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:
Permanent damage to part of your lung
from lack of blood flow to lung tissue
Low oxygen levels in your blood
Damage to other organs in your body
from not getting enough oxygen.
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.
People at high risk for a blood clot that
travels to the lung are those who:
Have DVT (a blood clot in the leg) or a
history of DVT
Have had a pulmonary embolism before.
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.
There are many factors that increase your
risk for DVT. They include:
Inherited conditions that cause
increased risk for blood clotting
Restricted or slow blood flow in a deep
vein, due to injury, surgery, or having to stay in bed for a long time
Cancer and its treatment
Medical conditions such as varicose
veins
Sitting for a long period of time, such
as on long trips in a car or on an airplane
During pregnancy and in the 6 week
period after delivery
Being over age 60 (although DVT can
occur at any age)
Being overweight or obese
Taking birth control or hormone
replacement pills
Having a medical condition that
requires a central venous catheter. A central venous catheter is a
tube placed in a vein to allow easy access to your bloodstream for
medical treatment.
The more risk factors you have, the
greater your chance for developing DVT and pulmonary embolism.
Some people with pulmonary embolism only
have signs and symptoms of DVT. These include:
Swelling of the leg or swelling along
the vein in the leg.
Pain or tenderness in the leg. The pain
is usually only in one leg. You might only have pain when standing or
walking.
Feeling of increased warmth in the area
of the leg that is swollen or that hurts.
Red or discolored skin on the affected
leg.
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.
Chest x-ray, which takes a picture of the lungs, heart, large
arteries, ribs, and the diaphragm.
Duplex ultrasound, the most common test
used to diagnose deep vein clots. It uses sound waves to evaluate the
flow of blood in your veins. A gel is put on the skin of the leg. A
handheld device is placed on the leg and passed back and forth over
the affected area. This device sends sound waves from the leg to an
ultrasound machine. A computer then turns the sounds into a picture.
The picture is displayed on the computer screen where your doctor can
see the blood flow in your leg. This is an indirect way to diagnose a
source of pulmonary embolism.
Blood work
To check for inherited disorders that
cause clots.
To measure the amount of oxygen and
carbon dioxide in the blood (arterial blood gas). A pulmonary embolism
may change the levels of oxygen and carbon dioxide in the blood.
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:
Pulmonary angiography, an accurate, invasive test used to diagnose
pulmonary embolism. A flexible tube called a catheter is threaded
through the groin or arm to the blood vessels in the lung. Dye is
injected to take a picture of the blood flow through the blood vessels
in the lungs. This test is not available at all hospitals, and a
trained specialist is required to perform the test.
Spiral computed tomography (CT) scan, a special type of x-ray that
takes pictures of structures inside the body. Dye is injected into a
vein, allowing the doctors to see the blood vessels in the lungs. This
is a very quick test and results are available shortly after the scan
is completed.
Magnetic resonance imaging (MRI), a test that shows pictures of
organs and structures inside the body. MRI uses radio waves to make
the image. In many cases, an MRI can provide information that would
not show on an x-ray.
Echocardiogram, a test that uses sound waves to check for blood
clots inside the heart and to check heart function. It can also
determine other possible causes for your symptoms.
D-dimer, a blood test that measures a
substance in the blood that is released when a clot breaks up. High
levels may indicate a clot. If your test is normal, a pulmonary
embolism is not likely.
The primary goals in treating pulmonary
embolism are to:
Keep the blood clot or clots lodged in
the lungs from getting bigger
Stop the development of new clots.
Treatment may include:
Medications
Emergency treatment to dissolve a clot
Other treatments.
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.
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:
Your blood clot occurred after a
short-term risk such as surgery. In this case, your treatment may be
shorter.
You have had clots before. You will
need longer treatment.
You are being treated for another
illness (such as cancer). You will take anticoagulants for as long as
those risk factors are present.
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.
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:
Medications called thrombolytics to
quickly dissolve the blood clot. Thrombolytics are used to treat large
clots causing severe symptoms.
Surgery to remove the blood clot.
A new procedure that uses a catheter to
reach the clots. The catheter is inserted into the groin or arm and
threaded to the clot in the lung. The catheter may be used to extract
the clot or deliver medication to dissolve it.
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.
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:
Exercise your lower leg muscles during
long car trips and plane rides.
Get out of bed and move around as soon
as you are able after having surgery or being ill. The sooner you move
around, the less chance you have of developing a clot.
Take medications to prevent clots after
some types of surgery as directed by your doctor.
Follow up with your doctor.
If you already have had DVT or a
pulmonary embolism, you need to prevent further clots from developing
by:
Seeing your doctor for regular checkups
Taking your medications to prevent or
treat blood clots as prescribed by your doctor
Using compression stockings as directed
to prevent chronic swelling in your legs after a DVT, if prescribed by
your doctor
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:
Take medications as prescribed.
Do not take any other medication,
including over-the-counter medications, vitamins, or food supplements
without first checking with your doctor.
Continue to have regular blood tests as
directed by your doctor.
Check with your doctor before changing
your diet or taking any supplements.
Wear your compression stockings as
directed, if prescribed by your doctor.
Medications used to treat pulmonary
embolism may thin your blood too much. This can cause:
Bleeding in the digestive system. Get
immediate treatment if you:
Vomit bright red blood or material that
looks like coffee grounds
Pass bright red blood in your stool or
have black tarry stools
Develop pain in your abdomen.
Excessive bleeding from a fall or
injury. Get immediate treatment if you cannot stop any bleeding after
applying pressure for 10 minutes.
Bleeding in the brain. Get immediate
treatment if you:
Develop a severe headache
Have any sudden changes in your vision
Have sudden loss of movement of your
legs or arms
Have sudden memory loss or confusion.
Treatment for pulmonary embolism usually
lasts up to 6 months. During treatment and after, you should continue
to:
A pulmonary embolism is a blockage of
an artery in the lung, usually due to a blood clot that traveled to
the lung from the leg.
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.
A pulmonary embolism blocks blood flow
to part of the lung. It can be a life-threatening condition.
Each year, more than 600,000 people in
the United States have a pulmonary embolism, 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.
The greatest risk for pulmonary
embolism occurs in people who:
Have or have previously had DVT
Have previously had a pulmonary
embolism.
Pulmonary embolism occurs equally in
men and women.
Your risk for pulmonary embolism
doubles every 10 years after age 60.
More than half of people with pulmonary
embolism do not have symptoms. Some have symptoms that could be due to
other conditions.
When present, the most common symptoms
of pulmonary embolism are:
Unexplained shortness of breath
Chest pain that gets worse with a deep
breath, coughing, or chest movement
Coughing up blood.
Your doctor will do a physical exam and
several tests to decide if you have a pulmonary embolism.
The primary goals in treating pulmonary
embolism are to keep the current clot or clots from getting bigger and
to stop the development of new clots.
Treatment varies depending on how
severe your symptoms are. Some people need immediate emergency
treatment, while others can be treated as an outpatient.
Treatment usually includes
anticoagulant medications (blood thinners), such as warfarin and
heparin, which help prevent clots from forming and help keep clots
from getting larger.
Preventing pulmonary embolism begins
with preventing DVT.
If you think that you have DVT or are
having symptoms of a pulmonary embolism, contact your doctor
immediately.
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