Description

A pulmonary embolism is a blood clot that blocks and stops the flow of blood from an artery in the lungs. In most cases, the blood clot that starts in a vein deep in the leg and travels to the lungs. Rarely, the clot forms in a vein from another part of the body. When a blood clot forms in one or more of the deep veins of the body, it is called deep vein thrombosis (DVT).

Because one or more of the clots that block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism.

Symptoms

Pulmonary embolism, the symptoms can vary a lot, depending on how much of your lung, the size of the clots, and if you have underlying heart or lung disease.

Common symptoms include:

  • Shortness of breath. This symptom tends to occur suddenly. Shortness of breath occurs even when the rest and worsens with physical activity.
  • Pain in the chest. You may feel as if you are having a heart attack. The pain is usually severe and is felt when you breathe in deeply. The pain may cease to be able to take a deep breath. You can also feel it when you cough, bend or lean.
  • Fainting. You can go if your heart rate or blood pressure drops suddenly. This is called syncope.

Other symptoms that can occur with pulmonary embolism include:

  • A cough that may include blood or blood-streaked mucus
  • Rapid or irregular heartbeat
  • Dizziness or lightheadedness
  • Excessive sweating
  • Fever
  • The leg pain or swelling, or both, usually in the back of the lower leg
  • Wet or coloration of the skin, called cyanosis

When to see a doctor

A pulmonary embolism can be life-threatening. Seek emergency medical attention if you experience unexplained shortness of breath, chest pain or fainting.

Causes

A pulmonary embolism occurs when a piece of material, most often a blood clot, gets stuck in an artery in the lungs, blocking the flow of blood. Blood clots most commonly come from the deep veins of the legs, a condition known as deep vein thrombosis.

In many cases, multiple clots are involved. The portions of lung served by each blocked artery you may not receive blood and may die. This is known as a pulmonary infarction. This makes it more difficult for the lungs to provide oxygen to the rest of your body.

Occasionally, blockages in the blood vessels are caused by substances other than blood clots, such as:

  • The fat from the inside of a fracture of a long bone
  • Part of a tumor
  • The bubbles of air

Risk factors

Although anyone can develop blood clots in the result of a pulmonary embolism, certain factors can increase your risk.

The history of blood clots

You are at a higher risk if you or any of your blood relatives, such as a parent or sibling, have had venous blood clots or pulmonary embolism in the past.

Medical conditions and treatments

Some medical conditions and treatments put you at risk, such as:

  • Diseases of the heart. Heart and blood vessel disease, specifically heart failure, causes the formation of blood clots more likely.
  • Cancer. Certain types of cancer, especially the brain, ovary, pancreas, colon, stomach, lung and kidney cancers, and cancers that have spread — can increase the risk of blood clots. Chemotherapy further increases the risk. They also have a higher risk of blood clots if you have a personal or family history of breast cancer and are taking tamoxifen or raloxifene (Evista).
  • Surgery. The surgery is one of the main causes of the problem of the formation of blood clots. For this reason, the medication to prevent clots can be administered before and after a major surgery, such as joint replacement.
  • Disorders that affect coagulation. Some inherited disorders affecting the blood, making it more likely to clot. Other medical conditions such as kidney disease may also increase the risk of blood clots.
  • Coronavirus disease 2019 (COVID-19). People who have severe symptoms from COVID-19 have a higher risk of pulmonary embolism.

Long periods of inactivity

Blood clots are more likely to form for longer than usual periods of inactivity, such as:

  • The bed rest. Being confined to bed for an extended period after surgery, a heart attack, leg fracture, trauma or a serious disease that puts you at risk of blood clots. When your legs lie down for long periods of time, the flow of blood through his veins slows down and the blood can accumulate in the legs. This can sometimes result in the formation of blood clots.
  • The long trips. Sitting in a cramped position for long plane or car trips slows the flow of blood in the legs, which increases the risk of blood clots.

Other risk factors

  • The habit of smoking. For reasons that are not well understood, the use of tobacco increases the risk of blood clots in some people, especially those who have other risk factors.
  • The overweight. Excess weight increases the risk of blood clots — particularly in people with other risk factors.
  • Supplemental estrogen. The estrogen in birth control pills and hormone replacement therapy can increase the clotting factors in the blood, especially in those who smoke or are overweight.
  • Pregnancy. The weight of the baby pressing on veins in the pelvis can slow blood return from the legs. Clots are more likely to form when the blood decreases, or swimming pools.

