What is pulmonary embolism?
A pulmonary embolism is a blockage in the pulmonary artery that supplies blood to the lungs. It is one of the most common cardiovascular diseases in the United States. Pulmonary embolism occurs every year in the US It affects 1 in 1,000 people.
A pulmonary embolism is a blood clot in the body’s lungs that moves through the bloodstream to another part of the body (often the leg or arm) and stops in the blood vessels in the lungs. It restricts blood flow to the lungs, lowers oxygen levels in the lungs, and increases blood pressure in the pulmonary arteries.
A clot in a vein and if it is there it is called a thrombus. When a lump separates from the wall of a vein and goes to another part of your body, it is called an embolus. Left untreated, PEs can cause heart or lung damage and even death. The blockage, usually a blood clot, prevents oxygen from reaching the lung tissue. This means that it is fatal.
The word “embolism” comes from the Greek embolus, which means “stopper” or “plug”. In pulmonary embolism, the embolism forms in one part of the body circulate throughout the blood supply and then blocks the flow of blood through a vessel in another part of the body, that is, the lungs. The embolus is different from the thrombus, which occurs and remains in one place.
How serious is a pulmonary embolism?
A pulmonary embolism may dissolve on its own; it is seldom fatal when diagnosed and treated properly. However, if left untreated, it can be serious, leading to other medical complications, including death. A pulmonary embolism can:
- Cause heart damage.
- Be life-threatening, depending on the size of the clot.
Symptoms of pulmonary embolism
The symptoms of a pulmonary embolism depend on the size of the clot and its location in the lungs. The most common symptom of pulmonary embolism is shortness of breath. It can be gradual or sudden.
Other symptoms of pulmonary embolism:
- Clean or red skin
- Chest pain spreads to your arm, jaw, neck, and shoulder
- Mild headache
- Inhale fast
- Rapid heartbeat
- Spit blood
- Weak pulse
If you notice one or more of these symptoms, especially shortness of breath, you should seek medical help immediately.
Causes of pulmonary embolism
Blood clots can occur for many reasons. Pulmonary embolisms are often caused by deep vein thrombosis, a condition in which blood clots in the deep veins of the body. The blood clots that cause pulmonary embolisms begin in the legs or pelvis. Blood clots in the deep veins of the body can have several causes, including:
- Injury or damage: Injuries such as bone fractures or muscle tears can damage blood vessels and cause clotting.
- Inactivity: During prolonged inactivity, gravity collects blood in the lower parts of the body, causing blood clots. This can happen if you sit on a long trip or lie in bed to recover from an illness.
- Medical conditions: Some health conditions make it easier for the blood to clot, which can lead to a pulmonary embolism. Treatments for medical conditions such as cancer surgery or chemotherapy can also cause blood clots.
Although anyone can develop a blood clot and subsequent pulmonary embolism, some factors can increase your risk.
Treatments and medical conditions for pulmonary embolism
If you or someone in your family has had venous thrombosis or pulmonary embolism before, you are at higher risk. Also, some medical conditions and treatments can put you at risk, including:
Heart disease Cardiovascular disease, especially heart failure, can cause blood clots.
- Cancer: Some cancers, especially those of the brain, ovaries, pancreas, colon, stomach, lungs, lungs, and kidney, spread, increasing the risk of blood clots and increasing the risk of chemotherapy. Women with a personal or family history of breast cancer who take tamoxifen or raloxifene also have an increased risk of blood clots.
- Surgery: The main cause of blood clots is surgery. For this reason, medications to prevent blood clots may be given before and after major surgery, such as joint restoration.
- Defects that affect coagulation: Some inherited disorders affect the blood, which can lead to clotting. Other medical conditions, such as kidney disease, also increase the risk of blood clots.
- Coronavirus disease 2019 (COVID-19): People with severe COVID-19 symptoms are at increased risk for pulmonary embolism.
Blood clots are common during the inactive period, namely:
- Bed rest: Restricting bed rest for a long time after surgery can lead to blood clots, heart attack, leg fracture, injury, or any other serious illness. When the lower limbs are extended horizontally, venous blood flow decreases and there are pools of blood in the legs, sometimes causing the blood to clot.
