Symptomatic venous thromboembolism occurs in 0.1–0.2% of adults each year with 33% presenting with PE, which carries a significant mortality (12–48%) depending on the size of the PE and the underlying health status of the patient. About 75% are first events with the remaining 25% recurrent presentations.
Asymptomatic (silent). These are picked up incidentally.
Dyspnoea (>90%) and cough.
Chest pain (may be pleuritic or non-pleuritic).
Signs
Hypoxia (SaO2 < 95%, PaO2 < 80%), tachypnoea and tachycardia (absent in up to 50%) and haemoptysis.
Diaphoresis (sweating) and fever (usually low grade).
Hypotension (often pre-terminal) and cardiac arrest (2%). Occasionally a PE may lead to a pulmonary wedge infarct after which patients often remain critically ill.
DVT (<25% will have a symptomatic DVT).
Investigations
CXR. (Low yield), but signs include dilated pulmonary vein with absent lung markings (Westermarks sign [2%]). Also aids in ruling out other causes of chest pain and hypoxia (e.g. pneumonia).
ECG. (Low yield). Often normal, but may rule out other causes of chest pain. ECG changes in PE include sinus tachycardia (most common), right heart strain (right axis deviation, high voltage R-waves in right heart leads, peaked p-waves) and, very rarely, SIQIIITIII (S-wave [lead I], Q-wave and T-wave inversion [lead III]).
Arterial blood gas (ABG).
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