Overview of Pulmonary embolism
Pulmonary embolism (PE) refers to sudden blockage of the blood vessels in lungs. It is one of the common complications of a condition known as deep vein thrombosis (DVT) wherein the blood clots from the deep veins in the leg can get dislodged and reach the lungs to block the blood vessels. Pulmonary embolism can cause permanent damage to the lung tissues or even lead to death in case of severe situations. Pulmonary embolism is a condition which occurs equally in both men and women. Risk increases in individuals aged above 60 years. PE is the third most common cause of death in hospitalized patients. About 100,000 individuals are diagnosed with pulmonary embolism every year.1
What are the signs and symptoms?
Symptom depends on the extent and severity of the blockage that has occurred in pulmonary blood vessels. Shortness of breath is most commonly seen leading to restlessness and anxious. Individuals show lightheadedness, fainting and seizures as the first symptoms. This is due to insufficient oxygenated blood supply to the brain and other body organs. In case of larger blockage individuals show increased or irregular heart rate leading to sudden death. Skin colour changes to bluish. Reoccurrences of the disease causes severe breathlessness and swelling of ankles and legs.3
Common causes of pulmonary embolism
In majority of the cases, pulmonary embolism occurs due to the deposition of the blood clots from the blood vessels of the leg and the pelvic region in individuals suffering from deep vein thrombosis. In other cases pulmonary embolism may be caused due to many other factors.
Hereditary factors include conditions such as antithrombin III deficiency, protein C deficiency, protein S deficiency and factor V Leiden deficiency. These disorders are known to increase the blood clotting ability leading to increased formation of clots.
Pulmonary embolism can also occur due the presence of several other factors that tend to increase the tendency of the blood to clot. This includes factors such as reduced mobility, old age, chemotherapy, presence of illnesses or conditions such as heart disorders, pregnancy, varicose veins, and others.
Diagnosis of Pulmonary embolism
The diagnosis of pulmonary embolism is based on the comprehensive review of the signs and symptoms noted the history of the condition, physical examination, and certain laboratory tests. Presence of large clots or a history of deep vein thrombosis can directly indicate the condition while more specific tests may be required in others. Imaging studies such as ultrasound, chest X-ray, CT scans, MRI, pulmonary angiography, and lung perfusion scans may be advised as appropriate to diagnose the presence of clots. Additionally certain blood tests, ECG and echocardiogram may also be advised in certain cases. 4
Treatment of pulmonary embolism
Pulmonary embolism is treated by medication or by surgery. Restricting the clot and avoiding the new blood clot is the primary goal for the therapy.
Anticoagulant is the first drug of choice for reducing the blood clot. They can be taken orally or administered through the blood vessels (intravenously). Warfarin and heparin are beneficial in treating pulmonary embolism. Heparin acts quickly by intravenous route.Warfarin is given orally and takes 2 to 3 days for its action.Once warfarin starts working heparin is stopped. Pregnant women are treated with heparin; as serious adverse events is seen with warfarin.
Thrombolytic medications are also recommended in emergency cases which dissolve the blood clot quickly. These are used to dissolve the larger clots which can lead to severe symptoms.
Surgery may be rarely indicated to remove large clots that are causing a major block in the blood vessels of the lungs.
There are several other measures that are advised to prevent the occurrence of pulmonary embolism in individuals considered to be at a high risk of developing this disorder.
Vena cava filter
Vena cava filter is a device which restricts the clot from travelling to lung. This is inserted in superior vena cava where the blood travels to the lungs. Here the clots are filtered, but this cannot stop the formation of clot. This is the choice of treatment in individuals suffering from DVT and is considered to be at a higher risk of developing pulmonary embolism.
Graduated compression stockings
Wearing of graduated compression stockings can prevent pooling of the blood in the legs and hence the occurrence of blood clots.
Whenever possible individuals are advised to walk around to prevent the pooling and clot formation in the blood vessels of the legs.
Prevention of pulmonary embolism
There are several measures advised in individuals who are at high risk of developing DVT or pulmonary embolism. The individuals must be physically active. They should not sit for a long duration while on long trips and should take breaks to walk around. Same applies true in case of illnesses that requires bed rest. Medications such as anticoagulants are prescribed by the physicians in some cases. Regular checkup and follow up is recommended .1 Devices that cause external compression of the leg muscles to improve blood circulation of in the legs may also be advised in certain instances. 3
1. National Heart Lung and Blood Institute Diseases and Condition Index. Pulmonary Embolism.[updated: June 2009;cited : Nov 2009].Available at : http://www.nhlbi.nih.gov/health/dci/Diseases/pe/pe_what.html
2. Sara F Sutherland. eMedicine. Pulmonary Embolism. [updated: May 8, 2009; cited: Nov 2009].Available at: http://www.merck.com/mmhe/sec04/ch046/ch046a.html.
3. Jeffrey A. Kline,, Kathryn L. Johns, Stephen A. Colucciello, Elizabeth G. Israel. New diagnostic tests for pulmonary embolism. Annals of Emergency Medicine.2000, 35(2): Pages 168-180.
Written by: healthplus24.com team
Date last updated: february 17, 2015