Pulmonary Embolism (PE) is a blood clot that lodges in the blood vessels in the lungs and prevents normal flow of blood in that area. The blood clot forms in the leg, pelvic, or arm veins, then breaks off from the vein wall and travels through the heart into the lung arteries. This blockage causes problems with gas exchange. Depending on how big a clot and number of vessels involved, it can be a life-threatening event.
Risk factors include immobility, smoking cigarettes, being overweight, and having high blood pressure—all of which can be potentially controlled with a heart healthy lifestyle. A recent study showed that eating fruits and vegetables can be protective against developing PE.
However, people who frequently eat red meat had double the risk of developing PE. Other risk factors for PE include cancer, long airline flights, surgery and trauma. PE is also associated with women’s health issues such as use of birth control pills, pregnancy and hormone replacement therapy. Certain genetic mutations predispose to PE, such as “factor V Leiden” and the “prothrombin gene mutation.”
What is a deep vein thrombosis (DVT) and how it is related to PE?
A DVT is a clot that forms and builds up in the large veins of legs or sometimes the arms. Signs and symptoms of a DVT in the affected leg (or arm) include; swelling, pain, redness and warmth Venous blood flow studies (Doppler) can be done to look for a blood clot. Treating a DVT promptly can help relieve symptoms and prevent a pulmonary embolism.
The most common symptom is unexplained shortness of breath and/or chest pain with difficulty breathing. However, PE can be difficult to diagnose and has been called “the Great Masquerader.” It can mimic pneumonia, congestive heart failure, and a viral illness known as pleurisy.
Critical Limb Ischemia
• Shortness of breath
• Chest pain, often worse when taking a breath
• A feeling of apprehension
• Sudden collapse
• Bloody phlegm (coughing up blood)
The signs and symptoms of these disorders can vary by individual and event. Some individuals may also experience uncommon symptoms such as dizziness, back pain or wheezing. Because PE can be fatal, if you experience these signs or symptoms seek medical attention right away.
A definitive diagnosis of PE must be made in a hospital or clinic with radiology facilities. A chest CT scan (“CAT scan”) or a nuclear medicine scan are the most common tests to diagnosis PE. The most crucial point is for patients and their health care providers to consider the possibility of PE. Prior to a chest CT scanning or a nuclear medicine scan, doctors may determine the likelihood of PE through screening tests such as a chest X-ray, electrocardiogram and a blood test called a “D-dimer” (low D-dimer levels virtually exclude PE).
The foundation of treatment is thinning the blood with anticoagulants such as heparin, low molecular weight heparin, fondaparinux, direct thrombin inhibitors (argatroban, lepirudin, or bivalirudin) or the oral blood thinner, warfarin. Immediately acting intravenous or injected blood thinner must be administered right away. The oral blood thinner, warfarin, takes about five days to become effective to prevent the development of a recurrent PE.
In addition to blood thinners, more aggressive therapies include “clot buster” drugs such as TPA or catheter-based or surgical embolectomy to remove the PE. The duration of treatment with the oral blood thinner will vary from 6 months to lifelong, depending upon the circumstances of the PE and other individual risk factors.