A pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE, is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from a vein in the leg. A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus. - PE is a serious condition that can cause:
- Permanent damage to part of your lung from lack of blood flow to lung tissue
- Low oxygen levels in your blood
- Damage to other organs in your body from not getting enough oxygen
Overview
In most cases, PE is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in the deep veins of the body—most often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery. This is unlike clots in the veins close the skin's surface, which remain in place and do not cause PE.
Outlook
At least 100,000 cases of PE occur each year in the United States. PE is the third most common cause of death in hospitalized patients. If left untreated, about 30 percent of patients with PE will die. Most of those who die do so within the first few hours of the event
Other Names for Pulmonary Embolism
- Venous thromboembolism (VTE). This term is used for both pulmonary embolism and deep vein thrombosis.
Populations Affected
Pulmonary embolism (PE) occurs equally in men and women. Risk increases with age: For each 10 years after age 60, the risk of PE doubles. Certain inherited conditions, such as factor V Leiden, increase the risk of blood clotting, and, therefore, the risk of PE.
Major Risk Factors
People at high risk for a blood clot that travels to the lungs are those who:
- Have deep vein thrombosis (DVT, a blood clot in the leg) or a history of DVT
- Have had PE before
People who recently have been treated for cancer or who have a central venous catheter (a tube placed in a vein to allow easy access to the bloodstream for medical treatment) are more likely to develop DVT. The same is true for people who have been bedridden or have had surgery or suffered a broken bone in the past few weeks. Other risk factors for DVT, which can lead to PE, include sitting for long periods of time (such as on long car or airplane rides), pregnancy and the 6-week period after pregnancy, and being overweight or obese. Women who take hormone therapy or birth control pills also are at increased risk for DVT. People with more than one risk factor are at higher risk for blood clots.
What Causes Pulmonary Embolism?
Major Causes
In 9 out of 10 cases, pulmonary embolism (PE) begins as a blood clot in the deep veins of the leg (a condition known as deep vein thrombosis). The clot breaks free from the vein and travels through the bloodstream to the lungs, where it can block an artery.
Other Causes
Rarely, an air bubble, part of a tumor, or other tissue travels to the lungs and causes PE. Also, when a large bone in the body (such as the thigh bone) breaks, fat from the marrow inside the bone can travel through the blood to the lungs and cause PE.
Signs and Symptoms of Pulmonary Embolism?
Major Signs and Symptoms
Signs and symptoms of pulmonary embolism (PE) include unexplained shortness of breath, difficulty breathing, chest pain, coughing, or coughing up blood. An arrhythmia(a rapid or irregular heartbeat) also may indicate PE. In some cases, the only signs and symptoms are related to deep vein thrombosis(DVT). These include swelling of the leg or along the vein in the leg, pain or tenderness in the leg, a feeling of increased warmth in the area of the leg that's swollen or tender, and red or discolored skin on the affected leg. See your doctor at once if you have any symptoms of PE or DVT. It's possible to have a PE and not have any signs or symptoms of PE or DVT.
Other Signs and Symptoms
Sometimes people who have PE experience feelings of anxiety or dread, lightheadedness or fainting, rapid breathing, sweating, or an increased heart rate.
Treatment
Goals of Treatment The main goals of treating pulmonary embolism (PE) are to:
- Stop the blood clot from getting bigger
- Keep new clots from forming
Specific Types of Treatment Medicines
Anticoagulants (AN-te-ko-AG-u-lants), which are blood-thinning medicines, decrease your blood's ability to clot. They're used to stop blood clots from getting bigger and to prevent clots from forming. They don't break up blood clots that have already formed. (The body dissolves most clots with time.)
Anticoagulants can be taken as either a pill, an injection, or through a needle or tube inserted into a vein (called intravenous, or IV, injection). Warfarin is given in a pill form. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube.
Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once warfarin starts to work, usually the heparin will be stopped.