- Long trips: Sitting in a cramped position during long aeroplane or car trips reduces blood flow to the legs, which can lead to clots.
Other risk factors
- Smoking: For reasons that are not well understood, tobacco use can lead to blood clots in some people, especially when combined with other risk factors.
- Being overweight: Being overweight increases the risk of blood clots, especially in those with other risk factors.
- Associated estrogen: The estrogen in birth control pills and hormone replacement therapy can increase blood clotting factors, especially if you smoke or are overweight.
- The pregnancy: The weight of the baby pressing on the veins in the pelvis reduces the return of blood from the legs. Tumours are more likely to form when blood is thin or pooled.
Pulmonary embolism diagnosis
Pulmonary embolism is difficult to diagnose, especially in people with heart or lung disease. For that reason, your doctor will discuss your medical history, perform a physical exam, and order one or more of the following tests.
Your doctor may order a blood test for the soluble substance D-dimer. High levels indicate the possibility of blood clots, although many other factors can also cause high levels of D-dimer. Blood tests can also measure the amount of oxygen and carbon dioxide in your blood. A clot in the blood vessels of the lungs reduces the level of oxygen in the blood. Also, blood tests may be done to determine if you have an inherited bleeding disorder.
This non-invasive test shows pictures of your heart and lungs in the picture. X-rays do not diagnose pulmonary embolism and appear normal even when there is a pulmonary embolism, but they can rule out conditions that mimic the disease.
A noninvasive test called a duplex ultrasound (sometimes called a duplex ultrasound or compression ultrasound) to check for blood clots in the deep veins uses sound waves to scan the veins in the thighs, knees, and calves, and sometimes, hands. A wand-shaped device called a transducer moves over the skin and directs sound waves into the veins. These waves have reflected the transducer to create a moving image on the computer. Lack of clotting reduces the likelihood of deep vein thrombosis. If there is a clot, treatment begins immediately.
CT pulmonary angiography
The CT scan produces x-rays to create cross-sectional images of your body. Pulmonary CT angiography, also known as a CT Pulmonary Embolism Study, creates 3D images that can detect abnormalities such as pulmonary embolism in the arteries of the lungs. In some cases, contrast material is given intravenously during a CT scan to help the pulmonary arteries show up better.
Ventilation-perfusion scan (V/Q scan)
When there is a need for radiation exposure or vice versa due to a CT scan due to a medical condition, a V / Q scan may be performed. In this test, a tracer is injected into a vein in the hand. The tracer maps the blood flow (perfusion) and compares it to the airflow in the lungs (ventilation) and can be used to determine if the symptoms of pulmonary hypertension are caused by a blood clot.
This test provides a clear picture of the blood flow in the pulmonary carotid arteries. This is a very accurate way to diagnose pulmonary embolism, but it usually occurs when other tests do not provide an accurate diagnosis because it requires a high level of experience and serious risks. In a pulmonary angiogram, a flexible tube (catheter) is inserted into a large vein, usually in the groin, and through the heart to the pulmonary arteries. A special dye is injected into the catheter, and x-rays are taken as the dye travels through the arteries in the lungs.
In some people, this procedure can cause a temporary change in heart rhythm. Also, people with decreased kidney function are at increased risk for kidney damage.
MRI is a medical imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of your body’s organs and tissues. MRI is usually assigned to pregnant women (to avoid radiation to the fetus) and to people with kidney damage with dyes used in other tests.
Treatment of pulmonary embolism
Treatment of pulmonary embolism involves keeping the blood clot large and preventing new clots. Prompt treatment is needed to prevent serious complications or death.
Medications include a variety of blood thinners and blood thinners.
These medications prevent existing clots from spreading, and new clots do not form while your body works to clot. Heparin is a commonly used anticoagulant that can be given intravenously or injected under the skin. It works quickly and overlaps with an oral anticoagulant such as warfarin for several days, until effective, it takes days.
The newer oral anticoagulants work faster and have less interaction with other medications. Some people benefit from oral administration, without heparin overdose. However, not all blood thinners have side effects, and bleeding is very common.
