Clinical Presentation of Pulmonary Thromboembolism

Symptoms and Signs

The European Society of Cardiology recommends that disnea, which is the most frequent symptom, is present in approximately 72% of patients, and can be acute and severe in central pulmonary thromboembolism (TEP) or mild and transient in small peripheral TEP 1, 3
Dolor torácico is present in approximately 38% of cases, generally caused by pleural irritation due to distal emboli that cause pulmonary infarction, and in central TEP, it can have characteristics of angina, possibly reflecting right ventricular ischemia 1, 4
Síncope, although infrequent, can occur independently of hemodynamic instability, and is associated with a higher prevalence of right ventricular dysfunction and hemodynamic instability 5, 1
Hemoptisis results from areas of alveolar hemorrhage caused by small distal emboli 3, 6

Central TEP is characterized by acute and severe disnea, dolor torácico with anginal characteristics, higher probability of hemodynamic instability, and more frequent síncope 3, 1, 4
Peripheral TEP is characterized by mild and sometimes transient disnea, pleuritic dolor torácico, hemoptisis, and derrame pleural (usually mild) 3, 6, 5, 2

Hipoxemia is frequent, although up to 40% of patients may have normal arterial oxygen saturation and 20% may have a normal alveolar-arterial oxygen gradient 1, 4
Hipocapnia is often present 1, 4
Inestabilidad hemodinámica is a rare but important form of clinical presentation, indicating central or extensive TEP with severely reduced hemodynamic reserve 1, 2

Cambios indicativos de sobrecarga ventricular derecha, such as inversion of T waves in leads V1-V4, QR pattern in V1, S1Q3T3 pattern, and incomplete or complete right bundle branch block, are often found in more severe cases of TEP 1, 4

In patients with pre-existing heart failure or lung disease, worsening disnea may be the only symptom indicative of TEP 1, 2
TEP can be completely asymptomatic and discovered incidentally during diagnostic study of another disease 1, 4
Approximately 40% of patients with TEP do not have predisposing factors 5, 4

TEP de alto riesgo is defined by hemodynamic instability (persistent arterial hypotension and/or shock), indicating a high risk of early mortality (in-hospital or at 30 days) 1, 3
TEP de riesgo no alto requires additional evaluation to determine the level of risk and adjust management decisions 1, 2