Pulmonary embolism (patient information)

Pulmonary embolism
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Pulmonary embolism?
What to expect (Outlook/Prognosis)?
Possible complications
Pulmonary embolism On the Web
Ongoing Trials at Clinical Trials.gov
Images of Pulmonary embolism
Videos on Pulmonary embolism
FDA on Pulmonary embolism
CDC on Pulmonary embolism
Pulmonary embolism in the news
Blogs on Pulmonary embolism
Directions to Hospitals Treating Pulmonary embolism
Risk calculators and risk factors for Pulmonary embolism

For the WikiDoc page for this topic, click here

Editors-in-Chief: C. Michael Gibson, M.S., M.D.; The APEX Trial Investigators

Overview

Pulmonary embolism (PE) is a sudden blockage in an artery within the lungs. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg. This clot blocks blood flow to part of the lung, and if the clot is large or if there are numerous clots, it may be fatal.

What are the symptoms of pulmonary embolism?

Signs and symptoms vary from person to person. However, the common symptoms are:

• Chest Pain
  • Under the breastbone or towards one side
  • May feel sharp or stabbing
  • May also be described as a burning, aching, or dull, heavy sensation
  • May get worse with deep breathing, coughing, eating, or bending
  • May cause you to bend over and hold your chest due to the pain

• Sudden cough
  • May cough up blood or bloody mucus

• Rapid heart rate

• Shortness of breath that starts suddenly

Other symptoms that may occur are:

• Anxiety or feeling of panic
• Bluish skin discoloration (cyanosis)
• Clammy skin
• Dizziness
• Leg pain, redness, and swelling
• Lightheadedness or fainting
• Low blood pressure
• Sweating
• Wheezing

What causes a pulmonary embolism?

A pulmonary embolism is most often caused by a blood clot in a vein in the leg or in the pelvis (hip area), which breaks off and travels to block an artery in the lung. The most common cause is a blood clot in a deep vein of the thighs. This type of clot is called a deep vein thrombosis (DVT).

Less common causes of a pulmonary embolism include air bubbles, fat droplets, amniotic fluid, parasites or tumor cells, all of which may lead to a blockage of an artery in the lung.

Risk factors for a pulmonary embolism include:

• Burns
• Cancer
• Childbirth
• Family history of blood clots
• Fractures of the hips or thigh bone
• Heart attack
• Heart surgery
• Long-term bed rest or staying in one position for a long time, such as a long plane or car ride
• Severe injury
• Stroke
• Surgery (especially orthopedic or neurological surgery)
• Use of birth control pills or estrogen therapy

People with certain clotting disorders also have a higher risk for developing a pulmonary embolism.

Who is at highest risk?

Certain conditions carry a significantly increased risk of pulmonary embolism. These conditions are:

• Thrombophilias are a group of conditions in which blood has an increased tendency to clot. Thrombophilias can be inherited or acquired. Acquired thrombophilias occur in association with other medical conditions such as polycythemia vera or antiphospholipid Antibody Syndrome.

• These are other conditions which also increase one's risk of having a PE:
  • Pregnancy
  • Obesity
  • Smoking
  • Cancer
  • Heart failure
  • Previous PE
  • Medications such as oral contraceptive pills, tamoxifen, and hormone replacement therapy.

When to seek urgent medical care?

Pulmonary embolism can be potentially life threatening and one should seek medical care when suffering from symptoms of Pulmonary embolism such as severe sharp chest pain, shortness of breath, blood in sputum, and a raised heart rate.

Diagnosis

The various methods used to diagnose a pulmonary embolism are:

• CT scan
• Angiography
• V/Q scan
• Echocardiogram

Treatment options

A pulmonary embolism requires emergency medical treatment and consequently you will have to stay in the hospital and will also recieve oxygen.In cases of severe, life-threatening pulmonary embolism, treatment may involve dissolving the clot with the use of medications called thrombolytic therapy. Clot-dissolving medications include:

• Streptokinase
• T-plasminogen activator (t-PA)

Blood thinners are given to prevent further clots. This is called anticoagulation therapy.

• The most common blood thinners are heparin and warfarin (Coumadin).
• Fondaparinux (Arixtra) is a newer blood thinner used under special circumstances.

Heparin or heparin-type drugs are usually tried first. They can be given through a vein (by IV) or by injection under the skin.

Warfarin is later given in pill form. When you first start taking warfarin, you will need frequent blood tests. This will help your doctor properly adjust your dose. You will likely need to take warfarin for several months.

• Patients who have reactions to heparin or related medications may need other medications.
• Patients who cannot tolerate blood thinners or for whom they may be too risky may need a device called an inferior vena cava filter (IVC filter). This device is placed in a main vein in the abdominal area. It keeps large clots from traveling into the blood vessels of the lungs. Sometimes a temporary filter can be placed and removed later.

Other medications to treat a pulmonary embolism may include:

• Anticoagulants - to prevent clot formation
• Thrombolytic - to remove the already formed clot
• Inferior vena cava filter - to prevent the clot, formed in legs, to reach the lungs
• Embolectomy - to remove the clot that’s already formed

Medications to avoid

Patients diagnosed with Pulmonary embolism should avoid using the following medications:

• Alteplase
• Esterified estrogens
• Raloxifene
  If you have been diagnosed with Pulmonary embolism, consult your physician before starting or stopping any of these medications.

Where to find medical care for pulmonary embolism?

Directions to Hospitals Treating Pulmonary embolism

What to expect (Outlook/Prognosis)?

It is hard to predict the outlook of a person recovering from a pulmonary embolism. It will depend on the cause of the initial problem, such as cancer, major surgery, or an injury.

Death is possible in people with a severe pulmonary embolism.

Possible complications

It is a potentially lethal condition if the main arteries of the lungs blocked . If left untreated, about 30 percent of patients die. Most of those who die, do so within the first few hours of the event.

Other possible complications:

• Heart failure or shock
• Heart palpitations
• Pulmonary hypertension
• Severe difficulty breathing
• Severe bleeding (usually a complication of treatment)
• Sudden death

Support Group

Members of a support group provide each other with various types peer help to fellow pulmonary embolism patients. The help may take the form of providing relevant and helpful information, relating to each others personal experiences, providing sympathetic understanding, and establishing social networks. A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy. To read more about PE Support group, click here.

Sources

http://www.nhlbi.nih.gov/health/dci/Diseases/pe/pe_what.html

http://www.nlm.nih.gov/medlineplus/pulmonaryembolism.html

Video

Below video demonstrate how a clot from leg can travel up to lungs and cause Pulmonary embolism. {{#ev:youtube| gGrDAGN5pC0 }} Template:WH Template:WS