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Clinical Features of Pulmonary Embolism

 
  By : , New Delhi, India       17.10.2010         Phone:8287833547, 9738626275          Mail Now
  Ayurvedic and Unani Tibbia College, Karolbagh
 
 
 

The characteristic symptom of pulmonary embolism is sudden breathlessness. Indeed, relatively few processes cause such sudden dyspnoea. Lateral, usually basal, pleuritic chest pain and haemoptysis develop sometime after the onset of breathlessness, and are only clinical features if infarction has occurred. The haemoptysis consists of frank red blood without sputum. 

In addition to respiratory symptoms there may be pain or swelling of a leg, suggesting deep vein thrombosis, or a history indicating an increased risk of thrombosis. On examination there may be signs of deep vein thrombosis. The respiratory rate is usually raised, and if infarction has taken place there may be a pleural rub and a small pleural effusion.

If embolization has been extensive there will be cyanosis and signs of cardiovascular stress. The most important cardiovascular sign is a tachycardia, and some patients will have an elevated jugular venous pressure and fourth heart sound. With extensive embolism patients may have signs of pulmonary hypertension, and occasion ally a systolic murmur can be heard over the lung fields, as a consequence of turbulent pulmonary blood flow past partial pulmonary arterial occlusion.


Within a few hours of pulmonary infarction fever is the rule. Arterial blood gas analysis usually demonstrates hypoxaemia. However, not all patients are hypoxaemic and hypoxaemia is in itself a very non-specific abnormality. As a consequence of hyperventilation, there is hypocapnia. Patients with pulmonary embolic disease are frequently anxious as well as breathless, and their hypocapnia is not uncommonly taken to reflect anxiety. However, anxiety hyperventilation syndromes produce hyperoxaemia. Immediately following embolization there is often bronchoconstriction, there may even be wheeze, and later, a reduction in surfactant in the affected lung is a contributory factor to atelectasis. Symptomatic pulmonary embolism occurs in about30% of patients with deep vein thrombosis in the leg or pelvis; if symptomatic events are added to this figure about 50-60% of patients with deep venous thrombosis will have a pulmonary embolism at some stage. However, in patients with suspected deep venous thrombosis only25% will actually prove to have the condition when fully investigated.



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