Patients with a PE may present to the emergency department (ED) in a variety of ways, and the key to successful diagnosis is to consider it as a possible cause of your patient’s symptoms.

Massive PE

Uncommon, where the patient is clinically shocked and hypoxic.

Usually, the clinical diagnosis is straightforward, though conditions such as right ventricular infarction, sepsis and concealed upper gastrointestinal haemorrhage can give present in a similar fashion.

The risk of death within 90 days is about 50%

Sub-massive PE

(<50% obstruction of the pulmonary vascular bed) in which the patient has acute dyspnoea and frequently chest tightness/pain.

The differential diagnosis in these patients includes acute coronary syndromes, pneumonia and heart failure.