Pulmonary Embolism

The type of clot that is likely to cause a pulmonary embolism usually originates in the veins deep in the muscles. This condition is called deep vein thrombosis (DVT). DVT usually occurs in the leg or pelvic veins. Less commonly, it can also occur in the arm veins. A number of factors can increase the risk of DVT or pulmonary embolism, including major surgery, inherited blood clotting abnormalities, hip or leg fractures, standing or sitting for long periods of time, cancer, obesity, smoking, having a history of heart attack or stroke, and having a close family member who has had a pulmonary embolism.

What is pulmonary embolism?

A pulmonary embolism is a blood clot that forms in a vein, travels through the bloodstream, and lodges in the lungs. A pulmonary embolism is a medical emergency because a large embolism, or sometimes many repeated smaller ones, can be fatal in a short time.

Symptoms

Shortness of Breath

Tightening in the chest, rapid breathing, and shortness of breath are the most common symptoms of pulmonary embolism.

Secondary Symptoms

Less common symptoms include anxiety and restlessness; chest pain which may extend to the arm, shoulder, neck, and jaw; coughing or spitting up blood; feeling lightheaded or fainting; and having a rapid heartbeat.

Diagnosis

Examination

A complete physical examination and history.

Chest X-Ray

A complete chest x-ray may help to identify and locate a pulmonary embolism.

Electrocardiography

An electrocardiogram measures your heart’s electrical activity.

D-dimer Enzyme-linked Immunosorbent Assay

This blood test can show if there is an increase in a type of protein that may rise after a pulmonary embolism.

Lung Scanning

This test measures blood flow in your lungs and your air intake.

Spiral Computed Tomography (CT) Scan

A spiral CT scan allows for uniform, highly accurate scans of pulmonary arteries.

Pulmonary Angiography

A pulmonary angiography shows x-ray pictures of the blood vessels in your lungs.

Duplex Ultrasound

This test allows your physician to measure the speed of blood flow and to see the structure of your leg veins.

Venography

Venography shows x-ray pictures of your leg veins.

Treatments

If you have a pulmonary embolism, your physician or vascular surgeon may administer an anticoagulant drug called Heparin intravenously as initial treatment. Anticoagulants help prevent your blood from clotting too easily. Heparin helps prevent clots from forming and keeps clots you already have from growing. Eventually, your body breaks up the clot that has caused your pulmonary embolism. After initial therapy with Heparin, daily oral anticoagulation medications are started.

If you have a large pulmonary embolism, or you have another medical condition, the vascular surgeon may recommend more aggressive treatments. A treatment called thrombolysis can dissolve the clot. In this procedure, the vascular surgeon injects clot-dissolving drugs through a catheter directly into the clot. Thrombolysis has a higher risk for bleeding complications and stroke than anticoagulant therapy but may be effective more quickly, a feature that may be important if the pulmonary embolism is large.

In you are unable to receive anticoagulant therapy or thrombolysis, the vascular surgeon may attempt to remove the clot using a catheter technique. Using this technique, called suction thrombectomy, the vascular surgeon guides a catheter through your blood vessels to your pulmonary embolism. The catheter shoots a salt solution into the blocked artery. The water pressure pulls the clot toward the tip of the catheter and breaks up the clot.

Rarely, physicians recommend surgery for a pulmonary embolism. The procedure is called pulmonary embolectomy. You may need this surgery if you have life-threatening blockages in your lungs that are not responsive to other treatments.

In some circumstances, your physician may recommend placement of a special metal filter in your main vein, the vena cava, if drug therapy isn’t feasible or isn’t enough to prevent pulmonary embolisms from recurring. This device is called a vena cava filter. The vena cava is a large vein in your abdomen that carries blood back to your heart and lungs. Vena cava filters can trap the clots that break away from your leg veins before they can reach your lungs. The vascular surgeon inserts the filter into your vena cava through a catheter. Some of these filters are left in place permanently and some can be removed.

Risks of Operation

Anticoagulation, both IV and oral forms have a risk of bleeding. Thrombolytic therapy has a higher incidence of bleeding than anticoagulation. The patients have to be monitored very closely in the ICU when these drugs are used. Open thrombectomy and suction thrombectomy are very high risk procedures and are performed rarely and as a last resort.