Pulmonary embolism

A pulmonary embolism is a blockage in a lung artery. Pulmonary embolism (PE) is usually caused by a blood clot in the leg called a deep vein thrombosis. The clot can break free, travel through the bloodstream to the lungs, and block an artery.

Signs and symptoms of pulmonary embolism (PE) include unexplained shortness of breath, chest pain, cough (which may be bloody), faster than normal heartbeat, and lightheadedness or fainting. In some cases the only signs and symptoms are related to deep vein thrombosis , such as swelling of the leg or along a vein in the leg, and pain or tenderness in the leg, among others.

Pulmonary embolism (PE) usually starts off as a blood clot in leg called a deep vein thrombosis. The clot can break free, travel through the bloodstream to the lungs, and block an artery. Other causes may include an air bubble, part of a tumor, or other tissue can travel to the lungs and cause PE (rarely). When a large bone in the body (such as the thigh bone) breaks, fat from the bone marrow can travel through the blood. If the fat reaches the lungs, it can cause PE.

Pulmonary embolism (PE) is treated with thrombolytics, anticoagulants, and procedures, and other treatments. The main goals of treating PE are to stop the blood clot from becoming bigger and prevent new clots from developing. The goals of treating PE are to prevent the blood clot from getting bigger or breaking off and moving to the brain, as well as reduce chances of having another blood clot. Anticoagulants are used to prevent the clots from becoming bigger (enoxaparin, dalteparin, fondaparinux, warfarin). Thrombolytics are used to quickly dissolve large blood clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations. 

Signs and symptoms of pulmonary embolism (PE) include:

• unexplained shortness of breath
• problems breathing
• chest pain
• cough (which may be bloody)
• faster than normal heartbeat
• lightheadedness or fainting

In some cases the only signs and symptoms are related to deep vein thrombosis (DVT). These include:

• swelling of the leg or along a vein in the leg
• pain or tenderness in the leg
• increased warmth in the area of the leg that is swollen or tender
• redness on the affected leg

See your doctor right away if you have any signs or symptoms of PE or DVT. It is also possible to have PE and not have any signs or symptoms.

Some people who have PE have feelings of anxiety or dread, light-headedness or fainting, rapid breathing, sweating, or an increased heart rate.

Pulmonary embolism (PE) usually starts off as a blood clot in leg called a deep vein thrombosis. The clot can break free, travel through the bloodstream to the lungs, and block an artery.

Other causes may include:

• In some rare cases, an air bubble, part of a tumor, or other tissue can travel to the lungs and cause PE.
• A large bone in the body (such as the thigh bone) breaks, fat from the bone marrow can travel through the blood. If the fat reaches the lungs, it can cause PE.

Pulmonary embolism (PE) occurs equally in men and women.

Risk Factors for PE

• advancing age. The risk increases with age. For every 10 years after age 60, the risk for a PE doubles.
• have deep vein thrombosis (DVT) or a history of DVT
• have had a PE before
• having certain inherited conditions, such as factor V Leiden
• being on bed rest or unable to move around much
• having surgery or breaking a bone (the risk goes up in the weeks following the surgery or injury)
• having certain diseases or conditions, such as a stroke, paralysis (an inability to move), chronic heart disease, or high blood pressure
• smoking

Risk factors for for DVT:

• have recently been treated for cancer 
• have a central venous catheter (a tube placed in a vein to allow easy access to the bloodstream)
• sitting for long periods (long car or airplane trips)
• Post certain types of surgery
• Bed rest for a long period of time
• pregnancy and the 6-week period after pregnancy
• being overweight or obese
• take hormone therapy pills or birth control pills
• damaged or veins from surgery or injured veins

The risk for developing blood clots increases as your number of risk factors increases.

Pulmonary embolism (PE) is diagnosed based on your medical history, a physical exam, and test results.

Medical History and Physical Exam

To diagnose PE, the doctor will ask about your medical history to determine the risk factors for deep vein thrombosis (DVT) and PE and rule out other possible causes for your symptoms.

During the physical exam, your doctor will examine your legs for signs of DVT as well as listen to your heart and lungs.

Diagnostic Tests

Your doctor can order an ultrasound, Computed Tomography Scans (CT scans), Lung Ventilation/Perfusion Scan, and or  Pulmonary Angiography to look for blood clots.

