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A pulmonary embolism involves an inability to breathe due to a blood clot that has settled somewhere in the lung arteries. In some cases, the blood clots are small and numerous. In other cases, there is one large embolus that blocks the opening to the lungs, called a saddle embolus. Blood clots like this are often deadly but the smaller ones are usually survivable.
The common symptoms of a pulmonary embolism include:
- Cough, which is productive of pinkish, foamy mucus
- Sudden onset of shortness of breath
- Sharp chest pain when taking a deep breath
- You may feel anxious or on edge
- Light headedness or feelings of faintness
- Palpitations or rapid heart beat
The cause of a pulmonary embolism is a blood clot that originated in the deep veins of the legs. The clot breaks off and travels up the venous system to the vessels of the lung where it interferes with circulation and oxygen flow. About 300,000 people per year suffer from either a pulmonary embolism or a deep vein thrombosis. Only a small percentage of patients with a DVT will go on to developing a pulmonary embolism.
There are rare causes of a pulmonary embolism include tumors, air bubbles, fat from broken bones and amniotic fluid during labor.
There are things that increase one’s risk of developing a pulmonary embolism. These include anything that causes an increase in the formation of blood clots in the system so that blood clots too fast. Some things that increase your risk include:
- Being inactive, such as illness, surgery, sitting for long periods of time on a car trip or flight
- Smoking history
- Taking estrogen replacement therapy or birth control pills
- Pregnancy and childbirth
- Cancer, heart failure, severe infection or stroke
- Recent surgery of the lower extremities, back or brain
- Age greater than 70 years
- Being overweight
The diagnosis of pulmonary embolism can be difficult and is primarily based on the symptoms the patient has. Symptoms can be similar to a panic attack, pneumonia or heart attack. A history and physical examination are good places to start. Tests to confirm the diagnosis of pulmonary embolism include a CT scan of the abdomen, MRI scan, ultrasound and an electrocardiogram. Historically, a ventilation perfusion or (V/Q) scan was the diagnostic of choice. This was before CT scan existed.
The treatment of pulmonary aneurysm is to give clot busters and blood thinners to break up the clots so they dissipate. Clot busters are used when the situation is dire and the clots have to break up as soon as possible. Heparin is then given to keep the blood from clotting and, after the patient is stable, the patient is given Coumadin or warfarin, which is a pill to take at home for a prescribed period of time or indefinitely.
Another treatment is surgical and is called a pulmonary embolectomy. The vascular surgeon goes in and removes the blood clot at the entrance to the lung vasculature. In some cases, a vena cava filter is surgically implanted so that blood clots in the legs do not travel to the lungs.
If you have had pulmonary embolism one time, your risk of having another one is significantly higher. It means you may need to take a blood thinner like warfarin indefinitely. Your bleeding risk is greater if you’re on blood thinners but the benefit out weight the risks.
The things you can do to prevent a pulmonary embolism from occurring include:
- Avoiding sitting for long periods of time
- Move as soon as you can following surgery
- Drink extra fluids while trying as long as the drink doesn’t include caffeine or alcohol
- Wear compression stockings if you happen to be high risk
- Take blood thinners absolutely as directed if you happen to need them
Pulmonary Embolism Overview
A pulmonary embolism is also sometimes called a pulmonary embolus. It happens when a blood clot in the arm or leg in the deep veins travels to the lung and blocks the circulation of blood to the long. Without circulation to the lung, the person cannot get oxygenated blood and the result is a fatal disease. The person dies almost instantaneously if the clot is big. If several small clots affect the lung, the disease is perhaps survivable if blood thinners are given. About a third of all patients with a pulmonary embolism do not survive the illness.
Pulmonary emboli result from blood clots that form usually in the deep veins of the legs, a condition known as a DVT or deep vein thrombosis. If you are at risk for a DVT, you are always at risk for a pulmonary embolus. Deep vein thromboses tend to be caused by inactivity, such as with a long car ride, airplane ride or surgery. There is an injury to the lining of the deep vein that forms a nidus that begins the clotting process. Clots can form along the valves of the vein as well. Eventually a deep vein thrombosis occurs that breaks off and can enter the pulmonary artery. No circulation gets to the lung and pulmonary infarction occurs. No blood gets to the oxygen and no oxygenated blood is formed. Death can occur within seconds.
About one out of 1000 individuals get a pulmonary embolism each year. Increased risk occurs with prolonged recovery after surgery or from a fracture with immobilization. Sixty to eighty percent of all patients with a DVT will get some degree of pulmonary embolism although more than half of those have any symptoms. It is the third most common cause of death of hospitalized patients. This means that about 650,000 deaths occur from pulmonary embolism each year in the US. The diagnosis is missed in about 70 percent of milder cases of the disease and they tend to recover fully. The rate of death is highest in intensive care units, in which the incidence can be as high as thirty percent. In those admitted for heart disease, about 30 percent develop DVTs. The rate increases to almost 50 percent in those who have had heart surgery, such as a bypass surgery. Women who are pregnant or postpartum have a very high risk of getting DVTs and pulmonary emboli.
A large pulmonary embolism is second only to sudden cardiac death as a cause of sudden death syndromes. Autopsies have shown that eighty percent of those who die suddenly from what is thought to be a heart attack in a hospital actually have a large pulmonary embolism. Ten percent die within an hour of the embolism and thirty percent die a bit later. Anticoagulant medications or clot busters can save many of these people if they are caught early enough. Unfortunately, 400,000 cases of this disease are missed every year. About 100,000 of these people could have been saved if the diagnosis is made promptly.
Testing for pulmonary embolism relies on a careful history and physical. There can be shortness of breath, dizziness and low blood pressure. In some cases, there can be sudden catastrophic hemodynamic collapse and death within seconds. If a pulmonary embolism is suspected, a V-Q scan can be done which is a radioactivity exam that looks for areas where the lung looks normal on x-ray but is not being oxygenated. These are areas of pulmonary embolism.
Treatment of pulmonary embolism is to use clot busting drugs and blood thinners to break up the clots that are forming in the lungs. If, however, the clot is huge and blocks the pulmonary artery, there is no good treatment and the patient dies.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here