What are the symptoms of PE?

While the vast majority of pulmonary emboli are believed to originate in the deep veins of the body, fewer than 30 percent of individuals who experience PE have symptoms of DVT. Instead, the most common symptoms are shortness of breath and chest pain. In the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study, a large study conducted by the National Heart Lung and Blood Institute of the National Institute of Health, 73 percent of patients with PE experienced shortness of breath, 66 percent experienced chest pain, 37 percent experienced cough, and 13 percent coughed up blood. During physical examination, 70 percent had rapid breathing and 30 percent had a rapid heart rate. When doctors listened to the study participants with a stethoscope, half had abnormal sounds in their lungs and one fourth had abnormal sounds in their hearts. Fourteen percent had a fever.

In some cases, PE may occur very suddenly, without any warning. The symptoms of PE, when noted, are also very nonspecific. For example, shortness of breath and chest pain may occur with pneumonia, bronchitis, or other lung or heart problems. Chest pain may be caused by a number of problems, including muscle strain, heart problems, lung infections, stomach problems such as acid reflux or hiatal hernia, or even anxiety. Whenever a patient has symptoms such as shortness of breath or chest pain, especially when the person has other risk factors for DVT (such as recent surgery, admission to the hospital for a medical disease, or recent immobility), PE should be considered as a possibility.

David’s story:

At age 35, I was into my ninth year as an electrical engineer. My involvement with the medical profession was brief and infrequent. I had a broken arm at age 4, all the vaccinations required to go to school, the usual childhood diseases (measles, mumps, chickenpox, and so on), a couple of lacerations that needed stitches, a few ear infections, a bout with hepatitis while in college—and that was about it. In other words, I was healthy.

One morning, I arrived at the plant, climbed the stairs two at a time (as I usually did to go to my office and lab on the second floor), and found myself at the top of the stairs gasping for breath and almost passing out. Because I had never experienced anything like this before, I was frightened, but not enough to seek immediate medical attention. I waited. In 30 minutes, I was breathing normally. I did call the office of the family doctor who saw our children. The receptionist asked me what I needed and I told her I needed a physical exam. She gave me an appointment for three weeks hence.

Meanwhile, I tried some self-diagnosis. I thought that I would try to get the episode to reoccur by running on the treadmill. Fortunately, it didn’t reoccur, but over the next two weeks, I started to feel more tired by the end of the day. In the third week after the episode, I was feeling really awful, so my wife called the doctor, and he came to our house that night. His diagnosis was a viral infection. His advice was to tough it out.

Two days later, I was so weak that I had to crawl to get to the toilet. My wife called the doctor again, who again came to the house. He still thought it was a viral infection, but because I was scheduled for my physical exam the next day, he told me that when I came into the office, I should get, among other things, a chest x-ray. The chest x-ray revealed a case of pneumonia. I was so sick that the doctor’s partner admitted me to the hospital to start intravenous (IV) antibiotics.

On the second night in the hospital, I got up to go to the toilet and collapsed on the floor gasping for breath. The staff put me back in bed, and in about 30 minutes I wasn’t short of breath anymore. In the morning, the doctor’s partner ordered a CT scan, which revealed several blood clots in my lungs. I was immediately taken to the intensive care unit and started on IV heparin. Three weeks later, I was out of the hospital, pneumonia under control, arterial blood gases normal, and taking Coumadin®. Six months later, I was told to stop the Coumadin®, start an exercise program, and take an aspirin a day. I did this for 30 years without another episode.

Two years ago, I contracted a case of Rocky Mountain spotted fever from a tick bite. I spent almost a week in bed with high fevers. A couple of nights later, I awakened with severe cramps in my lower ribcage. Hoping the problem would go away, I didn’t wake my wife. I felt better the next morning. When I finally told my wife about the episode, she asked me if I thought it could be a PE. I said “no,” because the PE 30 years earlier was accompanied by acute shortness of breath, and this episode was not.

Three days later, we started a 10-day vacation that included several airplane rides, including a round trip between New York City and Rome. Upon return from vacation, I resumed my customary exercise on the treadmill. I noticed that my stamina was basically half of what it had been a month before. I chalked it up to a month away from the gym, but after two weeks with no improvement, I contacted my internist, who scheduled me for a stress test the next day.

That next morning, I noticed that I got winded climbing the stairs in our house. Just walking outside to get the paper made me feel light-headed. I was concerned enough to inform my wife, who was getting ready for work. Her approach was to head for the emergency room.

The diagnosis was a PE! I had been fooled. From my experience 30 years ago, I thought I knew what a PE felt like, but apparently different episodes can be accompanied by different symptoms. The symptoms I had 32 years ago were acute shortness of breath and loss of stamina. The symptoms I had 2 years ago were cramps in the lower ribcage and gradual loss of stamina, but no shortness of breath. By the time I reached the emergency room, an echocardiogram revealed that the right side of my heart was beginning to fail. I was immediately started on Lovenox® and admitted to intensive care unit for tissue plasminogen activator (TPA) to help dissolve the clot. Now, I take Coumadin® every day, but I am lucky to be alive.

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