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Pulmonary embolismAlso known as Lung blood clot, and Embolus
A pulmonary embolism is a blood clot that blocks and stops blood flow to an artery in the lung. In most cases, the blood clot starts in a deep vein in the leg and travels to the lung. It can damage parts of the lungs due to restricted blood flow and decreased oxygen levels in the blood.
The most common symptoms of PE include chest pain, irregular heartbeat, weak pulse, palpitations (heart racing), sweating, and low blood pressure. It is generally seen in older individuals and men are more commonly affected by men. The risk factors for pulmonary embolism include genetic conditions that increase the risk of blood clot formation, family history, older age, obesity, cigarette smoking, and obesity.
The treatment of PE depends on the size and severity of the symptoms. If the problem is small, the doctor may recommend medication. But, in a few cases, minimally invasive procedures or surgery may be necessary. Following a healthy lifestyle, quitting smoking, and doing daily physical activity can decrease the risk of developing pulmonary embolism.
- Individuals after 60 to 70 years of age.
- Both men and women, but more common in women
- World: 10 million (2019)
- Acute coronary syndrome
- Stable angina
- Acute pericarditis
- Congestive heart failure
- Cardiac arrhythmias
- Vasovagal syncope
Imaging tests: Computed Tomographic Pulmonary Angiography (CTPA), Ventilation-perfusion scan (V/Q scan), Electrocardiogram (EKG, & Pulmonary angiogram
- Lab tests: Arterial blood gas (ABG) analysis & Brain natriuretic peptide (BNP).
Medications: Heparin and Fondaparinux
Reperfusion strategies: Catheter-directed treatment, Vena cava filter, thrombolytic therapy, and Pulmonary embolectomy
- Compression stockings
- Supportive treatment
Symptoms Of Pulmonary Embolism
The symptoms may vary depending on the size of the clots, involvement of the lungs, and depending upon underlying medical conditions. The following are the most common symptoms of pulmonary embolism (PE):
- Shortness of breath
- Chest pain
- Rapid or irregular heartbeat
- Pain or swelling in the leg
- Low blood pressure
- Coughing blood
- Cold clammy and discolored skin (cyanosis)
Chest pain is the most common symptom of pulmonary embolism. It is a sharp, stabbing, and aching pain that is difficult to manage an individual facing.
Learn about first aid for chest pain.
Types Of Pulmonary Embolism
Pulmonary embolism can be classified as follows:
1. Acute pulmonary embolism
An acute pulmonary embolism, or embolus, is a blockage of an artery in the lung. It develops due to the formation of blood clots in the legs or another part of the body (deep vein thrombosis) that travels to the lungs.
2. Chronic pulmonary embolism
This type is characterized by blockage of the pulmonary arteries that occurs when prior clots in the vessels do not dissolve over time. This can also happen despite treatment of an acute PE, or as a result of an undetected acute PE.
Causes Of Pulmonary Embolism
PE occurs when a blood clot gets stuck in an artery in the lungs, blocking blood flow. These blood clots most commonly come from the deep veins of your legs, a condition known as deep vein thrombosis. In most cases, multiple clothes can block a significant portion of the lungs leading to pulmonary infarction (where the portion does not get enough blood and dies). This makes it more difficult for your lungs to provide oxygen to the rest of your body.
Risk Factors For Pulmonary Embolism
Any individual can develop blood clots, which lead to pulmonary embolism. Certain factors that increase the risk of the disease are:
Individuals having parents or siblings with venous blood clots or pulmonary embolism are at the highest risk of developing this condition.
Blood clots are more likely to form during longer than usual periods of inactivity. Sitting at one place for a longer period can lead to slower blood flow in the legs causing blood clots leading to pulmonary embolism.
3. Medical conditions
Some medical conditions often increase the risk of pulmonary embolism. These include:
- Cancer: Various types of cancers like brain, ovary, stomach, lung, and kidney cancers, can increase the risk of blood clots. People undergoing cancer treatment (chemotherapy) further increase the risk of forming blood clots.
- Surgery: This is a significant cause of blood clot formation. In many surgeries, medicine is prescribed both before and after, to prevent blood clots.
- Heart disease: Patients with cardiac disease, such as coronary artery disease, atrial fibrillation (AF), and heart failure (HF), display a higher risk for PE.
- COVID-19: Individuals with severe symptoms of coronavirus, often display pulmonary embolism as one of the complications. The condition occurs when a blood clot formed in the legs travels through the bloodstream to the lungs.
Understand COVID-19 better
4. Bone fractures
Sometimes in the case of a bone fracture, the fat particles from inside the bone can release into the bloodstream. In a few cases, blockages in the blood vessels are caused by substances other than blood clots, such as fat from the inside of a broken long bone, and air bubbles.
Factor V Leiden is a genetic mutation that increases a person’s risk of forming blood clots. The most common complications of this mutation include DVT and PE. But, in many cases, people with this mutation may not develop a blood clot.
6. Other factors
Pregnancy: Women are at a higher risk for PE during pregnancy by five times when compared to nonpregnant women.