Complications

A pulmonary embolism can be life-threatening. Around a third of people with a diagnosis and untreated pulmonary embolism don't survive. When the condition is diagnosed and treated early, however, that number is drastically reduced.

Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in the lungs and in the right side of the heart is too high. When you have blockages in the arteries inside your lungs, your heart must work harder to push the blood through the blood vessels. This increases the blood pressure and, ultimately, weakens your heart.

In rare cases, small clots is called embolism remain in the lungs, and scarring develops in the pulmonary arteries over time. This restricts the blood flow and results in chronic pulmonary hypertension.

Prevention

To prevent the formation of blood clots in the deep veins of the legs helps to prevent pulmonary embolisms. For this reason, most hospitals are aggressive when taking measures to prevent blood clots, including:

  • Blood thinners (anticoagulants). These medications are often given to people at risk of clots before and after surgery. Also, they are often the people admitted to the hospital with certain medical conditions, such as heart attack, stroke, or complications of cancer.
  • Compression stockings. Compression stockings steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. Offer a safe, simple and low cost to prevent the build up of blood in the legs during and after surgery.
  • Leg elevation. Elevating your legs when possible and during the night it can be very effective. Lift the bottom of the bed 4 to 6 inches (10 to 15 cm) with blocks or books.
  • The physical activity. Moving as soon as possible after surgery can help prevent pulmonary embolism and hasten recovery overall. This is one of the main reasons that the nursing staff can push you to get up, even on the day of the surgery, and standing despite the pain at the site of the surgical incision.
  • Pneumatic compression. This treatment uses thigh-high or calf-high cuffs that automatically inflate with air and deflate every few minutes. This massage and compresses the veins of the legs and improves blood flow.

Prevention while traveling

The risk of blood clots in development for travel is low, but increases as long distance travel increases. If you have risk factors for blood clots, and is concerned about travel, talk to your health care provider.

Your healthcare provider may suggest the following to help prevent blood clots during the trip:

  • Drink plenty of fluids. The water is the best liquid for preventing dehydration, which can contribute to the development of blood clots. Avoid the consumption of alcohol, which contributes to the loss of fluids.
  • Take a break from the session. Move around the airplane cabin once an hour or so. If you're driving, stop every so often and walk around the car a couple of times. Do a few deep knee bends.
  • To move in his seat. Bend and make circle motions with your ankles and lift your toes up and down, every 15 to 30 minutes.
  • Wear support stockings. Your healthcare provider may recommend to help promote circulation and fluid movement in your legs. Compression stockings are available in a range of stylish colors and textures. There are even devices, called the planting of the stewards, to help you put the stockings on.

Diagnosis

A pulmonary embolism can be difficult to diagnose, especially if you have heart problems, or lung disease. For that reason, your health care provider will likely discuss your medical history, do a physical exam, and the end of the tests, which may include one or more of the following.

Blood tests

Your doctor may order a blood test for the clot to dissolve the substance D-dimer. High levels may suggest an increased likelihood of blood clots, although many other factors that can cause a high D dimer levels.

Blood tests can also measure the amount of oxygen and carbon dioxide in the blood. The formation of a clot in a blood vessel in the lungs can decrease the level of oxygen in your blood.

In addition, you can perform blood tests to determine if you have a clotting disorder, hereditary.

Chest X-ray

This non-invasive test shows images of your heart and lungs in the film. Although X-rays can diagnose a pulmonary embolism and can even appear good when a pulmonary embolism, can rule out other diseases with similar symptoms.

Ultrasound

A non-invasive test known as the doppler ultrasound device, sometimes called a duplex scan or compression of the ultrasound uses sound waves to scan the veins to check the depth of the vein of blood clots. This test can be seen in the veins in the thigh, the knee and calf, and sometimes the arms.

A magic wand in the form of a device called a transducer is moved over the skin, the direction of the sound waves to the veins being tested. These waves are reflected back to the transducer to create a moving image on a computer. The absence of blood clots and reduces the probability of deep venous thrombosis. If clots are present, the treatment probably will start immediately.

CT pulmonary angiogram

The TC generates X-rays to produce cross-sectional images of the body. CT pulmonary angiography — also called a CT pulmonary embolism study — create 3D images that can be found changes such as a pulmonary embolism within the arteries in the lungs. In some cases, the contrast material is administered through a vein in the arm or hand during the CT scan to the contour of the pulmonary arteries.

Ventilation-perfusion (V/Q) scan

When there is a need to avoid exposure to radiation or contrast of a ct scan due to a medical condition, a V/Q scan may be done. In this test, a small amount of a radioactive substance called a tracer is injected into a vein in your arm. The tracer maps of blood flow, called perfusion, and compares it with the flow of air to your lungs, called ventilation. This test can be used to see if the blood clots are the cause of the symptoms of pulmonary hypertension.

