Pulmonary Embolism
What is it?
An embolism is a blood clot that breaks off from the wall of a vein and travels with the blood to other organs in the body. Pulmonary embolism is a blood clot that lodges in the lungs and blocks the lung arteries so the flow of blood to the lungs and heart is reduced.
Who gets it?
The American Heart Association statistics show that around 600,000 Americans develop pulmonary embolism each year, and around 60,000 die from it. It can occur as a major complication of surgery, or in patients who are confined to bed, have cancer, severe varicose veins, phlebitis (inflammation of the wall of a vein), have suffered a recent heart attack or stroke, or have a chronic illness, such as congestive heart failure. Other factors that can increase the risk of blood clots include childbirth, obesity, a broken hip or leg, use of oral contraceptives, sickle cell anemia, blood clotting disorders, chest trauma, certain congenital heart defects, sitting for long periods of time, and old age.
What causes it?
More than 90 percent of the blood clots that cause pulmonary embolism usually form in the deep veins of the legs, a condition called deep vein thrombosis. Although it is uncommon, an embolism can also form from fat that escapes from the bone marrow when a bone is fractured, or from amniotic fluid during childbirth.
What are the symptoms?
Most pulmonary emboli cause shortness of breath. Breathing may be very rapid, and the patient may seem extremely anxious. Breathing deeply may cause severe chest pain. Other symptoms include increased pulse rate, dizziness, and fainting. If the lack of blood flow to the lungs has caused some lung tissue to die, called pulmonary infarction, the patient may also cough up blood-stained phlegm, have sharp chest pains, and fever. When the larger vessels of the lungs are blocked, the lack of oxygen gives the skin a bluish color. Patients with chronic pulmonary embolism, where small blood clots travel to the lungs repeatedly over a period of years, will have symptoms that build up gradually, including shortness of breath, leg swelling, and general weakness.
How is it diagnosed?
Your doctor will review your symptoms and your risk factors for pulmonary embolism. However, because pulmonary embolism can be difficult to diagnose, your doctor will use a number of diagnostic tests to determine the cause of the symptoms. These tests might include a chest x-ray; electrocardiogram, or ECG, which is a recording of the heart's electrical activity; arterial blood gas, which is a measurement of the level of oxygen in your blood; a lung scan; and an ultrasound scan of the legs to look for clots. A pulmonary angiogram is a test where a special dye is injected into an artery. When the dye flows to the arteries in the lungs, it shows any blockages to blood flow on an x-ray. Pulmonary angiogram is the most accurate way to diagnose pulmonary embolism, but it does carry some health risks and is more uncomfortable than the other tests.
What is the treatment?
Pulmonary embolism is a serious condition that can cause sudden death. The patient is hospitalized immediately and given drugs, such as heparin and
warfarin, to dissolve clots and prevent new ones from forming. Oxygen is given to bring the levels of oxygen in the blood to normal levels. Some patients can’t take drugs that prevent clots. These patients may need surgery to insert a device that filters blood returning to the heart and lungs until the pulmonary embolism dissolves. In very severe cases, doctors may need to perform surgery to remove the embolism. Thrombolytic therapy is another approach for severe pulmonary embolism.
Streptokinase, urokinase, and tissue plasminogen activator are thrombolytic drugs that are used to break up the clots. Thromobolytics can’t be given to people who are pregnant, have had a recent stroke, have a bleeding disorder, or had surgery within the last 10 days before the pulmonary embolism occurred. Most people who have had successful treatment for pulmonary embolism need to continue taking blood thinning medication after leaving the hospital.
Self-care tips
If you have any of the risk factors for pulmonary embolism, you can reduce the risk of developing this condition by taking drugs such as heparin, especially immediately before and after surgery. Leg exercises, elastic support stockings, and leg compression stockings can also help keep the blood moving in the legs, which will lower the risk of pulmonary embolism. See your doctor immediately if you have any signs of deep vein thrombosis or pulmonary embolism.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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