Pulmonary embolism physical examination

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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pulmonary emboli are associated with the presence of tachycardia and tachypnea. Signs of right ventricular failure include jugular venous distension, right sided S3, and parasternal lift. These are present in cases of massive pulmonary emboli.[1]

Physical Examination

Appearance of the Patient

The patient may appear anxious due to difficulty breathing. More severe cases may be associated with cyanosis.

Vital Signs

Temperature

  • Patient is often afebrile.

Pulse

Rate
Rhythm
  • The pulse is regular.
Strength
  • The pulse may be bounding and strong.
Symmetry
  • The pulses are symmetric.

Respiratory Rate

Blood Pressure

Skin

  • Cyanosis may be present, depending on severity of PE.

Neck

Heart

Inspection

Auscultation

Lung

  • Reduced breath sounds may be present.
  • Rales may be present.
  • Pulmonary hypertension and Rv overload are commonly seen at presentation and diagnosis.

Extremities

Signs of deep vein thrombosis (listed below) may be present in majority of patients with PE.[1]

Supportive trial data

The Prospective Investigation Of Pulmonary Embolism Diagnosis II (PIOPED II) study identified the following signs to be present in the majority of patients with proven pulmonary embolism proven by angiography.[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". The American Journal of Medicine. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458. Retrieved 2012-04-29. Unknown parameter |month= ignored (help)
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