- Smoking: It increases the activation of platelets by a hundred times, which can lead to a significant increase in blood clot formation.
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- Obesity: Being overweight or obese can increase the chances of blood clots and deep vein thrombosis. Weight gain changes lead to the thickness of the blood, making it harder to force through the veins and therefore increasing the risk of PE.
Diagnosis Of Pulmonary Embolism
Timely diagnosis of pulmonary embolism can prevent several major health complications. Diagnosis mainly consists of the following:
1. History and physical examination
A detailed family and medical history can help evaluate the risk factors for pulmonary embolism.
During the examination, patients with PE might have tachycardia (irregular heart rhythms), which is a common but nonspecific finding. Some of the other findings of PE include calf swelling, tenderness, redness, decreased breath sounds, and signs of pulmonary hypertension (which happens when the pressure in the blood vessels l from the heart to the lungs is too high) such as elevated neck veins.
2. Imaging tests
With physical and medical examination, a few imaging tests may be required to confirm pulmonary embolism. They include:
Computed tomographic pulmonary angiography (CTPA):.A CTPA is a CT scan that looks for blood clots in the lungs (mainly PE). A CT pulmonary angiogram takes pictures of the blood vessels that run from the heart to the lungs.
Chest radiograph (chest X-ray): This imaging test is used to assess the lungs and heart.
Ventilation-perfusion scan (V/Q scan): In this test, a small radioactive material is injected into the vein which helps in evaluating the movement of air into and out of the lungs along with the blood flow into the lungs.
Electrocardiogram (EKG): This is one of the simplest tests used for the evaluation of the heart. An EKG is recorded to detect the electrical activity of the heart to diagnose conditions of pulmonary embolism.
Duplex ultrasound (US): The duplex or doppler ultrasound test examines the blood flow in the major arteries and veins in the arms and legs to detect clots.
Magnetic resonance imaging (MRI): This test is a medical imaging technique that uses a magnetic field to create detailed images of the organs and tissues in your body. MRI has better sensitivity and specificity in detecting PE.
Pulmonary angiogram: A pulmonary angiogram is an imaging test to check the blood vessels of the lungs. The procedure is done with a special contrast dye administered into the blood vessels.
3. Lab tests
Arterial blood gas (ABG) analysis: ABG is a blood test that is used to indicate ventilation, gaseous exchange, and acid-base status. It is rarely used to diagnose PE.
- Brain natriuretic peptide (BNP): This is a blood test that measures the levels of a protein called BNP that is made by the heart and blood vessels. In a few individuals, there have been elevated plasma BNP levels in acute pulmonary embolism (APE).
Get all the tests done in the comfort and safety of your home.
Prevention Of Pulmonary Embolism
Pulmonary embolism is often caused by a blood clot that originally forms in the legs, and it is often difficult to detect a DVT before problems start. Therefore, preventing clots in the deep veins will help prevent pulmonary embolisms. It includes things such as:
1. Manage your weight
Obesity puts additional pressure on the veins in the legs, which can contribute to poor blood flow and the development of blood clots. Eating a balanced diet will help in maintaining a healthy weight, and reduces the risk of blood clot formation.
Here is a list of 7 weight loss foods to lose weight naturally.
2. Use compression stockings
These stockings fit tightly around your lower legs and encourage the blood to flow more quickly around your body. This is a very safe, simple, and inexpensive way that squeezes or compresses the veins and prevents blood from flowing backward.
Check out our widest range of compression support products to meet all your needs.
3. Start moving after surgery
There is a misconception that you need to lie in bed post-surgery. But, the main reason why doctors and nurses push you to get up and move is to prevent clots from forming by stimulating blood circulation.
4. Try pneumatic compression devices
Intermittent pneumatic compression (IPC) devices are used to help prevent blood clots in the deep veins of the legs. These are the inflatable sleeves that you wear on your calves (lower legs) that are connected to a machine that provides alternating pressure on the legs to improve blood flow.
5. Say no to tobacco
Toxic chemicals in cigarettes harm red and white blood cells and blood vessels and make you more susceptible to deep vein thrombosis and pulmonary embolism.
Want to quit smoking?
Here are a few tips that can help you achieve your goal.
Note: Along with these make sure to keep your legs elevated at least for half an hour, twice a day, avoid sitting with crossed legs and wear loose-fitting clothes for better blood flow.
Doctor To Visit
The doctors that can be your best option to treat and manage pulmonary embolism are:
A pulmonologist is a doctor who specializes in treating lung conditions. The doctor diagnoses and treats diseases of the respiratory system. A cardiologist is a doctor who specializes in the study or treatment of heart diseases and heart abnormalities.
Note: The treatment of PE may include medication management by a cardiologist, which may help in prescribing one or more blood thinning or clot-dissolving medications.
Get a consultation from our team of the best and most trusted doctors.
Treatment Of Pulmonary Embolism
Treatment choices for pulmonary embolism (PE) include:
In most cases, the treatment involves administering anticoagulant medications (blood thinners). This medicine decreases the blood’s ability to clot and prevents future blood clots from forming. These include:
Newer oral anticoagulants (NOACs) and vitamin K antagonists (VKA) have also been used for anticoagulation in PE.