Pulmonary angiography

This test provides a clear picture of the blood flow in the arteries of the lungs. It is the most accurate way to diagnose a pulmonary embolism. But due to that it requires high degree of skill to perform and has potentially serious risks, it is usually performed when other tests do not provide a definitive diagnosis.

In a pulmonary angiogram, a thin, flexible tube called a catheter is inserted into a large vein — usually in the groin — and passes through your heart and into the pulmonary arteries. A special dye is then injected through the catheter. X-rays are taken as the dye travels along the arteries of the lungs.

In some people, this procedure can cause a temporary change in the heart rhythm. In addition, the dye may cause an increased risk of kidney damage in people with reduced kidney function.

Magnetic resonance imaging

Magnetic resonance imaging is a medical imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of organs and tissues of your body. Magnetic resonance imaging is usually only occurs in those who are pregnant, to prevent radiation to the baby — and in people whose kidneys can be damaged by the dyes that are used in other tests.

Treatment

The treatment of pulmonary embolism focuses on keeping the blood clot from getting bigger and preventing the formation of new clots. Timely treatment is essential to prevent serious complications or death.

Treatment may include medications, surgery and other procedures, and ongoing care.

Medications

The medications include different types of blood thinners and clot solvent.

  • A blood thinner.These blood-thinning medications called anticoagulants prevent existing clots from getting bigger and the formation of new blood clots, while your body works to dissolve the clots. Heparin is frequently used anticoagulant that can be given through an iv, or injected under the skin. It acts quickly and is often given together with an oral anticoagulant, such as warfarin (Jantovin), until the oral medication that is effective. This can take several days. New oral anticoagulants work more quickly and have fewer interactions with other medications. Some have the advantage of which is given by the mouth until they are effective, without the need for heparin. However, all anticoagulants have side effects, and the bleeding is the most common.
  • Clot solvent. While blood clots are usually dissolve on their own, sometimes clot-busting drugs (drugs that dissolve clots given through a vein can dissolve clots quickly. Because these clot-dissolving medicine. can cause severe bleeding, are usually reserved for life-threatening situations.

A blood thinner. These blood-thinning medications called anticoagulants prevent existing clots from getting bigger and the formation of new blood clots, while your body works to dissolve the clots. Heparin is frequently used anticoagulant that can be given through an iv, or injected under the skin. It acts quickly and is often given together with an oral anticoagulant, such as warfarin (Jantovin), until the oral medication that is effective. This can take several days.

New oral anticoagulants work more quickly and have fewer interactions with other medications. Some have the advantage of which is given by the mouth until they are effective, without the need for heparin. However, all anticoagulants have side effects, and the bleeding is the most common.

Surgical and other procedures

  • Extraction of the clot. If you have a large, life-threatening blood clot in the lung, your health care provider can remove it using a thin, flexible catheter threaded through the blood vessels.
  • Vein filter. A catheter can also be used to place a filter in the main body of the vein, the inferior vena cava, which leads from the legs to the right side of his heart. The filter can help to keep clots from going to the lungs. This procedure is usually only used for people who cannot take blood thinners or those who are blood clots, even with the use of anticoagulants. Some filters can be removed when no longer needed.

Course of care

Because of that you may be at risk of a deep vein thrombosis or pulmonary embolism, it is important to continue the treatment, such as blood thinners and be monitored as often as suggested by your health care provider. Also, to maintain regular visits with your doctor to prevent or treat complications.

Preparing for your appointment

A pulmonary embolism is often evaluated for the first time in a hospital, emergency room, or urgent care center. If you think you may have a pulmonary embolism, seek medical attention immediately.

What you can do

Also you can prepare a list that includes:

  • A detailed description of your symptoms
  • Information about your past medical problems, especially recent surgeries, injuries or illness that kept him in bed for several days
  • Details about any of the last trips that involved long car or airplane rides
  • All of the medicines you are taking, including vitamins, herbal products and other supplements, and dosage
  • The information about the medical problems of the parents or siblings
  • The questions you want to ask your health care provider

What to expect from your doctor

During the physical exam, your doctor will probably examine your legs so that the evidence of a deep vein clot — an area in which the swollen, tender, red, and hot. Your provider will also listen to your heart and lungs, checked his blood pressure and it is likely that the end of one or more tests.

Symptoms and treatment of Pulmonary embolism