Pregnant women usually are treated with heparin only, because warfarin is dangerous for the pregnancy.
If you have deep vein thrombosis, treatment with anticoagulants usually lasts for 3 to 6 months.
If you have had blood clots before, you may need a longer period of treatment. If you're being treated for another illness, such as cancer, you may need to take anticoagulants as long as risk factors for PE are present.
The most common side effect of anticoagulants is bleeding. This happens if the medicine thins your blood too much. This side effect can be life threatening. Sometimes, the bleeding can be internal. This is why people treated with anticoagulants usually receive regular blood tests. These tests are called PT and PTT tests, and they measure the blood's ability to clot. These tests also help the doctor make sure you're taking the right amount of medicine. Call your doctor right away if you have easy bruising or bleeding.
Thrombin inhibitors are a newer type of anticoagulant medicine. They're used to treat some types of blood clots for patients who can't take heparin.
Emergency Treatment
Thrombolytics are medicines given to quickly dissolve a blood clot. They're used to treat large clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations.
In some cases, the doctor may use a catheter to reach the blood clot. A catheter is a flexible tube placed in a vein to allow easy access to the bloodstream for medical treatment. The catheter is inserted into the groin (upper thigh) or arm and threaded through a vein to the clot in the lung. The catheter may be used to extract the clot or deliver medicine to dissolve it.
Rarely, surgery may be needed to remove the blood clot.
Other Types of Treatment
Graduated compression stockings can reduce the chronic (ongoing) swelling that may occur after a blood clot has developed in a leg. The leg swelling is due to damage to the valves in the leg veins. Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the ankle and become looser as they go up the leg. This causes a gentle compression (or pressure) up the leg. The pressure keeps blood from pooling and clotting.
Prevention
Preventing pulmonary embolism (PE) begins with preventing deep vein thrombosis(DVT). Knowing whether you're at risk for DVT and taking steps to lower your risk are important.
If you've never had a deep vein clot, but are at risk for it, these are steps you can take to decrease your risk.
- Exercise your lower leg muscles during long car trips and airplane rides.
- Get out of bed and move around as soon as you're able after having surgery or being ill. The sooner you move around, the lower your chance of developing a clot.
- Take medicines to prevent clots after some types of surgery (as directed by your doctor).
- Follow up with your doctor.
- Visit your doctor for regular checkups.
- Use compression stockings to prevent chronic swelling in your legs after DVT (as directed by your doctor).
Living With Pulmonary Embolism
Treatment for PE usually takes place in the hospital. After leaving the hospital you may need to take medicine at home for 6 months or longer. It's important to:
- Take medicines as prescribed.
- Have blood tests done as directed by your doctor.
- Talk to your doctor before taking anticoagulants with any other medicines, including over-the-counter medicines. Over-the-counter aspirin, for example, can thin your blood. Taking two medicines that thin your blood (even if one is over-the-counter) may increase your risk for bleeding.
- Ask your doctor about your diet. Foods that contain vitamin K can affect how well warfarin (Coumadin®) works. Vitamin K is found in green leafy vegetables and some oils, such as canola and soybean oil. It's best to eat a well-balanced, healthy diet.
- Discuss with your doctor what amount of alcohol is safe for you to drink if you're taking medicine.
Signs and symptoms of bleeding in the digestive system include:
- Bright red vomit or vomit that looks like coffee grounds
- Bright red blood in your stool or black, tarry stools
- Pain in your abdomen
- Severe pain in your head
- Sudden changes in your vision
- Sudden loss of movement in your legs or arms
- Memory loss or confusion
Once you have had PE (with or without deep vein thrombosis (DVT)), you have a greater chance of having another one. During treatment and after, continue to:
- Take steps to prevent DVT
- Check your legs for any signs or symptoms of DVT, such as swollen areas, pain or tenderness, increased warmth in swollen or painful areas, or red or discolored skin
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