Overview

When your blood goes from your heart to your lungs through your pulmonary artery. In the lungs, the blood is supplied with oxygen and then goes back to the heart, which pumps the oxygen-rich blood to the rest of your body.A pulmonary embolism (PE) happens when a blood clot suddenly blocks an artery that supplies blood to your lungs.

This blockage can cause serious problems such as damage to your lungs and low oxygen levels in your blood. The lack of oxygen can harm other organs in your body, too. If the artery is clogged by a big clot or many smaller clots, it can cause a deadly pulmonary embolism.

If you think you may have deep vein thrombosis (DVT), the best thing you can do is call your doctor as soon as possible. There are several ways that they can figure out likeUltrasound, MRI,Pulmonary angiogram etc. Some people with DVT might need to take blood thinners for the rest of their lives. Your doctor will make this decision based on how likely you are to have another blood clot. They’ll also consider your risk of bleeding when they suggest longer treatment with blood thinners.

Therefore, pulmonary embolism condition is a medical emergency  requiring quick treatment, a pulmonary embolism can cause heart or lung damage and even death. With timely diagnosis and treatment, a PE is seldom fatal.

Symptoms and Causes

• Sudden shortness of breath — whether you’ve been active or at rest.
• Fast breathing.
• Wheezing.
• Unexplained sharp pain in your chest, arm, back, shoulder, neck or jaw. The pain may be similar to symptoms of a heart attack and can get worse when you take a breath.
• Cough with or without bloody mucus.
• Pale, clammy or bluish skin.
• Rapid heartbeat (pulse).
• Excessive sweating.
• In some cases, feeling anxious, lightheaded, faint or passing out.

What causes a pulmonary embolism?

Pulmonary embolism causes include:

• Blood collecting or “pooling” in a certain part of your body (usually an arm or leg). Blood usually pools after long periods of inactivity, like after surgery, bed rest or a long flight or plane ride.
• Injury to a vein, like from a fracture or surgery (especially in your pelvis, hip, knee or leg).
• Another medical condition, like cardiovascular disease (including congestive heart failure, atrial fibrillation, heart attack or stroke).
• An increase or decrease in your blood’s clotting factors. Elevated clotting factors can occur with some types of cancer or in some people taking hormone replacement therapy or birth control pills. Abnormal or low clotting factors may also happen as a result of blood clotting disorders.

People at risk of developing a PE include those who:

• Have a blood clot in their leg, or deep vein thrombosis (DVT).
• Are inactive for long periods of time while traveling via motor vehicle, train or plane (such as a long, cross-country car ride).
• Have recently had trauma or injury to a vein, possibly from surgery, a fracture or varicose veins.
• Are using hormonal-based contraception (like birth control pills, patches or rings) or hormone replacement therapy.
• Have a blood clotting disorder.
• Have a family history of blood clots.
• Currently smoke.
• Have diabetes.
• Have cancer.
• Are older than 60.
• Have a history of heart failure, heart attack or stroke.
• Have overweight (a body mass index or BMI greater than 25) or obesity (a BMI greater than 30).
• Are pregnant or have given birth in the previous six weeks.
• Received a central venous catheter through their arm or leg.

If you have any of these risk factors and you’ve had a blood clot, talk with your healthcare provider so they can take steps to reduce your risk of PE.

Diagnosis and Tests

After looking at your symptoms and risk factors, a provider will use the following tests to make a PE diagnosis:

• Blood tests (including the D-dimer test).
• Computed tomography (CT) angiogram.
• Ultrasound of your leg. (This helps identify blood clots in people’s legs, or deep vein thrombosis, which can move to the lungs, become a PE and cause more damage.)
• A VQ scan, if you’re unable to get contrast for a CT scan. (This is a nuclear scan that can detect clots in your lung.)
• A pulse oximeter (pulse ox) that attaches to your fingertip to check your oxygen level.
• Echocardiogram.

Other tests your provider may order include:

• Pulmonary angiogram.
• Chest X-ray.

Classification of PE

PE severity is commonly classified three main categories based on easily obtainable clinical variables.  High-risk PE is defined as presenting with hypotension, a systolic arterial pressure less than 90 mm Hg or drop of more than 40 mm Hg for at least 15 minutes and the need for vasopressor support.  Intermediate-risk PE is defined by a patient being normotensive with evidence of RV dysfunction or myocardial ischemia.  Low risk PE are patients that do not meet the criteria for intermediate-risk.

Management and Treatment

The length of your pulmonary embolism treatment and hospital stay will vary, depending on the severity of the clot. Some people may not need to stay overnight.

The main treatment for a pulmonary embolism is an anticoagulant (blood thinner).

Depending on the severity of your clot and its effect on your other organs such as your heart, you may also undergo thrombolytic therapy, surgery or interventional procedures to improve blood flow in your pulmonary arteries.

In most cases, treatment consists of anticoagulant medications (blood thinners). Anticoagulants decrease your blood’s ability to clot. This prevents future blood clots.

Compression stockings

Compression stockings (support hose) improve blood flow in your legs. People with deep vein thrombosis often use them. You should use them as your provider prescribes. The stockings are usually knee-high length and compress your legs to prevent your blood from pooling.

Thrombolytic therapy

Thrombolytic medications (“clot busters”), including tissue plasminogen activator (TPA), dissolve the clot. You’ll always receive thrombolytics in the emergency department or intensive care unit (ICU) of a hospital where a provider can monitor you. You may receive this type of medication if you have a special situation, like low blood pressure or an unstable condition because of the pulmonary embolism.

Can a pulmonary embolism be prevented?

Yes, you may be able to prevent it. Ways to prevent a pulmonary embolism include:

• Getting regular physical activity. 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.
• Drinking plenty of fluids, but limiting alcohol and caffeine.
• Not using tobacco products.
• Avoiding crossing your legs.
• Not wearing tight-fitting clothing.
• Getting to a weight that’s healthy for you.
• Elevating your feet for 30 minutes twice a day.
• Talking to your provider about reducing your risk factors, especially if you or any of your family members have had a blood clot.
• Talking to your provider about a vena cava filter.

Conclusion

It can take months or years for a pulmonary embolism to go away completely. Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic manifestation of PEs that keep coming back.You’ll need to take a blood thinner for three to six months or longer. Don’t stop taking it unless your provider instructs you to. If you’re taking a blood thinner, don’t do things that put you at risk of an injury that could make you bleed.

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