Internal Medicine

Pulmonary Embolism Symptoms

Pulmonary embolism discomfort

Pulmonary embolism symptoms generally depend on the size of the obstructed artery. About 30-50% of all embolisms are asymptomatic. Particularly smaller embolisms usually develop without clinical symptoms or are accompanied by a brief cough.

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Large, acute embolisms lead to abruptly onset of severe symptoms. Clinically, these are particularly common in acute shortness of breath and Heart rate increases with> 100 beats / min walk in peace. But also sudden chest pain especially during inhalation, fears and Anxiety occur in about 60% of cases.

The lack of oxygen becomes noticeable in the form of a blue discoloration, especially of the lips and fingernails (cyanosis). About half of all patients report a cough with sometimes bloody sputum. Rattling noises can usually be heard with the stethoscope. In some cases, the neck veins become congested. In rare cases, sweating, brief loss of consciousness and a drop in blood pressure leading to shock symptoms can occur.

If the embolus does not dissolve completely but in stages, the symptoms mentioned above occur in bursts on. In some cases the deep vein thrombosis of the legs symptomatic. This is expressed in a strong Feeling of tension and pulling Pain similar to one aching in the affected leg. Also, the leg can swelling, warmed up itself and is over the affected veins pressure sensitive. The typical triad with swelling, pain and cyanosis (Lack of oxygen with blue coloration) occurs only in approx. 10% in all cases.

The vast majority of all fatal embolisms, on the other hand, run in episodes. These are usually expressed clinically

in recurrent attacks of dizziness,
brief loss of consciousness,
unclear fever and
Heart rate increases.

The pulmonary embolism can be classified into 4 degrees of severity occur, depending on the artery affected.

Severity 1 usually symptom-free
Severity 2 with acute shortness of breath, chest pain, and palpitations
Grade 3 symptoms of the second degree combined with unconsciousness and cyanosis
Severity 4 circulatory shock with cardiovascular arrest requiring resuscitation

First signs of a pulmonary embolism

In addition to a large number of typical symptoms that can occur in a pulmonary embolism, some of them should be emphasized as the first signs of a pulmonary embolism that has occurred. Especially when certain risk factors are present, such as a long period of sedentarism after an operation, travel or illness, these signs should be interpreted in good time as symptoms of a pulmonary embolism.

More about this topic can be found: Causes of pulmonary embolism

It should be noted that depending on the severity of the event that occurred, the signs are perceived very strongly or only subtly.

A typical sign of a pulmonary embolism is sudden shortness of breath or difficulty breathing. At the same time, there is usually severe pain in the chest area. In severe cases, an immediate loss of consciousness can occur.

Read more on the topic Burning in the lungs

Pulmonary embolism in most cases is caused by a blood clot in the leg veins, which is why a painful leg in combination with the other symptoms is also a sign of a pulmonary embolism.

Since pulmonary embolism is a life-threatening event, a doctor should be consulted immediately if slight signs of pulmonary embolism are heard, who can confirm the diagnosis and initiate therapy if necessary.

Find out more about: Tension in the chest

More symptoms

Back pain

In addition to a number of other symptoms that occur in a pulmonary embolism, back pain is one of the symptoms that can be perceived individually. The back pain is here not a key symptom pulmonary embolism and the diagnosis of pulmonary embolism can never be made solely from the occurrence of severe back pain.

Typically, pulmonary embolism occurs Chest pain on, which, however, also in other body regions such as the Radiate back can. The location of the pain depends on the location and severity of the pulmonary embolism that has occurred. In the case of severe back pain, which may be accompanied by shortness of breath and other typical symptoms of a pulmonary embolism, a doctor should be consulted, who can diagnose the cause of the symptoms and initiate therapy for the pulmonary embolism.

to cough

Coughing is quite a common symptom of pulmonary embolism. Coughing is the body's own mechanism that ensures that the lungs are cleaned. He is also a Protective reflexso that no liquid or food gets into the lungs, for example if you choke.
With a pulmonary embolism, you cough because the organism wants to improve the ventilation of the lungs and thus the exchange of oxygen, which, however, does not dissolve the blood clot that triggered the pulmonary artery embolism.
The cough is a symptom of pulmonary embolism rather dry and without expectoration. If it is a bloody cough, this is more likely to indicate a pulmonary embolism. Otherwise it is a rather unspecific symptom and can occur in many diseases.

