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Pulmonary Embolism

by | Jan 24, 2023 | Info | 0 comments

Pulmonary Embolism Overview

A pulmonary embolism is a blockage in the pulmonary artery, which supplies the blood to the lungs. It is one of the most common cardiovascular diseases in the United States.

Pulmonary embolism affects around 1 in 1,000 patients in the U.S. every year.

The blockage, usually a blood clot, prevents oxygen from reaching the tissues of the lungs. This means it can be life-threatening. The word “embolism” comes from the Greek émbolos, meaning “stopper” or “plug.”

In a pulmonary embolism, the embolus, forms in one part of the body, it circulates throughout the blood supply, and then it blocks the blood flowing through a vessel in another part of the body, namely the lungs. An embolus is different from a thrombus, which forms and stays in one place.


Signs and Symptoms of Pulmonary Embolism

Following are the signs and symptoms of pulmonary embolism:

  • A cough, normally dry but possibly with blood, or blood and mucus.
  • Chest pain, a sharp, stabbing pain that might become worse when breathing in.
  • Difficulty catching breath, which may develop either suddenly or over time.
  • Dizziness.
  • Increased or irregular heartbeat (arrhythmia).
  • Rapid breathing.

Severe symptoms call for immediate emergency medical assistance. Even more severe cases may result in shock, loss of consciousness, cardiac arrest, and death.


Causes of Pulmonary Embolism

A pulmonary embolism occurs when an embolus, usually a blood clot, blocks the blood flowing through an artery that feeds the lungs.

A blood clot may start in an arm or leg, known as deep venous thrombosis (DVT).

After that, it breaks free and travels through the circulatory system towards the lungs. There, it is too large to pass through the small vessels, so it forms a blockage.

This blockage stops blood from flowing into a part of the lung. This causes the affected section of the lung to die through lack of oxygen.

Rarely, a pulmonary embolism can result from an embolus that is formed from fat droplets, amniotic fluid, or some other particle that enters the bloodstream.


Diagnosis of Pulmonary Embolism

To reach a diagnosis, the doctor will look at the patient’s history and consider whether an embolism is likely. They will carry out a physical examination. Diagnosis can be challenging because other conditions have similar symptoms.

Tests for diagnosing pulmonary embolism include:

  • A mathematical model that helps a doctor predict the course of DVT and the risk of an embolism.
  • Arterial blood gas study, to measure oxygen, carbon dioxide, and other gases in the blood.
  • Chest X-rays, to generate a picture of the heart, lungs, and other internal organs.
  • D-Dimer test, a blood test that can diagnose thrombosis that can rule out further testing if it produces a negative result.
  • Computerized Tomography (CT) Scan, which can reveal abnormalities in the chest, brain, and other organs, and in cases where a V/Q is not possible.
  • Electrocardiogram (EKG), to record the electrical activity of the heart.
  • Pulmonary angiogram, to reveal blood clots in the lungs.
  • Magnetic Resonance Imaging (MRI), to obtain detailed pictures of internal structures.
  • Pulmonary V/Q scan, two tests that analyze the ventilation and structural properties of the lungs and give off less radiation than a CT scan.
  • Ultrasound, of the legs, to measure the speed of blood flow velocity and any changes.


Treatment of Pulmonary Embolism

Treatments for embolism aim to do the following:

  • Destroy or remove any existing clot,
  • Prevent new clots from forming. 
  • Stop the clot from growing.

A first step in treating most embolisms is to treat shock and provide oxygen therapy.

Anticoagulant medications, such as heparin, enoxaparin, or warfarin are usually given to help thin the blood and prevent further clotting.

Patients who need anticoagulant medications should seek treatment with an anticoagulant management service, not their primary care physician.

Clot-busting drugs called thrombolytics may also be administered. However, but these carry a high risk of excessive bleeding. Thrombolytics include Activase, Retavase, and Eminase.

If the patient has low blood pressure, dopamine may be given to increase pressure.

The patient will normally have to take medications regularly for an indefinite amount of time, usually at least 3 months.


Risk Factors of Pulmonary Embolism

The risk of developing a pulmonary embolism increases with age. Patients who have conditions or diseases that increase the risk of blood clotting are more likely to develop pulmonary embolisms.

A person has a higher risk of pulmonary embolism if they have or have had a blood clot in the leg or arm (DVT), or if they have had a pulmonary embolism in the past.

Long periods of bed rest or inactivity increase the risk of DVT and, therefore, increase the risk of pulmonary embolism. This could be a long flight or car ride.

When we do not move much, our blood pools in the lower parts of our body. If blood is moving around less than normal, a blood clot is more likely to form.

Damaged blood vessels also increase the risk. This can occur because of injury or surgery. If a blood vessel is damaged, the inside of the blood vessel may become narrower, increasing the chances of a blood clot forming.

Other factor risk includes certain cancers, inflammatory bowel disease, obesity, pacemakers, catheters in the veins, pregnancy, estrogen supplements, a family history of blood clots, and smoking.

Prevention of Pulmonary Embolism

Several measures can reduce the risk of a pulmonary embolism.

  • A high-risk patient may use anticoagulant drugs such as heparin or warfarin.
  • Compression of the legs is possible, using anti-embolism compression stockings or pneumatic compression. An inflatable sleeve, glove, or boot holds the affected area and increases pressure when required.

Compression methods prevent blood clots by forcing blood into deep veins and reducing the amount of pooled blood.

Other ways to decrease the risk include physical activity, regular exercise, a healthy diet, and giving up or avoiding smoking tobacco.

Following are some ways to prevent a pulmonary embolism:

  • Avoid crossing your legs.
  • Drink plenty of fluids, but limit alcohol and caffeine.
  • Exercise regularly. If you can’t walk around, move your arms, legs and feet for a few minutes every hour. If you know you’ll need to sit or stand for long periods, wear compression stockings to encourage blood flow. 
  • Elevating your feet for 30 minutes twice a day.
  • Losing weight if you are overweight.
  • Stop wearing tight-fitting clothing.
  • Talk to your provider about reducing your risk factors, especially if you or any of your family members have had a blood clot. 
  • Quit smoking.


Prognosis of Pulmonary Embolism

With effective and timely treatment, most patients who experience a pulmonary embolism can make a complete recovery.

The condition carries a high risk of fatality. However, early treatment can dramatically reduce this risk.

The period of highest risk is in this hours after the embolism first occurs. The outlook is also worse if the embolism was caused by an underlying condition, such as a type of cancer.

However, most patients with pulmonary embolism can make a complete recovery.

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