Physical Examination

The physical findings in patients with PE are as varied and nonspecific as the clinical presentations. Vital signs reveal tachypnea (RR > 16/min) in over 90 percent of cases, while tachycardia (PR > 100/min) and fever (>37.8°C) occur in less than 50 percent.5 Blood pressure may be elevated, normal, or low.

Depending on the extent of the PE and preexisting cardiopulmonary disease, the patient may appear to be in no apparent distress or be found to be anxious, diaphoretic, or dyspneic. Cyanosis is uncommon, generally signifying massive PE or underlying cardiopulmonary disease.

Findings of acute right heart dysfunction—neck vein distention, accentuation of the pulmonic heart sound, and right parasternal heave—may occur in massive and submassive PE. Chest exam reveals a pleural friction rub in less than 20 percent of cases. Rales are a more common but less specific finding. Localized wheezes are suggestive of PE but uncommon. Clinical evidence of DVT occurs in less than 50 percent of patients. However, up to 80 percent of patients with PE have positive venography.3

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