There may also be pulmonary embolism shortness of breath, one cyanosis (Blue discoloration of the lips and skin) Chest pain or one wheezing. In 20 percent of patients, the so-called triad of symptoms of pulmonary embolism occurs: They have a cough with bloody sputum, shortness of breath (dyspnoea) and chest pain. A sudden onset of coughing may indicate a pulmonary embolism rather than a harmless cold, for example. However, there are also small pulmonary embolisms that can last for weeks without the patient experiencing severe shortness of breath. Sometimes these trigger what is known as infarct pneumonia, i.e. pneumonia in the area affected by the pulmonary embolism. Then there can also be a cough as a symptom.

fatigue

Fatigue is not a typical symptom of acute pulmonary embolism. It can lead to weakness and exhaustion and also shortness of breath or even shortness of breath under exertion. Often times, patients with pulmonary embolism tend to be restless or anxious.
However, many patients who have had a pulmonary embolism often complain of tiredness, decreased performance and weakness. This is comparable to a past pneumonia: the lungs have to recover first, which can take several years under certain circumstances.

Drop in blood pressure

Pulmonary embolisms are not always severe. Sometimes only very small blood vessels in the lungs are affected, which do not necessarily have to cause symptoms. However, if you have a severe pulmonary embolism, you may experience one among other symptoms Drop in blood pressure come. A large pulmonary artery is blocked here. The body tries to compensate for this obstacle by increasing the heartbeat, giving the patient a Palpitations or palpitations can feel. If the body or the heart is no longer able to maintain blood pressure through increased pumping, the blood pressure drops. This can lead to the breakdown of the cycle.

fever

A pulmonary embolism can progress in flares if small blood clots keep blocking small blood vessels in the lungs. With this small pulmonary embolism, the typical symptoms such as shortness of breath, palpitations and coughing may be absent. The body is then often still able to dissolve small clots on its own. As part of this healing by the body, symptoms like Fever, dizziness, or shortness of breath occur.
These symptoms usually go away on their own after a while, once the body has successfully broken up the blood clots.

Another cause of fever in pulmonary embolism can be one caused by the embolism lung infection which is favored by the poor ventilation of the lungs. If you have a long-term fever, cough and shortness of breath, the cause may be another lung disease and should be clarified by a doctor.
Read about this: Symptoms of pneumonia

Is there a pulmonary embolism without symptoms?

Since the symptoms of a pulmonary embolism are very unspecific, embolisms can also occur without being noticed immediately. The following generally applies: the smaller the embolism, the more inconspicuous the symptoms.
When speaking of a pulmonary embolism without symptoms, one has to differentiate between two cases: the pulmonary embolism, which appears to appear without symptoms, and the embolism, in which there are actually no symptoms.

Most of the time, no symptoms are present unless the blood clots causing the pulmonary embolism are particularly small.
They get stuck in the smallest vessels in the lungs and clog only a minimal part of the entire vascular system. The thrombus (= clot) has hardly any influence on lung function. In addition, the body can quickly break down the clot and compensate for the functional impairment.
If such small pulmonary embolisms occur frequently, they usually only lead to symptoms such as shortness of breath, fatigue and reduced resilience after years.

The pulmonary embolisms, which are only supposedly not accompanied by symptoms, are usually somewhat larger. They are accompanied by unspecific complaints such as coughing, a slightly increased pulse and somewhat reduced performance.
Since a pulmonary embolism cannot be directly inferred from these symptoms, one could speak of a pulmonary embolism without any particular symptoms in such cases.

EKG changes in a pulmonary embolism

A pulmonary embolism places acute stress on the right heart, which is responsible for pumping blood through the lungs. In the case of a pulmonary embolism, this has to work against increased pressure in the pulmonary circulation. On the one hand, this leads to a Increase in heart ratewhich is visible in the ECG. The heartbeat increases to over 100 beats per minute, one then speaks of one Tachycardia.
Furthermore, this shows up Right heart strain with more specific symptoms on the EKG, which can give medical staff an indication of the pulmonary embolism. Especially when the rest of the clinical symptoms match. However, the right heart strain can also occur in the context of other diseases. A sign of a pulmonary embolism on the EKG would be the so-called S1Q3 type.

