Clinical Presentation

Patients with PE can present with a wide array of symptoms, ranging from subtle and nonspecific to severe and life-threatening. The clinical presentation is highly variable and depends on factors such as the size and location of the embolus, underlying cardiopulmonary health, and individual response. Common symptoms include:

• Dyspnea: Sudden onset of shortness of breath is often the most prominent symptom.
• Chest Pain: Pleuritic chest pain, exacerbated by deep breathing or coughing, may be present.
• Hemoptysis: Coughing up blood or blood-streaked sputum can occur.
• Syncope: Fainting or near-fainting spells may be a sign of significant obstruction.
• Tachycardia: Elevated heart rate is a frequent finding, reflecting the body’s compensatory response.
• Tachypnea: Rapid breathing may be noted on physical examination.
• Anxiety or Apprehension: A feeling of impending doom or unexplained anxiety may be reported.

Physical examination may reveal signs of deep vein thrombosis (DVT), such as swelling or tenderness in the legs, and evidence of right heart strain or failure. Diagnostic clues from electrocardiogram (ECG) may include signs of right heart strain, such as S1Q3T3 pattern or T wave inversions in right precordial leads. Clinical prediction rules, such as the Wells criteria or Geneva score, can be used to assess the pretest probability of PE.