Download March 11, 2014 Pulmonary Embolism

Pulmonary Embolism
Pulmonary Embolism (PE) is a blockage of one or more arteries of the lungs. For the most part, a
pulmonary embolism occurs when blood clots travel through the bloodstream to your lungs from
another part of your body, usually your legs. Pulmonary embolism is a complication of deep vein
thrombosis (DVT) a medical condition in which a blood clot develops in a deep vein. These clots
usually are formed in the lower leg, thigh and pelvis, but can also develop in the arm. When the clot is
small, and you receive appropriate treatment, you can recover from PE. In some cases there may be
damage to the lungs. A large clot can prevent blood from reaching the lungs and is fatal.
Pulmonary embolism can be a life-threatening condition, however, immediate medical treatment with
anti-clotting medications can significantly reduce the risk of death. It is also important to take the
necessary measures to prevent clots in your legs and other parts of your body where blood clots tend to
develop, which will help protect you from having a pulmonary embolism.
Pulmonary Embolism Symptoms
The symptoms of a pulmonary embolism may vary depending on several factors such as the size of the
clots; which are usually multiple not single, the amount of your lung that is involved; and the overall
condition of your health, including whether there is any underlying lung disease or heart disease.
Common signs and symptoms of pulmonary embolism (PE) include:
 Shortness of breath
 Faster than normal or irregular heart beat
 Chest pain or discomfort that worsens with a deep breath, coughing, eating, stooping or
bending. The pain also gets worse with exertion and does not go away when you rest.
 Anxiety
 Coughing up blood or blood-streaked sputum
 Excessive sweating
 Very low blood pressure, lightheadedness, dizziness or fainting
 Clammy or discolored skin (cyanosis)
 Leg pain or swelling, or both, usually in the calf
There are other substances that can form blockages within your blood vessels inside your lungs which
include:
 Part of a tumor
 Fat from the marrow of a broken bone
 Air bubbles
Risk Factors
Anyone can develop blood clots that later result in a pulmonary embolism, but certain factors that can
increase your risk include:
 Inherited disorders that affect blood clotting. Family members who have had deep vein
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thrombosis (DVT) or pulmonary embolism places you at a higher risk for PE.
Cancer. Pancreatic, ovarian and lung cancers as well as cancers with metastasis can increase
substances that help blood to clot. In addition, women taking tamoxifen or raloxifene with a
history of breast cancer are at a higher risk for developing blood clots
Prolonged inactivity/immobility. Blood clots are more likely to develop in your legs if you are
confined to bed for an extended period following a heart attack, surgery, leg fracture or an
illness. In addition, long trips that result in you sitting in a cramped position in a car or plane
may slow blood flow and may contribute to the development of clots in your legs.
Surgery. A major cause of blood clot formation is surgery, especially knee and hip joint
replacements.
Being overweight. Excess weight increases the risk of blood clots, particularly in women who
have hypertension or smoke.
Smoking. Some people who use tobacco are at an increased risk for forming blood clots,
which is increased when other factors are present.
Supplemental estrogen. Estrogen that is in birth control pills and hormone replacement therapy
can increase blood clots, especially if you are overweight or smoke.
Pregnancy. When the baby's weight presses on the veins in the pelvis it can slow the blood
return from the legs. When blood slows or pools clots are more likely to form.
Tests
Oftentimes pulmonary embolism (PE) is difficult to diagnose, especially when people have an
underlying heart or lung disease. Your doctor will conduct a physical exam, and look to see if there are
any signs of a deep vein clot, listen to your lungs and heart and take your blood pressure. Your doctor
is likely to order tests including the following:
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Blood tests
Chest x-ray
Ultrasound
CT scan
V/Q lung scan
Pulmonary angiogram
MRI
Treatment
Medications
Your doctor might prescribe medications like blood thinners (anticoagulants) to prevent new clots from
developing. Most of the time clots dissolve on their own but you may be given clot dissolvers
(thrombolytics) which are medications that help clots to dissolve quickly. These drugs are usually
administered in life-threatening situations because they can cause sudden and severe bleeding.
Surgery
 Clot removal. Doctors might recommend surgery for a person who has a very large clot in
their lung. The clot is removed using a flexible tube or catheter, threaded through the blood
vessels.
 Vein filter. A catheter with a filter is usually placed in the main vein, the inferior vena cava,
which leads from your legs to the right side of your heart. The purpose of this filter is to block
clots from being carried to your lungs.
Other Procedures
 Pneumatic compression. Thigh-high or calf-high cuffs are used that inflate and deflate with air
automatically every several minutes massaging and squeezing the veins in your legs to improve
blood flow.
 Graduated compression stockings. Compression stockings are used to help your veins and leg
muscles move blood efficiently by squeezing your legs, and are often used after general surgery
to prevent blood from becoming stagnant.
 Physical activity. Moving is encouraged as soon as possible after surgery to prevent pulmonary
embolism and to speed recovery.
Most cases of pulmonary embolism are first evaluated in emergency rooms and urgent care facilities.
If you think you have a pulmonary embolism, you should seek medical attention immediately.
References
Deep Vein Thrombosis (DVT)/ Pulmonary Embolism (PE)- Blood Clot Forming in a Vein. Centers For
Disease Control and Prevention. September 25, 2012.
Pulmonary Embolism. Mayo Clinic. January 2, 2014.