Clinical Presentation The classic triad Hemoptysis Dyspnea, pleuritic Pain Not very common! Occurs in less than 20% of patients with documented pe Three clinical presentations Pulmonary Infarction Submassive embolism Massive embolism MBBS project, Zhongshan Hospital
MBBS project, Zhongshan Hospital Clinical Presentation • The Classic Triad: — Hemoptysis, Dyspnea, Pleuritic Pain — Not very common! — Occurs in less than 20% of patients with documented PE • Three Clinical Presentations — Pulmonary Infarction — Submassive Embolism — Massive Embolism
Clinical Syndromes Pts with massive Pe present with systemic arterial hypotension and evidence of peripheral thrombosis ° Pts with moderate pe wil‖ have right ventricu hypokinesis on echocardiogram but norma/ar systemic arterial pressure Pts with small to moderate pe have both normal right heart function and normal systemic arterial pressure Pulmonary Infarction usually indicates a small Pe, but is very painful because it lodges near the innervation of the pleural nerves MBBS project, Zhongshan Hospital
MBBS project, Zhongshan Hospital Clinical Syndromes • Pts with massive PE present with systemic arterial hypotension and evidence of peripheral thrombosis • Pts with moderate PE will have right ventricular hypokinesis on echocardiogram but normal systemic arterial pressure • Pts with small to moderate PE have both normal right heart function and normal systemic arterial pressure — Pulmonary Infarction usually indicates a small PE, but is very painful, because it lodges near the innervation of the pleural nerves
Symptoms 73% Dyspnea 66% Pleuritic pain Presentation is often 15% Hemoptysis atypical 43%Cough 33%Leg Swelling Signs and symptoms are frequently vague 30% Leg pain and nonspecific and °12% Palpitations rarely"classic 10%Wheezing 5% Angina-Like pain MBBS project, Zhongshan Hospital
MBBS project, Zhongshan Hospital Symptoms • 73% Dyspnea • 66% Pleuritc Pain • 15% Hemoptysis • 43% Cough • 33% Leg Swelling • 30% Leg Pain • 12% Palpitations • 10% Wheezing • 5% Angina-Like pain Presentation is often “atypical” Signs and symptoms are frequently vague and nonspecific and rarely “classic
Sians with Angiographically proven PE Sign Percent Tachypnea >20 / min 92 Rales 58 Accentuated s2 53 Tachycardia >100/ min Fever >37.8 43 Diaphoresis 36 S3 or S4 gallop 34 Thrombophebitis 32 Lower extremity edema 24 MBBS project, Zhongshan Hospital
MBBS project, Zhongshan Hospital Signs with Angiographically Proven PE Sign Percent Tachypnea > 20/min 92 Rales 58 Accentuated S2 53 Tachycardia >100/min 44 Fever > 37.8 43 Diaphoresis 36 S3 or S4 gallop 34 Thrombophebitis 32 Lower extremity edema 24