What are the warning signs of pulmonary embolism, and how is it treated?
Roughly 70% of pulmonary embolism is caused by a blood clot in the leg, called a deep vein thrombosis, breaking free and moving into the lung.
What is a pulmonary embolism?
Pulmonary embolism (PE) is a blood clot that creates a blockage of normal blood vessels in the lungs. Depending on how big a clot and the number of vessels involved, it can be a life-threatening event, which is why prompt diagnosis is important.
Roughly 70% of PE is caused by a blood clot in the leg, called a deep vein thrombosis (DVT), breaking free and moving into the lung. When this happens, the clot blocks the flow of blood to the lung that needs to pick up oxygen. If not enough blood gets oxygen, the oxygen level in the body drops dangerously low, which can cause damage to all the organs in body including the brain, kidneys, and heart.
What are the symptoms?
Shortness of breath (usually sudden in onset)
Light-headedness
Chest pain on deep inhale
Rapid heart beat
Loss of consciousness
Coughing up blood
Your doctor will order various blood tests and imaging to understand the severity and risk of the clot. A CT of the pulmonary arteries is the most commonly used test to look for PE. In this test, dye is injected into the veins of a hand or arm, and a CT scan of the chest is done to look for clot in the lungs. Blood tests can also look for clotting abnormalities, strain on the heart, or damage to other organs.
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How is a pulmonary embolism treated?
If you have a pulmonary embolism, you will need immediate treatment. Typically, a patient will be hospitalized and given a blood thinner, either through injection or IV infusion, to help prevent the clot from getting bigger or new ones from forming while the body slowly dissolves the clot on its own. If the clot is large and causing severe symptoms, special medications or catheter based interventions can be used to help break up and dissolve the clot. Sometimes, in the case of life-threatening symptoms, surgery is performed to remove the clot.
Most people who have had a PE are sent home on oral blood thinners (anticoagulants). Blood thinner treatment is usually recommended for at least three to six months. Some people at high risk of blood clots may stay on blood thinner indefinitely.
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Who is at higher risk of a blood clot?
Patients with the following conditions or habits may be among those at higher risk:
Abnormal blood vessels such as varicose veins
Certain diseases such as cancer or heart disease
Pregnancy or in the six weeks following delivery
Smoking
Obesity
Long car or airplane rides without stops to get up and move around (four to six hours at a time)
Prolonged bed rest after major surgery or trauma
Oral contraceptive pills/hormonal medications
Those age 70 and older
Additionally, people with prior history of PE are at a higher risk for future blood clots. That’s why it is very important that you take blood thinners exactly as prescribed to prevent future clots.
All patients diagnosed with a blood clot may have undiagnosed lung or heart conditions, and sometimes cancer. It is very important to follow up with a primary care provider and often times a specialist like a pulmonologist.
Parth M. Rali is an associate professor in the Division of Thoracic Medicine and Surgery at Lewis Katz School of Medicine at Temple University and the director of Temple University Health System’s Pulmonary Embolism Response Team (PERT) Program. He serves as chair of National PERT Consortium Protocol Committee and a guideline panelist for American College of Chest Physician COVID-VTE guidelines.