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Pulmonary Embolism

NIH Publication No. 05-5684
March 2005

What is Pulmonary Embolism?
Other Names for Pulmonary Embolism
What Causes Pulmonary Embolism?
Who Gets Pulmonary Embolism?
Risk Factors of DVT
What Are the Signs and Symptoms of Pulmonary Embolism?
Signs and Symptoms of DVT
How is Pulmonary Embolism Diagnosed?
Physical Exam
Tests
How is Pulmonary Embolism Treated?
Medications
Emergency Treatment
Additional Considerations
How is Pulmonary Embolism Prevented?
Life after Pulmonary Embolism
Summary
Links to More Information on Pulmonary Embolism

What Is Pulmonary Embolism?

A pulmonary embolism (PULL-mun-ary EM-bo-lizm) is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from the leg. A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus.

Pulmonary embolism is a serious condition that can cause:

If a clot is large, or if there are many clots, pulmonary embolism can cause death.

In most cases, pulmonary embolism is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in the deep veins of the body--most often in the legs. These clots can break free, travel to the lung, and block an artery.

More than 600,000 people in the United States have a pulmonary embolism each year, and more than 60,000 of them die. Most of those who die do so within 30 to 60 minutes after symptoms start. Pulmonary embolism is one of the most common causes of death in hospitalized people who must remain in bed for a long time.

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Other Names for Pulmonary Embolism

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What Causes Pulmonary Embolism?

Nine out of 10 cases of pulmonary embolism are caused by blood clots that form in the legs (deep vein thrombosis) and then travel to the lungs.

Leg clots can form when blood flow is restricted and slows down. This happens when you do not move around for long periods of time, such as:

Veins damaged from surgery or injured in other ways are more prone to blood clots.

Rarely, an air bubble, part of a tumor, or other tissue travels to the lung and causes pulmonary embolism.

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Who Gets Pulmonary Embolism?

People at high risk for a blood clot that travels to the lung are those who:

Pulmonary embolism occurs equally in men and women. As you age, your risk increases. Your risk of having a pulmonary embolism doubles for each 10 years after age 60.

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Risk Factors for DVT

There are many factors that increase your risk for DVT. They include:

The more risk factors you have, the greater your chance for developing DVT and pulmonary embolism.

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What Are the Signs and Symptoms of Pulmonary Embolism?

Common Signs and Symptoms

Pulmonary embolism usually occurs suddenly, causing the onset of new symptoms.

The most common signs and symptoms of pulmonary embolism are:

Sometimes, small pulmonary emboli can occur over time. These emboli may cause a more gradual onset of symptoms.

 

Other Signs and Symptoms

General, less-specific signs and symptoms may occur, including:

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Signs and Symptoms of DVT (Deep Vein Thrombosis)

Some people with pulmonary embolism only have signs and symptoms of DVT. These include:

Signs and symptoms of pulmonary emboli vary depending on the amount of blood flow blocked in the lung by clots. Large clots or many clots are life threatening and cause more severe symptoms. Smaller clots cause fewer symptoms or no symptoms at all. It is important that you see your doctor immediately if you have any symptoms of pulmonary embolism or DVT.

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How Is Pulmonary Embolism Diagnosed?

Your doctor will take a health history and perform a physical exam in order to:

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Physical Exam

The physical exam will include:

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Tests

To help determine if you have a pulmonary embolism or related disease or condition, initial testing includes:

Your doctor will order additional tests based on how likely it is that you have a pulmonary embolism and which tests are available. Tests could include:

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How Is Pulmonary Embolism Treated?

The primary goals in treating pulmonary embolism are to:

Treatment may include:

Treatment will vary depending on how severe your symptoms are. If your symptoms are severe, you need immediate emergency treatment. If your symptoms are mild, you can be treated as an outpatient.

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Medications

Anticoagulants (blood thinners) decrease your blood's ability to clot. They are used to stop clots from getting bigger and to prevent blood clots from forming. Anticoagulants do not break up blood clots that have already formed. Your body's natural system will dissolve the clot. Anticoagulants can be given:

Heparin and warfarin may be given at the same time. Heparin acts quickly, while warfarin takes 2 to 3 days before it starts to work. Once warfarin is working, the heparin will be stopped. Pregnant women cannot take warfarin and are treated with heparin only.

If you have DVT, treatment with anticoagulants usually lasts for 3 to 6 months. However, the length of treatment may vary if:

The most common side effect of anticoagulants is bleeding. You need to have regular blood tests to check how well the medicine is working. You should call your doctor right away if you have easy bruising or bleeding.

Thrombin inhibitors are new medications that interfere with the clotting process. They are used to treat some types of clots and for patients who cannot take heparin.

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Emergency Treatment

When pulmonary embolism is life threatening, doctors may use treatments to remove or break up clots in the lungs. These treatments are given in the emergency room or in the hospital and include:

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Additional Considerations

Vena cava filters are used when you cannot take medications to thin your blood, or if you are taking blood thinners and continue to develop clots. The filter is inserted inside a large vein called the inferior vena cava (the vein that carries blood from the body back to the heart). It can catch the clots as they try to move through the body to the lungs. This treatment can prevent a clot from traveling to the lungs. It cannot stop other clots from forming.

Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the feet and become looser as they go up the leg. This causes a gentle compression (or pressure) up your leg. The stockings provide support and reduce the chronic swelling that can occur in the leg after a blood clot has occurred.

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How Is Pulmonary Embolism Prevented?

Preventing pulmonary embolism begins with preventing DVT. It is important to know if you are at risk for DVT and to take steps to lower your risk.

If you have never had a deep vein clot, but are in a situation that may increase your risk, be sure to:

If you already have had DVT or a pulmonary embolism, you need to prevent further clots from developing by:

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Life after Pulmonary Embolism

Once you have had a pulmonary embolism (with or without a DVT), you have a greater chance of having another one. After treatment has begun and you are feeling better, your treatment will continue at home.

At home, you will continue taking blood-thinning medications. It is important that you:

Medications used to treat pulmonary embolism may thin your blood too much. This can cause:

Treatment for pulmonary embolism usually lasts up to 6 months. During treatment and after, you should continue to:

If you think that you have DVT or are having symptoms of a pulmonary embolism, you should contact your doctor immediately.

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Summary

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Links to More Information on Pulmonary Embolism

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Clinical Trials

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The information contained in materials published by the National Heart, Lung, and Blood Institute (NHLBI) is in the public domain. No further permission is required to reproduce or reprint the information in whole or in part. However, organizations that reproduce NHLBI publications should cite the National Heart, Lung, and Blood Institute as a part of the National Institutes of Health and the U.S. Department of Health and Human Services as the source. This applies to printed publications as well as documents from the NHLBI Web site. Organizations may add their own logo or name. We further ask that no changes be made in the content of the material, and that the material as well as any NHLBI Internet links should not be used in any direct or indirect product endorsement or advertising.

Where to find this information: http://www.nhlbi.nih.gov/health/dci/Diseases/pe/pe_what.html

 

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