Differences in Symptoms in Men and Women

In principle, the symptoms of pulmonary embolism in men and women are similar. However, since pulmonary embolism can present with a variety of symptoms, none of which are particularly specific, the diagnosis is not always easy to make. Typical symptoms would be chest pain, cough with bloody sputum, fast and shallow breathing and a racing heart.
Pulmonary embolism coming more common in women in front. Symptoms that can only affect women are derived from the causes of the pulmonary embolism. In women this is, for example, pregnancy or a previous birth or taking the pill, which can indicate a pulmonary embolism if there are other suitable symptoms.

Duration of symptoms

The duration of the symptoms that occur in a pulmonary embolism depends on the course, the severity of the disease and the time it takes to start therapy.

The first two hours after the symptoms appear are critical for the person concerned. During this time it is risksuffer serious complications or die from pulmonary embolism the biggest. For this reason, if a pulmonary embolism is suspected, a doctor should always be consulted and no time should be lost.

If no therapy takes place and the affected Person survived the pulmonary embolism, the body is usually able to do that Dissolve blood clots on their own. By dissolving the blood clot The symptoms also usually decrease.

With or without therapy, the symptoms usually improve when the affected vessel is free again and the lungs are completely supplied with blood again.

Symptoms of pulmonary embolism after surgery

As part of an operation and the subsequent bed rest, the blood flow slows down. If there are additional factors that promote thrombosis, i.e. the formation of a blood clot in the veins, such as taking the pill, coagulation disorders or varicose veins, pulmonary embolism with the typical symptoms of the fast heartbeat over 100 beats per minute (tachycardia) and an acceleration and Flattening of breathing come. to cough, with or without bloody sputum, can also occur in the context of pulmonary embolism.
Another symptom are Chest painwhich may increase with inhalation.
Lying down, ventilation during the operation and poor ventilation of the lung area affected by the pulmonary embolism can lead to a lung infection come. The patient then has a fever and chills, but also coughs and shortness of breath.

If the pulmonary embolism is severe, it can lead to shortness of breath and a drop in blood pressure Circulatory collapse come. Typically, these symptoms appear the first time the patient starts moving properly, after a long bed rest. Some patients then also complain of restlessness, are afraid and do not want to lie down flat. Often there are parallel signs of thrombosis in a leg from which the blood clot has reached the lungs. The leg hurts, is reddened and thicker compared to the healthy leg.

Pulmonary embolism after pregnancy

A thrombosis, a blood clot that can lead to a pulmonary embolism, occurs in one or two women after pregnancy. It occurs especially in women who are at increased risk of thrombosis. These are e.g. Women over the age of 35, overweight, or assisted reproduction.
There is an increased risk of pulmonary embolism in the first two to twelve weeks after pregnancy. It is therefore important to know about the symptoms of pulmonary embolism and, if necessary, to speak to your doctor about thrombosis prophylaxis. This is because the blood naturally thickens during pregnancy as more red blood cells are produced in order to supply the child with sufficient oxygen. Together with other factors that promote the formation of a blood clot, this thrombosis can lead to a pulmonary embolism if the blood clot gets into the bloodstream of the lungs.
Read more about this under: Thrombosis in pregnancy

There are some warning symptoms such as premature placenta loosening or high blood pressure during pregnancy (preeclampsia or gestosis) that should suggest pulmonary embolism. But a caesarean section also increases the risk of thromboembolism.

If pulmonary embolism occurs after pregnancy, typical symptoms would be an accelerated heartbeat (tachycardia), breathing-dependent chest pain and accelerated breathing. This can also be accompanied by coughing with or without bloody sputum. A pronounced pulmonary embolism can lead to a drop in blood pressure, circulatory failure and respiratory failure.
With pulmonary embolism after pregnancy, patients are often afraid or restless. In addition, there are the typical symptoms of deep vein thrombosis: swelling, pain, redness and hardening of the affected leg.