Pulmonary embolism (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [1]

Synonyms and keywords: PE; Venous thromboembolism; lung blood clot; blood clot-lung; embolus; tumor embolus; embolism-pulmonary

What is Pulmonary embolism?

Pulmonary embolism is a condition in which a blood clot blocks one or many arteries of the lung. Blood clot are most commonly formed in legs and then travel to lungs.

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What are the symptoms of Pulmonary embolism?

Signs and symptoms vary from person to person. However, the common symptoms are:

• Chest Pain
  • Under the breastbone or on one side
  • May feel sharp or stabbing
  • May also be describes as a burning, aching, or dull, heavy sensation
  • May get worse with deep breathing, coughing, eating, or bending
  • You may bend over or hold your chest in response to the pain

• Sudden cough
  • May possibly cough up blood or bloody mucus

• Rapid heart rate

• Shortness of breath that starts suddenly

Other symptoms that may occur:

• Anxiety
• Bluish skin discoloration (cyanosis)
• Clammy skin
• Dizziness
• Leg pain, redness, and swelling
• Lightheadedness or fainting
• Low blood pressure
• Sweating
• Wheezing

What causes a pulmonary embolism?

A pulmonary embolism is most often caused by a blood clot in the vein, especially a vein in the leg or in the pelvis (hip area). The most common cause is a blood clot in one of the deep veins of the thighs. This type of clot is called a deep vein thrombosis (DVT). The DVT breaks off and travels to the lungs.

Less common causes include air bubbles, fat droplets, amniotic fluid, or clumps of parasites or tumor cells, all of which may lead to a pulmonary embolism.

Risk factors for a pulmonary embolism include:

• Burns
• Cancer
• Childbirth
• Family history of blood clots
• Fractures of the hips or thigh bone
• Heart attack
• Heart surgery
• Long-term bed rest or staying in one position for a long time, such as a long plane or car ride
• Severe injury
• stroke
• Surgery (especially orthopedic or neurological surgery)
• Use of birth control pills or estrogen therapy

People with certain clotting disorders may also have a higher risk.

Who is at highest risk?

There is increased risk of PE in many conditions which are

• Thrombophilia is a condition in which blood has an increased tendency to clot. Thrombophilia can be Inherited or Acquired. Acquired Thrombophilia occurs in association with other medical conditions like Polycythimia vera or Antiphospholipid Antibody

• There are many other condition that increases the risk of PE
  • Pregnancy
  • Obesity
  • Smoking
  • Cancer
  • Heart failure
  • Previous PE
  • Medications like OCP,tamoxifen,Hormone Replacement Therapy

When to seek urgent medical care

Pulmonary embolism can be potentially life threatening and one should seek medical care when suffering from symptoms of Pulmonary embolism. Severe sharp chest pain, shortness of breath, blood in sputum, raised heart rate may be ominous signs.

Treatment options

A pulmonary embolism will require emergency treatment; consequently you will have to stay in the hospital and will receive oxygen. In cases of severe, life-threatening pulmonary embolism, treatment may involve dissolving the clot. This is called thrombolytic therapy. Clot-dissolving medications include:

• Streptokinase
• T-plasminogen activator (t-PA)

Blood thinners are given to prevent clots. This is called anticoagulation therapy.

• The most common blood thinners are heparin and warfarin (Coumadin).
• Fondaparinux (Arixtra) is a newer blood thinner used under special circumstances.

Heparin or heparin-type drugs are usually tried first. They can be given through a vein (by IV) or by injection under the skin.

Warfarin is later given in pill form. When you first start taking warfarin, you will need frequent blood tests. This will help your doctor properly adjust your dose. You will likely need to take the warfarin for several months.

• Patients who have reactions to heparin or related medications may need other medications.
• Patients who cannot tolerate blood thinners or for whom they may be too risky may need a device called an inferior vena cava filter (IVC filter). This device is placed in the main vein in the belly area. It keeps large clots from traveling into the blood vessels of the lungs. Sometimes a temporary filter can be placed and removed later.

Other medications to treat a pulmonary embolism may include:

• Anticoagulants - to prevent clot formation.
• Thrombolytic - to remove the already formed clot.
• Inferior vena cava filter-that prevent the clot, formed in legs, to reach the lungs.
• Embolectomy- which removes the clot that’s already formed.

Once the cause of the pulmonary embolism is identified, the physician may decide to do the following as far as imaging tests:

• CT scan
• Angiography
• V/Q Scan
• Echocardiogram

Where to find medical care for Pulmonary embolism

Directions to Hospitals Treating Pulmonary embolism

Possible complications

It’s a potential lethal condition if the main artery is blocked . If left untreated, about 30 percent of patients who have PE will die. Most of those who die do so within the first few hours of the event.

Sources

http://www.nhlbi.nih.gov/health/dci/Diseases/pe/pe_what.html

http://www.nlm.nih.gov/medlineplus/pulmonaryembolism.html