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Venous pulmonary embolism causes 50,000 to 200,000 thousand deaths annually, primarily because early signs and symptoms often are unrecognized. Prodromal signs and symptoms of a venous pulmonary embolism are presented based on a review and synthesis of the literature.
In the United States, pulmonary embolism (PE) is one of the leading causes of unexpected death and the third most common cause of death following ischemic heart disease and stroke (Feied & Handler, 2002; van Beek et al., 2005). PE and deep vein thrombosis (DVT) are components of the venous thromboembolic (VTE) disease process (Kroegel & Reissig, 2003). DVT and pulmonary emboli can occur in children, adults, and older adults; however, the incidence of developing VTE increases with age (Torbicki et al., 2000). Risk of PE increases for individuals over age 40, men and women who are obese, pregnant women, women taking oral contraceptives, people with a congenital thrombophilia, smokers, and people with cancer (Torbicki et al., 2000). A pulmonary embolus is a complication of a venous thrombosis that results in the lodging of a blood clot in a pulmonary artery, causing obstruction of lung vasculature (Feied & Handler, 2002; Merck Manual, 2004). When an obstruction of the lung vasculature occurs, hemodynamic instability results; the obstruction increases pulmonary vascular resistance, resulting in pulmonary hypertension and acute right ventricular failure (RVF) (Gawlinski & Hamwi, 1999). RVF affects left ventricular output, leading to systemic arterial hypotension and cardiac failure (Wood, 2002). The obstruction also causes impaired gas exchange and hypoxia because of an increase in "...alveolar dead space, right to left shunting, ventilation/perfusion (V/Q) inequality, and a low mixed venous O2 level" (Wood, 2002, p. 882). Impaired gas exchange and cardiac failure cause decreased oxygenation to all body tissues and organ failure. If hemodynamic instability is not corrected, irreversible shock, cardiac arrest, and death ensue.
Venous thromboemboli originate as a result of one or more components of Virchow's triad, named after Rudolph Virchow, who described the phenomenon during the 19th century (Cardin & Marinelli, 2004). Virchow's triad consists of venostasis, hypercoagulability, and injury or inflammation of the vessel walls. The triad occurs with health problems that increase the risk of developing a VTE. According to Charlebois (2005), stasis health problems include immobilization, burns, stroke, heart failure, cancer,...