Pulmonary embolism signs
The pulmonary embolism signs are not always at the forefront of the clinical picture but they are always present:
- Constant dyspnea, a form of superficial polypnea more intense, as pulmonary embolism is more severe,
- Chest pain, usually in the form of stitch basilar chest, sometimes in the form of angina-like chest pain,
- Hemoptysis, a late sign and very fickle, often limited to a few bloody sputum,
- Cyanosis is rare, and it is met only in severe forms of pulmonary embolism.
Extra-pulmonary embolism signs
- Syncope when you wake up, always a sign of severe pulmonary embolism
- Shock maiden
- Unexplained anxiety along with dyspnea,
- Fever, often delayed relative to the clinical onset,
- Acute pulmonary edema, rare, but particularly misleading,
- Abdominal pain, right upper quadrant, hepatitis can be mistaken for a surgical abdominal syndrome.
Pulmonary embolism clinical signs
These are signs that can be seen at the bedside of the patient.
Functional pulmonary embolism signs
- Dyspnea, a type of polypnea in general, present in 80% of cases,
- Chest pain (60%), pleural type 3 out of 4 times, sometimes pseudo-anginal,
- Cough: 50%
- Hemoptysis, later in general discrete (25%),
- Syncope, sometimes inaugural, in general being a criterion of severity (10%).
Physical pulmonary embolism signs
- Fever, moderate, 2 out of 3, sometimes with sweating,
- Cyanosis of the extremities (20%)
- Tachycardia 90/mn than 90% of cases,
- Pulmonary or pleural syndrome outbreak in 50% of cases,
- Signs of right heart failure in 30-50% of cases, producing an array of acute pulmonary heart, element of very severe pulmonary embolism,
- Hypotension, rare, maximum cardiovascular collapse with oligo-anuria, extreme gravity,
- For signs of phlebitis, particularly to the lower limbs, is systematic, but quite often negative.
Expressive marks ECG
- It may be normal (30%) with the exception of sinus tachycardia more or less marked,
- Ischemia in epicardial anterior septal or less with negative T wave is the aspect most suggestive but not specific
- The right axis deviation is less common (10%)
- As well as the appearance S1 Q3 (20%)
- And the right bundle branch block mat be complete or incomplete (30%)
- In all cases, the comparison with a previous ECG is important.
Radiological pulmonary embolism signs
- The chest radiograph can be considered normal in 30% of cases,
- Elevation of a dome diaphragm,
- Pleural effusion in general discrete
- Hyperlucent parenchymal localized
- Dilation of the pulmonary artery, often right
- Triangular opacities (pulmonary infarction) or discoid atelectasis flat bases, evocative,
- Each of these abnormalities can occur in approximately 20% of cases.
Clinical forms of pulmonary embolism
- Silent: frequent (40% in addition to high-popliteal DVT)
- EP Graves are often multiple, possibly being the first silent, are marked by significant hypoxemia and hypotension or even collapse;
- Latent in a patient already ill, the diagnosis is difficult;
- Ambulatory in a subject in apparent good health, diagnosis is also difficult. (Think if family history or contraceptive estrogen-progestin).
- Heart pulmonary thromboembolism chronic: secondary right heart failure to multiple emboli and spread over time in general with pulmonary hypertension, severe.
Treatment of pulmonary embolism
Apart from some specific aspects (oxygen therapy, treatment of severe), it is very close to that of phlebitis. This is an emergency, as the risk of recurrence in the short term, often serious, is very high in the absence of effective treatment (50%).