What symptoms characterize a pulmonary embolism?

• A. Dull chest pain with no respiratory symptoms
• B. Sharp chest pain with radiation to shoulder
• C. Palpitations only
• D. Focal pleuritic chest pain with tachypnea, tachycardia, and possibly hemoptysis

Answer: (D)

When a pulmonary embolism happens, a clot blocks a branch of the pulmonary artery, causing irritation of the lung lining and a sudden change in blood flow. This tends to produce focal pleuritic chest pain — sharp pain that worsens with deep breaths or coughing. The body responds to the mismatch between ventilation and perfusion with rapid breathing (tachypnea). The heart also speeds up (tachycardia) as it tries to compensate for reduced oxygen delivery. In some cases, a portion of lung tissue may infarct, leading to coughing up blood (hemoptysis). This combination—focal pleuritic chest pain with tachypnea, tachycardia, and possibly hemoptysis—is the classic presentation of a pulmonary embolism. Other patterns, like dull chest pain without respiratory symptoms or palpitations alone, don’t fit the typical acute, respiratory-focused picture of PE.