Pulmonary Embolism

A pulmonary embolism (PE) happens when a blood clot gets lodged in a lung artery. This blockage stops blood from flowing to part of the lung. Most often, these blood clots begin in the deep veins of the legs. They travel up through the heart, then into the lungs. This process is called deep vein thrombosis (DVT).

Essentially, a pulmonary embolism is a blood clot that stops blood from reaching a lung artery. Usually, this clot originates in a large vein deep inside the leg. Sometimes, though, the clot can start in a vein in another part of the body, such as the arm or pelvis. A blood clot in one or more deep veins is called deep vein thrombosis (DVT).

Pulmonary embolism can be very dangerous because the blockage prevents blood from getting to the lungs. This can be life-threatening. However, if treated quickly, the chances of survival are greatly improved. Taking steps to prevent blood clots in your legs can help prevent a pulmonary embolism. This is important because preventing the initial blood clot in the leg is crucial.

Pulmonary embolism symptoms can vary. How much of your lung is affected, the size of the blood clots, and any existing lung or heart problems all play a role. Common signs include:

Shortness of Breath: This is often a sudden problem. You might feel like you can't get enough air, even when resting, and the problem gets worse with activity.

Chest Pain: The pain can mimic a heart attack. It's usually sharp, especially when you take a deep breath. The pain might also be felt when coughing, bending, or leaning over.

Fainting: If your heart rate or blood pressure drops quickly, you could lose consciousness. This is called fainting or syncope.

Other Possible Symptoms:

• Cough: Sometimes, the cough produces mucus that's bloody or streaked with blood.
• Fast or Irregular Heartbeat: Your heart might beat faster or skip beats.
• Lightheadedness or Dizziness: You might feel unsteady or like you're going to pass out.
• Sweating: You might sweat more than usual.
• Fever: A fever can be a sign of a pulmonary embolism.
• Leg Pain or Swelling: Often, one or both legs, especially the back of the lower leg, might hurt or swell.
• Cool or Bluish Skin (Cyanosis): Your skin might feel cool to the touch and look bluish or grayish.

Serious Issue: A pulmonary embolism can be very dangerous. If you have unexplained shortness of breath, chest pain, or fainting, get immediate medical help.

A pulmonary embolism is a serious medical condition that can be life-threatening. If you suddenly feel short of breath, have chest pain, or faint, get immediate medical help. These are signs that something might be wrong with your lungs, and prompt medical attention is crucial.

A pulmonary embolism happens when a lump of material, usually a blood clot, gets stuck in a lung artery. This stops blood from flowing properly through that part of the lung. These blood clots often start in the deep veins of the legs, a condition called deep vein thrombosis (DVT).

It's not unusual for more than one clot to be involved. When an artery is blocked, the part of the lung it supplies can't get enough blood, and the tissue might die. This is called a pulmonary infarction. A pulmonary embolism makes it harder for your lungs to send oxygen to the rest of your body.

Sometimes, things other than blood clots can block lung arteries. These include:

• Fat from a broken bone: If a long bone breaks, pieces of fat from inside the bone can travel to the lungs.
• Pieces of a tumor: Cancer can sometimes release bits of tumor that travel to the lungs.
• Air bubbles: In rare cases, air bubbles can block a lung artery.

Blood clots in the leg can cause pain, swelling, warmth, and tenderness. These clots can sometimes travel to the lungs, causing a serious problem called a pulmonary embolism. While anyone can get a blood clot, some things make you more likely to develop one.

Risk Factors for Blood Clots:

• Family history: If you or a close relative (parent, sibling) has had blood clots or pulmonary embolism, your risk is higher. This means your genes might make you more prone to these problems.

• Medical conditions: Certain health issues can increase your risk:

  • Heart problems: Heart conditions, like heart failure, can disrupt blood flow, making it easier for clots to form.
  • Cancer: Many types of cancer (especially those that have spread) and cancer treatments (like chemotherapy) increase the risk of blood clots. Even if you have a family history of breast cancer and are taking tamoxifen or raloxifene, you may be more susceptible.
  • Surgery: Surgery, particularly major procedures like joint replacement, is a significant risk factor. Doctors often give medication to prevent clots before and after surgery to reduce this risk.
  • Blood clotting disorders: Some people have inherited conditions that make their blood more likely to clot. Kidney disease can also increase the risk.
  • COVID-19: Severe cases of COVID-19 have been linked to a higher chance of pulmonary embolism.

• Lifestyle factors: Certain behaviors and situations can also contribute:

  • Extended periods of inactivity: Being still for long periods, like during bed rest (after surgery, injury, or illness), or long trips (by plane or car), can slow down blood flow in your legs, allowing blood to pool and potentially form clots.
  • Smoking: Smoking increases the risk of blood clots, particularly if you have other risk factors. The exact reason for this isn't fully understood.
  • Obesity: Being overweight or obese increases your risk of blood clots, especially if you have other risk factors.
  • Hormone replacement therapy or birth control pills: The hormones in these treatments can increase the clotting factors in your blood, which is particularly true if you smoke or are overweight.

Understanding these risk factors can help you and your doctor take steps to prevent blood clots.

Pulmonary embolism is a serious condition that can be deadly. In fact, about one out of every three people with an undiagnosed and untreated pulmonary embolism will not survive. However, when the condition is discovered and treated quickly, the survival rate improves significantly.

Pulmonary embolism can also lead to a related problem called pulmonary hypertension. This means the blood pressure in the lungs and the right side of the heart becomes dangerously high. Think of it like this: when blood clots block the arteries in the lungs, the heart has to work extra hard to pump blood through these narrowed pathways. This extra effort raises the blood pressure, and over time, weakens the heart muscle.

In some uncommon cases, small blood clots (called emboli) get stuck in the lungs. As time passes, these clots can cause scarring in the blood vessels of the lungs. This scarring makes it harder for blood to flow through the lungs, and this can lead to a long-term condition called chronic pulmonary hypertension.

Deep vein clots in your legs can lead to serious lung problems called pulmonary embolisms. To prevent this, hospitals often take steps to stop clots from forming. These include:

Blood thinners (anticoagulants): These are medicines that stop blood from clotting too easily. Doctors often prescribe them before and after surgery, or when someone is in the hospital with conditions like heart attacks, strokes, or cancer complications, because these situations increase the risk of blood clots.

Staying active: Getting up and moving around as soon as possible after surgery is very important. Your nurse might encourage you to walk, even if it hurts a bit, because this helps prevent blood clots and speeds up your recovery.

Traveling: The chance of getting a blood clot while traveling is usually small, but it goes up with longer trips. If you have a family history of blood clots, or other risk factors, and are worried about traveling, talk to your doctor. They can advise you on what to do.

Preventing clots during travel: To help prevent blood clots during travel, consider these tips:

• Hydrate: Drink plenty of water. Staying hydrated is key for preventing dehydration, which can make blood more likely to clot. Avoid alcohol, as it can dehydrate you.

• Movement: Get up and move around regularly. On a plane, walk around the cabin at least once an hour. If driving, stop every now and then to stretch your legs and walk around the car. Even simple exercises like bending your knees or circling your ankles can help.

• In-seat exercises: Even while sitting, you can help prevent clots. Every 15-30 minutes, bend your ankles and feet, circle them, and point your toes up and down. These small movements keep your blood flowing.

Diagnosing a Pulmonary Embolism: Finding Blood Clots in the Lungs

A pulmonary embolism (PE), a blood clot in the lungs, can be tricky to diagnose, especially if you have other health problems like heart or lung disease. Doctors use a combination of methods to find out if you have a PE.

Talking to You and a Physical Exam:

The doctor will first talk to you about your medical history and any symptoms you're experiencing. They'll also do a physical exam to check for signs of a PE, like shortness of breath or chest pain.

Blood Tests:

• D-dimer test: This blood test looks for a substance called D-dimer, which is released when blood clots break down. High levels of D-dimer often suggest a clot, but other things can also cause high levels.

• Oxygen and Carbon Dioxide Levels: Blood tests measure the amounts of oxygen and carbon dioxide in your blood. If you have a blood clot in your lungs, your oxygen levels might be low.

• Inherited Clotting Disorders: Blood tests can also check for inherited conditions that increase your risk of blood clots.

Imaging Tests:

• X-rays: X-rays create images of your lungs and heart, but they can't definitively diagnose a PE. While an X-ray might look normal even with a PE, it can help rule out other conditions with similar symptoms.

• Ultrasound (Doppler): This non-invasive test uses sound waves to create images of the blood vessels in your body. It helps to identify blood clots in your veins. If clots are found, treatment can begin immediately.

• CT Scan (Computed Tomography): CT scans use X-rays to create detailed cross-sectional images of your body. A CT pulmonary angiography, a specialized CT scan, creates 3D images of the arteries in your lungs, helping identify a PE. Sometimes, a special dye is injected to make the blood vessels show up better.

• Ventilation/Perfusion (V/Q) Scan: This scan is used when radiation exposure or dye used in other scans is not suitable. A small amount of radioactive substance is injected into a vein. The scan measures blood flow and airflow to the lungs and compares them, helping to detect clots.

• Pulmonary Angiogram: This test is the most precise way to find a PE. A thin tube (catheter) is inserted into a vein (often in the groin) and guided to the arteries in your lungs. A special dye is injected, and X-rays are taken as the dye travels through the vessels. However, this method involves more risks, including temporary heart rhythm changes and possible kidney problems, so it's typically used only if other tests are inconclusive.

• MRI (Magnetic Resonance Imaging): MRI uses magnets and radio waves to create detailed images. It's usually reserved for pregnant women (to avoid radiation) or people with potential kidney problems that would be worsened by the dyes used in other tests.

These different tests help doctors narrow down the cause of your symptoms and determine the best course of action. The choice of test depends on your individual situation and health status.