Pulmonary embolism

2021-08-05 08:32 PM

Pulmonary embolism can occur in healthy people. Signs and symptoms often include sudden, unexplained shortness of breath, chest pain, cough of bloody sputum.

Define

Pulmonary embolism is a condition that occurs when one or more arteries in the lungs become blocked. In most cases, a pulmonary embolism is caused by a blood clot traveling to the lungs from another part of the body - most commonly the leg.

Pulmonary embolism can occur in healthy people. Signs and symptoms can vary from person to person, but often include sudden and unexplained shortness of breath, chest pain, and a cough that may produce bloody sputum.

Pulmonary embolism can be life-threatening, but anticoagulation can reduce the risk of death. Preventing blood clots in the legs may also help protect against pulmonary embolism.

Pulmonary embolism

Symptoms

Pulmonary embolism symptoms can vary greatly, depending on how much lung is involved, the size of the clot, and overall health - particularly the presence or absence of lung or heart disease.

Common signs and symptoms include

Shortness of breath. This symptom usually comes on suddenly and occurs while active or at rest.

Chest pain. It may feel like you're having a heart attack. The pain may get worse with deep breathing, coughing, eating, bending, or standing. The pain is worse with exertion but will not go away with rest.

Cough. Coughs can be bloody or bloody sputum.

Signs and symptoms that may occur with a pulmonary embolism include

Wheeze.

Leg swelling.

The mucous membranes or skin are bluish in color.

Sweating too much.

Fast heartbeat or irregular heartbeat.

Weak circuit.

Dizziness or fainting.

Pulmonary embolism can be life-threatening. Seek immediate medical attention if you experience unexplained shortness of breath, chest pain, or coughing up bloody sputum.

Causes

Pulmonary embolism occurs when an object, usually a blood clot, enters an artery in the lung. These blood clots usually originate in the deep veins of the legs, but can also come from other parts of the body. This condition is called deep vein thrombosis (DVT).

Occasionally, other substances can cause blockages inside the blood vessels in the lungs. Eg:

Fat from inside the marrow of the broken bone.

Part of a tumor.

Air balloon.

It is rare to experience a solitary pulmonary embolism. In most cases, multiple blood clots are involved. The lung tissue served by each artery is blocked and can die. This makes it harder for the lungs to deliver oxygen to the rest of the body.

Because pulmonary embolism occurs almost always in association with deep vein thrombosis, some doctors tie the two problems together.

Risk factors

Although anyone can develop blood clots and subsequent pulmonary embolism, certain factors can increase the risk.

Prolonged immobility

Blood clots are more likely to form in the legs during periods of inactivity, such as:

Rest in bed. Being in bed for a long time after surgery, a heart attack, broken leg or serious illness makes you more susceptible to blood clots.

Long journey. Sit in tight seats in airplanes or long car trips. Reduces the speed of blood flow, which contributes to the formation of blood clots in the legs.

Age

Older adults are at higher risk of developing blood clots. Factors include:

Injury to the venous valve. Small valves in veins keep blood moving in the right direction. The valves tend to decline with age. When not working properly, blood pools, and sometimes blood clots form.

Loss of water. Older adults are at higher risk for dehydration, thickening, and making blood more likely to clot.

Medical problem. Older adults are also more likely to have medical problems with independent risk factors for blood clots - such as joint replacement surgery, cancer, or heart disease.

Family history

There is a higher risk of future blood clots if you have had a blood clot or pulmonary embolism in the past. This may be due to an inherited blood clotting disorder.

Surgery

Surgery is one of the leading causes of blood clots, replacing especially the hip and knee joints. During preparation for artificial joints, tissue debris can enter the bloodstream and help cause a blood clot. Simply being immobile during surgery can lead to the formation of blood clots. The length of time general anesthesia increases the risk.

Medical problem

Heart disease. High blood pressure and cardiovascular disease make it more likely that blood clots form.

Pregnant. The baby's weight on the veins in the pelvis can slow blood from the legs. Blood clots are more likely to form when the blood slows down or builds up.

Cancer. Certain cancers - especially pancreatic, ovarian, and lung cancers - can increase levels of substances that help blood clot, and chemotherapy increases the risk. Women with a history of breast cancer who are taking tamoxifen or raloxifene are also at increased risk of blood clots.

Life style

Smoking. For not well-understood reasons, tobacco use leads some people to form blood clots, especially when combined with other risk factors.

Overweight. Being overweight increases the risk of blood clots - especially in women who smoke or have high blood pressure.

Estrogen supplement. The estrogen in birth control pills and hormone replacement therapy can increase blood clotting factors, especially if you smoke or are overweight.

Complications

Pulmonary embolism can be life-threatening. About one-third of people are undiagnosed and untreated pulmonary embolism survives. When the condition is diagnosed and treated promptly, however, that number drops dramatically.

Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in the lungs is too high. When there is an obstruction in the arteries in the lungs, the heart has to work harder to push blood through the pulmonary vessels. This increases blood pressure in the blood vessels.

Examination and diagnosis

Pulmonary embolism can be difficult to diagnose, especially in people with heart failure or lung disease. For that reason, your doctor may order a variety of tests to help find the cause of your symptoms.

X-ray. This noninvasive test shows images of the heart and lungs on film. Although radiographs cannot diagnose pulmonary embolism and may even appear normal when a pulmonary embolism exists, a pulmonary embolism-like condition can be ruled out.

Lung screening. This test called a ventilation-perfusion scan (V/Q scan), uses a small amount of radioactive material to study gas and blood flow in the lungs. For the first part of the test, inhale a small amount of radioactive material while a camera that can detect the radioactive material takes pictures of the movement of air in the lungs. Then, a small amount of radioactive material is injected into a blood vessel in the arm, and a picture of the blood flow in the blood vessels of the lungs is seen. Comparing the results of the two studies will help provide a more accurate diagnosis of pulmonary embolism.

Computed tomography (CT scan). CT scans are frequent, taking X-rays from many different angles and then combining them to form two-dimensional images of internal structures. In a spiral CT scan, the scanner rotates around the body to create a three-dimensional image. This type of CT can detect abnormalities with much greater accuracy, and it is also faster than conventional CT.

Pulmonary angiography. This test provides a clear picture of the blood flow in the arteries of the lungs. It is the most accurate way to diagnose pulmonary embolism, but because it requires a high level of management skill and carries serious risks, it is often done when other tests do not provide a definitive diagnosis. determined. It also has the advantage of being able to measure pressure on the right side of the heart. There will be an abnormal reading in the presence of pulmonary embolism.

A catheter is inserted into a large vein during a pulmonary angiogram - usually in the groin area - and threaded through the heart into the pulmonary artery. A special dye is then injected into the catheter, and an X-ray shows the dye traveling along an artery in the lung. The risk of this procedure is a temporary change in heart rate. In addition, dyes can cause kidney damage in people with reduced kidney function.

D-dimer. High levels of D-dimer in the blood, may suggest an increased likelihood of blood clots, although D-dimer may be increased by other factors, including recent surgery.

Supersonic. The noninvasive test called venous duplex ultrasound uses high-frequency sound waves to check for blood clots in the femoral veins. In this test, the doctor uses a wand-shaped device called a transducer to direct sound waves to the veins being tested. These waves have then reflected the transducer and translated into a moving image on a computer. An ultrasound can estimate the blood pressure on the right side of the heart.

Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to create detailed images of internal structures. Because MRI is expensive, it's usually reserved for pregnant women and people whose kidneys may be damaged by the dye used in other tests.

Treatments and drugs

Treatment of pulmonary embolism is essential to prevent serious complications or death.

Medicine

Anticoagulants. Heparin is rapid and is usually given as an infusion. Warfarin (Coumadin) in drug forms. Both prevent new blood clots from forming, but it takes a few days before warfarin begins to work effectively. Risks include bleeding gums, easy bruising.

Dissolve blood clots (thrombosis). While blood clots usually dissolve on their own, there are medications that can dissolve blood clots quickly. Because clot-busting medications can cause severe and sudden bleeding, it is usually reserved for life-threatening situations.

Surgery and other procedures

Remove blood clots. If there is a very large blood clot in the lung, your doctor may recommend removing it through a catheter threaded through a blood vessel.

Vein filter. The catheter can also be used to position the filter in the main vein - called the inferior vena cava - that leads from the leg into the right side of the heart. This filter can block blood clots from entering the lungs. This procedure is usually for people who can't take their blood thinners or their anticoagulants aren't working well enough.

Prevention

Preventing blood clots in the deep veins of the legs (deep vein thrombosis) will help prevent pulmonary embolism. Several precautions are used in the hospital. Others take their own precautions.

Precautions in the hospital

Heparin or warfarin (Coumadin). The anticoagulants heparin and warfarin are indicated for people at risk for blood clots - as well as for people hospitalized with a heart attack, stroke, one of the complications of cancer.

Compression socks. Compression stockings squeeze the legs, helping the blood in the veins and calf muscles move more efficiently. It is simple and inexpensive, to keep blood from stagnation after surgery is generally safe.

Use compressed air. This treatment uses a device that automatically releases air every few minutes to massage and compress the veins in the legs and improve blood flow.

Physical activity. Moving as soon as possible after surgery can help prevent pulmonary embolism and speed up overall recovery. This is one of the main reasons nurses are able to push up and walk despite the pain of the surgical incision.

Provision for traveling

Sitting during a flight or long car ride increases the risk of developing blood clots in the veins of the legs. To help prevent blood clots from forming:

Take a walk. Move around in an airplane cabin once an hour or so. If you're driving, stop every hour and walk around the car a few times.

Exercise while sitting. Extend and rotate the ankle or press the foot, or try up and down toes. And don't sit with your legs crossed for long periods of time.

Wear supportive socks. Helps promote circulation, fluid movement.

Drink a lot of water. Water is the best fluid to prevent dehydration, which can contribute to the development of blood clots. Avoid drinking alcohol, which contributes to fluid loss.