Choose the content to read

• Pulmonary Embolism
• What are the symptoms of a pulmonary embolism?
• When to see a doctor?
• What are the causes of pulmonary embolism?
• What are the risk factors for a pulmonary embolism?  
• What are the complications of pulmonary embolism?
• What are the diagnostic tests for pulmonary embolism?
• What are the treatment options for pulmonary embolism?

Pulmonary Embolism

A pulmonary embolism occurs when a blood clot obstructs the blood flow in an artery in the lung. Often, a blood clot forms in a deep vein in the leg, which becomes dislodged and travels to the lungs, obstructing the blood flow. Pulmonary embolisms can be fatal, but timely intervention can significantly diminish the risk of death. Deep vein thrombosis preventive measures can reduce the risk of pulmonary embolisms.

What are the symptoms of a pulmonary embolism?

• Shortness of breath.
• Chest pain that aggravates when taking a deep breath.
• Coughing up blood.
• Sharp pain in the chest, neck, jaw, shoulder, and arm.
• Pale and bluish skin.
• Rapid pulse
• Profuse sweating.
• Wheezing.
• Lightheadedness
• Syncope

When to see a doctor?

If you develop sudden shortness of breath, chest pain, or syncope without known cause, seek immediate medical care. Pulmonary embolism is life-threatening but treatable. Timely treatment can minimize the mortality rate.

What are the causes of pulmonary embolism?

• Blood pooling and stasis in a specific area of the body, typically an arm or leg, often after surgery and prolonged bed rest.
• Vein damage resulting from fractures or surgical procedures of the pelvis, hip, knee, or leg.
• Cardiovascular diseases such as heart attack, stroke, congestive heart failure, and atrial fibrillation.
• Increased coagulability due to cancer, hormone replacement therapy, or birth control pills.

What are the risk factors for a pulmonary embolism?

• Deep vein thrombosis or blood clots in the leg.
• Varicose veins or vein injury from surgery or bone fracture.
• Use of oral contraceptives or hormone replacement therapy.
• Smoking.
• BMI greater than 25.
• Pregnancy or childbirth in the past six weeks.
• Central venous catheter through arm or leg.
• Sit or stay inactive for a prolonged period.

What are the complications of pulmonary embolism?

Acute and chronic pulmonary hypertension can occur if emboli remain in the lungs and cause fibrosis in the pulmonary arteries.

What are the diagnostic tests for pulmonary embolism?

Diagnosing a pulmonary embolism can be challenging, particularly in individuals with preexisting heart or lung conditions.

• Blood tests: Blood tests for D-dimer, a degradation product of blood clots. Elevated levels indicate a higher probability of blood clots. Blood tests can check blood oxygen and carbon dioxide saturation levels. If you have blood clots in pulmonary arteries, your blood oxygen levels will drop. Furthermore, checking for blood clotting factors can ascertain if you have an inherited clotting disorder.
• Chest X-ray: It can help eliminate other possible causes of your symptoms.
• Duplex ultrasonography: It uses sound waves to check for deep vein blood clots and blood flow in the knee, thigh, calf, and arms.
• CT pulmonary angiography: CT pulmonary angiography can produce 3D images to locate a pulmonary embolism in the lung arteries.
• Ventilation-perfusion (V/Q) scan: This test assesses for the presence of pulmonary embolism. During the procedure, you breathe and receive an injection of a radioactive substance known as a tracer into a vein in your arm to evaluate the proper matching of perfusion and ventilation in your lungs.
• Pulmonary angiogram: This test is considered the gold standard for diagnosing pulmonary embolisms. However, due to its complexity and potential risks, it is typically reserved for cases where other diagnostic tests have not provided a conclusive result. During a pulmonary angiogram, a catheter is inserted into a large vein, usually in the groin area, and guided through the heart into the pulmonary arteries. A radio-opaque dye is then injected through the catheter to delineate filling defects in the lung arteries. Some people may experience temporary arrhythmia during this procedure. The dye may predispose to kidney damage in individuals with compromised kidney function.
• MRI: MRI is advisable for people with chronic kidney diseases or those who should avoid radiation exposure, such as pregnant women.

What are the treatment options for pulmonary embolism?

• Anticoagulant medications: Anticoagulants reduce blood clotting ability, thereby preventing future blood clots. The anticoagulant, dosage, and treatment duration will be determined individually by monitoring clotting times. While taking anticoagulants, doctors will order serial coagulation tests to monitor how fast your blood clots to help with dosage adjustment.
• Compression stockings: Compression stockings prescribed for medical use enhance blood circulation in your legs and prevent blood pooling. It is crucial to discuss with your doctor the proper usage, duration, and maintenance of your compression stockings.
• Thrombolytic therapy: Thrombolytic medications such as tissue plasminogen activator (TPA) are usually administered in the intensive care unit (ICU) under close monitoring by your doctors. Thrombolytics are necessary if you have low, unstable blood pressure due to pulmonary embolism. The side effects of this treatment include bleeding.

How can I prevent a pulmonary embolism?

• It is essential to prevent clots in the deep veins of your legs to forestall pulmonary embolism.
• Take anticoagulants often given to people who are at risk of developing pre- and post-operative blood clots or those with stroke, heart attack, or cancer.
• Wear compression stockings, which help with the blood circulation in the legs.
• Use pneumatic compression to massage and improve the blood flow in the legs. 
• Sit or sleep with elevated legs for at least 30 minutes twice daily. Keeping your leg elevated at night can be highly effective. Consider raising the end of your bed by 4 to 6 inches with wooden blocks or books.
• Move about regularly. Do not sit or stay in the same position for an extended period. Mobility after surgery can significantly reduce the risk of pulmonary embolism and accelerate overall recovery.
• Exercise regularly.
• Drink 6-8 glasses of water a day.
• Limit your caffeine and alcohol consumption.
• Stop smoking.
• Lose weight and keep a healthy weight.

What is the preparation before seeing your doctor?

A pulmonary embolism is an emergency. Seek immediate medical attention if you think you have a pulmonary embolism.

What you can do before seeing your doctor is to list your symptoms, preexisting medical conditions, recent injuries or illnesses, medications or dietary supplements you are taking, recent long car or plane rides, your family history, and questions you would like to ask your doctor.

A note from MedPark’s doctors

If you notice signs of pulmonary embolism, see your doctor for a proper diagnosis. The condition is treatable with timely treatment.