Your doctor may order blood tests such as a D-dimer test to help determine  whether you're likely to have PE

Your doctor may order other blood tests to look for inherited disorders that cause blood clots as well as measure the amount of oxygen and carbon dioxide in your blood.

Other Tests

Your doctor may order other tests to help rule out other possible causes of your symptoms such as:

• Echocardiography (echo)
• EKG (electrocardiogram)
• Chest x ray
• Chest MRI (magnetic resonance imaging)

In order to preventing pulmonary embolism (PE) , you must prevent deep vein thrombosis (DVT). With that being said, knowing your risk for DVT becomes important.

• If you are going to sit for long periods of time, try to exercise your lower leg muscles.
• Try to get out of bed and move around as soon as soon as you can after surgery or after being sick.

If you have had a PE (with or without deep vein thrombosis (DVT)) before, you are at a higher risk of having another PE. you should continue to take steps to prevent new blood clots from forming. Also, use compression stockings to prevent chronic (ongoing) swelling in your legs from DVT, as your doctor advises.

Continue to check your legs for any signs or symptoms of DVT. Contact your doctor right away if you notice any signs or symptoms of DVT or PE.

Pulmonary embolism (PE) usually is treated in a hospital. After leaving the hospital, you may need to take medicine at home for 6 months or longer. It's important to:

• Take all medicines as prescribed, and have blood tests done as your doctor advises.
• Tell your doctor about all the medications you take including over-the-counter medicines and herbals. Some medications and/herbals can interact with your medications and increase your risk for bleeding.
• If you are taking warfarin (Coumadin), ask your doctor about your diet. Foods that contain vitamin K, found in green leafy vegetables, can affect how well warfarin (Coumadin) works.
• Ask your doctor about alcohol use.

Medicines used to treat PE can thin your blood too much. This can cause bleeding. Contact your doctor right away if you notice signs or symptoms of bleeding.

Pulmonary embolism (PE) is treated with thrombolytics, anticoagulants, procedures, and other treatments. The main goals of treating PE are to stop the blood clot from becoming bigger and prevent new clots from developing.

Medicines

Anticoagulants, or blood thinners, decrease your blood's ability to clot. They're used to stop blood clots from getting larger and prevent clots from forming. Blood thinners don't break up blood clots that have already formed. (The body dissolves most clots with time.)

Warfarin (Coumadin) is given as a pill and Heparin is given as an injection or through an IV tube.

• You may be treated with both heparin and warfarin at the same time since heparin acts quickly and it takes 2 to 3 days before warfarin starts working. Once warfarin starts to work, your doctor will probably stop heparin.

If you have a DVT, you will probably be treated with blood thinners for 3 to 6 months. If you have had blood clots before, you may need to be treated for a longer period of time.

• Blood thinners can cause bleeding. As a result, your doctor will order routine blood tests such as PT and PTT tests. These tests measure the blood's ability to clot as well as determine if the dose you are taking is appropriate. If you notice any signs or symptoms of bleeding, call your doctor right away.

For those who can not take heparin, your doctor may prescribe a Thrombin inhibitors, which is a newer type of medicine.

Emergency Treatment

In life threatening situations, medications such as thrombolytics, can be used to remove or dissolve a blood clot. These medications are used in only in life-threatening situations since they can cause sudden bleeding.

In some cases, a doctor may use a catheter (a flexible tube) to reach the blood clot. The catheter is inserted into a vein in the groin (upper thigh) or arm up to the clot in the lung. The catheter may be used to remove the clot or deliver medicine to break up the clot.

Rarely, surgery may be needed to remove the blood clot.

Other Types of Treatment

• In some cases, a vena cava filter can be used. Vena cava filter prevents blood clots from moving to your lungs. The filter is inserted inside a large vein called the inferior vena cava. The filter catches clots before they travel to the lungs. Although this type of treatment can prevent PE, it won't prevent the formation of other blood clots.
• Graduated compression stockings can help decrease swelling that may be associated with a blood clot in the leg. Graduated compression stockings prevents the blood from pooling and clotting.

Pulmonary embolism (PE) is a serious condition that can cause:

• Damage to the affected lung that may be permanent
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

Pulmonary embolism can result in death if a clot is large or if there are multiple clots.

If left untreated, about 30 percent of patients who have PE will die. Most of those who die do so within the first few hours of the event. The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE.