Published on Sep 14, 2019 and last reviewed on Oct 03, 2019 - 4 min read
Pulmonary embolism occurs when a lump, most commonly a blood clot, gets stuck in an artery in the lung, which stops the blood supply to the lung. Read about its causes, symptoms, and treatment.
“Embolism” means plug or stopper in greek. A blockage in the artery that supplies the blood to the lungs (pulmonary artery) is called pulmonary embolism. It affects around 1 in 1,000 people in the US and is one of the most common cardiovascular diseases. It can be fatal, as it prevents oxygen from reaching the lungs.
The block or embolus is most commonly a blood clot. The embolus can form in one part of the body and block the blood flow to other parts by traveling through the blood vessels. A thrombus, unlike an embolus, forms and stays in the same place. Prompt treatment can prevent complications and reduce death rates.
The symptoms vary depending on the size of the embolus, existing lung and heart problems, and the amount of lung involved. The common signs and symptoms of pulmonary embolism include:
Difficulty breathing, which gets worse with exertion.
Chest pain that gets worse with a deep breath, cough, exertion, and bending.
Cough with or without bloody or blood-streaked sputum.
Calf pain or swelling.
Bluish discoloration of the skin (cyanosis).
If you find it difficult to breathe and have chest pain, get immediate medical pain, as they are also signs of a heart attack.
Pulmonary embolisms are most often caused by blood clots blocking the deep veins in the body, which is called deep vein thrombosis. These blood clots usually originate in the arteries of legs or pelvis, and result from:
Blood vessel damage caused by bone fractures or muscle tears.
Long periods of inactivity result in blood clots as blood gets stagnated in the lowest areas of the body due to gravity.
Medical conditions that make the blood to clot easily.
Apart from blood clots, sometimes, the blood vessels get blocked by:
A segment of a tumor.
Fat dislodged from a fractured bone.
Factors that increase the risk of developing deep vein thrombosis (DVT) and pulmonary embolism include:
A positive family history.
After a major surgery.
Taking hormones like estrogen or testosterone.
Fracture of a major bone like hip or thigh.
People with blood clotting disorders like Factor V Leiden and elevated levels of homocysteine.
Previous heart attack or stroke.
Prolonged bed rest.
Sitting in a single position during a trip.
Some of the common complications of pulmonary embolism are:
Heart attack - The embolus can block the major blood vessel of the heart, which might result in a heart attack. It is a medical emergency.
Pleural effusion - Collection of fluid between the layers that surround the lungs.
Pulmonary infarction - It occurs when a portion of lung tissue dies, as the blood supply is cut off.
Arrhythmia - Pulmonary embolism makes the right side of the heart work harder, which results in abnormal heart rhythm or arrhythmia.
Pulmonary hypertension - Increased blood pressure in the arteries of the lungs.
An underlying heart or lung disease like hypertension or emphysema makes diagnosing PE difficult. Your doctor will ask about your overall health and any pre-existing conditions, and might tell you to get one or more of the following tests done:
Blood test - To detect clot-dissolving substance D dimer in the blood.
Chest X-ray - The heart and lungs can be seen in detail.
Electrocardiography (ECG) - To measure the electric activity of the heart.
MRI and CT scan - To see detailed and cross-sectional images of the heart and lungs.
Pulmonary angiogram - Here, specialized tools are passed through the veins and a dye is injected. The dye helps doctors see the blood vessels of the lungs.
Duplex venous ultrasound - Here, soundwaves are used to detect any clots in the veins.
Venography - It is a special type of X-ray, which shows the veins of the legs.
Depending on the size and location of the blood clot, your doctor will plan your treatment. Small clots can be broken up with medicines like:
Blood thinners - Anticoagulants or blood thinners prevent the formation of a new clot. Examples are Warfarin and Heparin.
Thrombolytics - Otherwise called clot dissolvers, help breakdown clots. It is used
only in case of an emergency.
For clots that cause serious blood flow restriction to the heart and lungs, surgery may be necessary. The surgical options are:
Clot removal - The clot is removed using a thin, flexible tube inserted through the blood vessels.
Vein filter: A small filter is installed in the main artery of the heart through a small incision. This filter prevents blood clots from reaching your lungs from your legs.
Open surgery - Open surgery is done in emergencies.
If you have any of the factors that increase the risk of PE, try the following to prevent blood clots:
Drinking a lot of water prevents dehydration and blood clots.
Do not consume alcohol as it helps fluid loss.
Compression stockings help promote blood circulation to your legs.
Avoid sitting for long hours while traveling or working. Take frequent breaks or flex your ankles every 15 to 30 minutes.
The underlying cause has to be treated, after treatment for PE. Your doctor will prescribe blood thinners to prevent more blood clots. To know more about preventing such blood clots, consult a doctor online.
Pulmonary embolism causes sharp pains, which gets worse with each breath. Such chest pain does not get better with rest. It can also cause difficulty breathing and rapid heart rate.
A PE can be fatal if the embolus blocks the blood flow to major organs like the heart and lungs. It can also damage other organs.
Foods that help reduce blood clots are turmeric, ginger, peppers, vitamin E rich foods, garlic, grape seeds, cinnamon, and Bromelain (an enzyme extracted from pineapple).
Prompt diagnosis and treatment of pulmonary embolism reduce the fatality rate. But most often, this condition goes undiagnosed because of underlying heart or lung disease, which results in the death of one-third of people with PE.
People with deep vein thrombosis (DVT), which is a blood clot in the deep vein like the leg, are mostly affected by PE. The factors that increase the risk of DVT are cancer, fracture, sedentary lifestyle, obesity, smoking, pregnancy, and people older than 60 years.
Small clots can get cleared on its own by the body. The body activates a protein called plasmin, which is present in the clot. This plasmin, once activated, breaks down the clot.
The survival rate depends on the size of the embolus. The first week after the clot has formed is the risk period. If you survive that, the clot might take months to years to dissolve. You might have to live with shortness of breath, pulmonary hypertension, and exercise intolerance.
The survival rate of PE is between 77 % and 94 %. A large embolus can block the blood supply to the lungs, which can reduce the blood oxygen levels. This, in turn, affects other organs.
An embolus can dissolve on its own. But in some cases, if PE is left untreated, it can cause heart attack, pleural effusion, pulmonary infarction, arrhythmia, pulmonary hypertension, and death.
Query: Hello doctor, I am a 43 year old male. I have been taking Xarelto for about a year-and-a-half due to a pulmonary embolism that I had. They were very small. I have done every test including the factor 5 and the conclusion was my constant driving. My biggest fear is obviously getting another blood cl... Read Full »
Query: Hello doctor,I am having a burning sensation in my leg. I am wondering if that is a blood clot and if I should go to the emergency room. I had a massive pulmonary embolism and have been coded for 45 minutes. I am on a blood thinner called Eliquis. I am very freaked out right now as I have not had th... Read Full »
Query: Hi doctor, I have extreme swelling and pain in both lower legs and feet. I also have severe pain in both hands, on all fingers, both wrists, both forearms,both elbows as well as both knees. It is extremely painful for me to stand and walk. I had a CMP (comprehensive metabolic panel) and CBC done... Read Full »
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