What is the presentation of pulmonary embolism (PE)?

Updated: Dec 31, 2017
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

PE ranges in severity from acute massive PE to acute pulmonary infarction to acute embolism without infarction to multiple emboli.

In addition to generalized, nonspecific symptoms, patients with acute massive PE also present with systemic hypotension (systolic blood pressure [BP] below 90 mm Hg or a decrease in systolic arterial pressure of at least 40 mm Hg for at least 15 minutes), persistent profound bradycardia, or cardiogenic shock. [28]

Nevertheless, a subgroup of patients are hemodynamically stable at presentation but have RV dysfunction; these patients have an increased risk of death and thus might benefit from fibrinolytic therapy. [29] Submassive PE is defined as an acute PE without systemic hypotension (systolic blood pressure >90 mm Hg) but with either RV dysfunction or myocardial necrosis.


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