are:pulmonary embolism symptoms and signs

  • Cough
  • Hemoptysis – the coughing up of blood
  • Palpitations – the sensation of pounding or irregular heartbeats
  • Alteration of mental status (particularly in the elderly)
  • Lightheadedness – the feeling that you might faint
  • Wheezing
  • Syncope – fainting
  • Presyncope
  • Sudden death
  • Anxiety – uneasiness and apprehension

Syncope or sudden death often occurs with a massive pulmonary embolism.  

Uncommon and atypical symptoms include:  

  • Vague chest pain
  • Seizures
  • Abdominal pain
  • Flank pain – pain in the kidney areas

When chest pain occurs it is easy to mistakenly attribute it to another cause such as a heart attack.  Abdominal pain might also be misleading.  

Symptoms of deep venous thrombosis (DVT) might or might not be present.  When DVT symptoms are present they can be any one or more of the following: pain, swelling, warmth, redness, or tenderness in the upper or lower limb that has the blood clot. 

Signs of a pulmonary embolism

The most common signs of a pulmonary embolism are:

  • Tachycardia – a rapid heart rate
  • Tachypnea – rapid breathing
  • Rales – lung crackles – particularly if there is pulmonary infarction  

Less common signs are:

  • Hypotension or a significant drop in blood pressure (shock in the worst case scenario)
  • An irregular heartbeat
  • A loud second heart sound heard with a stethoscope – due to forced closure of the pulmonic valve because of the elevated pressure in the pulmonary trunk (main pulmonary artery)
  • S3 or S4 gallop – a third or fourth heart sound respectively
  • Low-grade fever
  • Wheezing
  • Bradycardia – a slow heart rate
  • Cyanosis if there is severe hypoxemia
  • Diaphoresis – sweating
  • Distended neck veins – due to elevated venous pressure  

Marked hypotension or shock is a sign of a massive pulmonary embolism.  The defining criteria for massive pulmonary embolism are the following:

  • A systolic blood pressure less than 90 mmHg for 15 or more minutes 
  •   An absolute drop in the systolic blood pressure of 40 mmHg or more  
  •  The need for intravenous medication(s) to achieve or maintain a blood pressure that is not too low 
  •   A cardiac arrest 
  • A heart rate of less than 40 bpm

The abnormalities of rhythm might result from heart muscle damage caused by decreased perfusion.  The decreased blood flow to the heart can result from reduced cardiac output.  There are various theories as to the cause of the low grade fever that can occur. 

 

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