Clot solvents (thrombolytics)
While clotting usually dissolves on its own, thrombolytics given through the venous clot sometimes dissolve quickly. Because these anticoagulants cause sudden and severe bleeding, they are usually assigned to malignant conditions.
Surgery and other procedures
- Clot removal: If you have a very large malignant tumour in your lungs, your doctor may recommend that you remove it through a thin, flexible tube (catheter) that is inserted through your blood vessels.
- Venous filtration: The catheter also serves to hold the filter in the body’s main vein (inferior vena cava) that runs from the legs to the right side of the heart. This filter helps prevent clots from reaching your lungs. This procedure is generally for people who are not taking blood thinners or for those with recurrent clotting, even if blood thinners are used. Some filters can be removed when not needed.
Since you are at risk for another deep vein thrombosis or pulmonary embolism, it is important to continue treatment, such as thinning your blood and monitor it as often as your doctor tells you. Also, make regular visits to the doctor to prevent or treat problems.
Embolism treatments are aimed at:
- Stop clot growth
- Avoid the formation of new clots
- Destroy or remove any existing bulk
- The first step in treating most strokes is treating shock and giving oxygen therapy.
Anticoagulants such as heparin, enoxaparin, or warfarin are usually given to thin the blood and prevent further clotting. People who need blood-thinning medications should seek treatment with a blood-thinning management service rather than their primary care physician.
Blood-thinning medications called thrombolytics are also given. However, there is a risk of excessive bleeding. Thrombolytics include activase, retavase, and aminase. If the patient has low blood pressure, dopamine can be given to increase the pressure. The patient generally needs to take the drug regularly for at least 3 months, indefinitely.
- Pulmonary embolism is fatal. One-third of people with undiagnosed and untreated pulmonary embolism do not survive. However, when the condition is diagnosed and treated right away, that number drops dramatically.
- Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in the lungs and the right side of the heart is too high. When you have blockages in the arteries within your lungs and lungs, your heart must work hard to push blood through those vessels, which can raise your blood pressure and eventually weaken your heart.
In rare cases, a small embolism often occurs and develops over time, resulting in chronic pulmonary hypertension, also known as chronic thromboembolic pulmonary hypertension.
How can I prevent pulmonary embolism?
The best way to prevent PD is to try to stop blood clots in your veins. This can be challenging if you are on bed rest after surgery or illness, or if you are travelling on a long flight. If you are at risk, here are some things that can help reduce the chances of this dangerous blood clot:
Doctors call them anticoagulants. They prevent blood from clotting. Your doctor may prescribe them while you are in the hospital for surgery. They may suggest that you take them with you for a while after you go home. If you are hospitalized after a stroke or heart attack or have cancer problems, your doctor may recommend a blood-thinning.
They are long socks that tighten your legs. Excess pressure helps blood flow through the veins and muscles in the legs. Your doctor may recommend that you use them shortly after surgery.
Get out of bed when you are in the hospital for a long time or when you are sick and stay in bed for a long time. It causes blood to flow through the legs, so it is unlikely to pool.
Stretching during the trip
If you are on a long flight, try to walk every few hours. If you cannot stand, bend your ankles by pulling the leg toward you. Here is another stretch you can try while sitting:
- Pull the leg towards the chest with one hand.
- Support the sole of that foot with the other hand.
- Hold this pose for 15 seconds, then try the other leg.
- Do this up to 10 times an hour.
If you drive a long distance, stop every hour and stretch your legs. Also, don’t forget to drink more fluids to stay hydrated.
Changes in lifestyle
Other steps you can take:
- Keep a healthy weight.
- If you want to take hormones for birth control or restorative therapy, talk to your doctor about the risk of blood clots.
- If you have other health problems like diabetes or heart failure, take your medications, watch what you eat, and talk to your doctor about any changes.
- Talk to your doctor if you have a history of kidney disease or certain autoimmune diseases or a family history of blood clots.
- If you smoke, stop it.
In malignant cases of pulmonary embolism, your doctor may decide to give you drugs called thrombolytics to break up the clot. Although it is very rare, it may need to be surgically removed or dissected.