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Pulmonary Embolism

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21 Aug, 2018

A pulmonary embolism is a blood clot that occurs in the arteries of the lungs. It usually results from a disease called Deep vein thrombosis (DVT), where blood clots formed in the veins in the legs travel to the pulmonary artery in the lungs. It restricts blood flow and reduces blood oxygen levels thereby damaging other organs as well. The blockage can be life-threatening, especially if there are large or multiple clots. At least one-third of the people suffering from pulmonary embolism die if they are undiagnosed or untreated.

 

Causes

As mentioned above, pulmonary embolisms are most commonly caused by deep vein thrombosis in the legs, and less often in the pelvic region. Blood clots form due to several reasons such as:

  • Trauma or injury: Broken and damaged blood vessels can also lead to clots, such as during bone fractures or muscle tears.
  • Inactivity: When you are inactive for long periods, blood starts to stagnate in the lower parts of your body, due to gravity, for example, when you are seated or standing in one position for a few hours during a long-distance trip.
  • Medical conditions: Some health disorders (like bleeding disorders) cause blood to clot too easily, which can result in pulmonary embolism. Some anti-cancer drugs may also cause blood clotting as a side effect.

 

Symptoms

Symptoms depend on the size of the clot and where it lodges in the lung.

  • Shortness of breath (could be sudden or gradual)
  • clammy or bluish skin
  • chest pain that may extend into your arm, jaw, neck, and shoulder
  • fainting
  • irregular or rapid heartbeat
  • lightheadedness
  • rapid breathing
  • restlessness
  • anxiety
  • spitting blood
  • weak pulse

 

Diagnosis

For people already suffering from a lung or cardiac disorder, such as high blood pressure, emphysema or chronic obstructive pulmonary disorder (COPD), diagnosis can be difficult. The doctor usually asks questions about the symptoms and family medical history and conducts a physical examination. Other tests that can be done are:

  • Chest X-ray: This is a standard noninvasive test, that is used to image the heart and lungs in detail. Any bone problems in the chest area can also be detected.
  • Electrocardiography (ECG): This measures your heart’s electrical activity.
  • MRI: This uses a strong magnetic field and radio waves to create detailed images.
  • CT scan: This produces cross-sectional images of your lungs.
  • Pulmonary angiography: In this test, the doctor makes a small incision in the veins and injects a dye using special tools. This dye serves as a marker of what is going on inside.
  • Duplex ultrasound or venography: These are specialized imagining techniques to visualize the flow of blood in your veins.
  • D-dimer test: This is a test to detect blood levels of D-dimer protein. Very high levels of this protein likely indicate thrombosis.

 

Treatment

Depending on the size and location of the blood clot, treatment may be just by medications or surgery for a serious case. If the problem is minor and detected early, some medications can be used to break up the clots and resolve the issue, such as:

  • Anticoagulants: They prevent the formation of new clots in your blood. Examples are heparin and warfarin.
  • Clot dissolvers: These drugs hasten the process of clot breakdown. However, they are given only during emergencies as they may cause excess bleeding as a side effect.

Surgery may be a necessity to remove bigger or difficult clots that cannot be resolved with medications. Some surgical procedures to rectify pulmonary embolism are:

  • Vein filter: A small filter is inserted inside the inferior vena cava (this is the principal vein that carries blood from the legs to the right side of your heart). This filter stops blood clots from entering into the lung arteries.
  • Clot removal: A catheter is used to suck the clots out of the blood vessels. However, this is a very risky operation and not efficient all the time, hence this procedure is rarely used.
  • Open surgery: This is done only in emergencies when a person is in shock and medications fail to work.

 

Tips for prevention

  • Compression stockings: These are worn to slowly and steadily squeeze the legs. This helps the veins and leg muscles to circulate blood more efficiently. They are safe, easy to put on and inexpensive.  
  • Leg elevation: Keep elevating your legs when possible, especially at night.
  • Physical activity: It is important to move as much as possible as staying still leads to stagnation of blood in the lower body parts. This is very important, especially after a surgery.
  • Pneumatic compression: This therapy uses inflated cuffs are wrapped around the calves or thighs to gently massage the blood vessels and improve blood circulation in the legs.