2. Reperfusion strategies
Reperfusion therapy is used to restore blood flow through a suspected or known blocked coronary artery immediately upon diagnosis. These include:
Catheter-directed treatment: This technique involves the insertion of a catheter into the pulmonary arteries, which is then used for ultrasound-assisted thrombolysis.
Vena cava filter: This treatment is used when a person cannot go for anticoagulation treatment due to medical reasons. It involves placing a small metal device in the vena cava (the large blood vessel that returns blood from the body to the heart) to keep clots from traveling to the lungs.
Thrombolytic therapy: This therapy is called clot busters which use medications or a minimally invasive procedure to break up blood clots and prevent new clots from forming.
- Pulmonary embolectomy: This is a rarely used surgery conducted to remove a PE. This surgery is performed in cases, where the embolism is large enough and medicines or thrombolytic therapy cannot be used.
3. Compression stockings
These are designed to apply pressure to the lower legs and help to maintain blood flow and reduce discomfort and swelling. These stockings are usually knee-high in length and squeeze the legs to prevent the blood from pooling.
4. Supportive treatment
The treatment given to the body to cope with the ill effects of PE. These include oxygen support being given to the patient to reduce breathlessness, and in a few cases, intravenous fluids being administered to support circulation. In some cases, close monitoring and care are given to the patient depending upon the state of the patient.
Home Remedies For Pulmonary Embolism
Home remedies might not cure the blood clots permanently, but they can provide relief from the symptoms of PE. These include:
Garlic(Lahsun): Garlic helps in blood thinning and reduces blood clot formation in the arteries. It is advisable to eat garlic bulbs on an empty stomach in the morning.
Neem: A few studies have demonstrated that neem has good or moderate clot-breaking properties. Small leaves of neem can be consumed daily to see the results.
Turmeric (Haldi): Turmeric extract has shown benefits in dissolving blood clots in some studies. Turmeric can be taken by adding it to a glass of warm milk and consumed immediately.
Read more about 5 other benefits of turmeric for a healthy body
Tulsi: Tulsi extract has shown moderate to good activity in breaking down clots. Tulsi can be taken by chewing fresh tulsi leaves or drinking tulsi tea for its benefits. Tulsi tea can be prepared by boiling fresh or dried tulsi leaves in some water and straining the leaves.
- Cayenne pepper: It has a high amount of salicylates. These salicylates have powerful blood-thinning effects and can be used to treat blood clots.
Complications Of Pulmonary Embolism
If left untreated, pulmonary embolism can lead to the following complications:
1. Pulmonary infarction (PI)
Pulmonary, or lung, infarction (PI) refers to the death of lung tissue due to a lack of blood supply. According to research in 2021, it has been noted that 30 percent of individuals having PE show signs of PI.
2. Pleural effusion
PE is one of the most common causes of pleural effusion (water on the lungs). Pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. The symptoms include sharp chest pain, cough, and shortness of breath.
3. Cardiogenic shock
It is a life-threatening condition in which your heart is unable to pump enough blood suddenly. This can ultimately lead to a drop in blood pressure and pulse rate leading to brain injury or organ failure.
4. Bleeding by taking blood thinners
Treatment of PE involves the administration of anticoagulants for resolving blood clots. In cases, where the blood becomes too thin, a minor cut can cause too much bleeding.
5. Cardiac arrest
A PE increases the risk of cardiac arrest by many folds. Cardiac arrest further increases the risk of death by 95%.
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Living With Pulmonary Embolism
Recovery from pulmonary embolism can vary based on the severity of the condition and the treatment. The major treatment takes place in the hospital and after leaving the hospital, a patient may be required to take medicines for six months or longer. Certain tips to keep in mind if you have PE include:
1. Following up regularly
Studies suggest that individuals with pulmonary embolism should visit their doctors every 2 weeks for 3 months post-PE.
- The routine follow-up visits scheduled by the doctor should never be missed as this can help the doctor to conduct imaging tests. This helps the doctor to check for signs of new blood clots forming in the legs that can lead to PE.
- Taking all the medicines prescribed by the doctor on time.
2. Preventing recurrence
The doctor may recommend combining medication and lifestyle changes simultaneously to manage the long-term risks of a recurrence of deep vein thrombosis which leads to PE. To prevent recurrence the doctor may include:
- Staying physically active
- Drinking more fluids
- Maintaining a healthy weight
- Quitting smoking
- Avoiding the use of oral contraceptives.
3. Avoiding injuries
Suitable caution must be taken if you are taking anticoagulants as this can lead to serious bleeding risk. Your doctor may suggest avoiding foods rich in vitamin K, alcohol, and over-the-counter medicines (such as aspirin).
Frequently Asked Questions
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- Vyas V, Goyal A. Acute Pulmonary Embolism. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
- Tarbox AK, Swaroop M. Pulmonary embolism. Int J Crit Illn Inj Sci. 2013 Jan;3
- Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Semin Intervent Radiol. 2018 Jun
- Huisman MV, Barco S, Cannegieter SC, Le Gal G, Konstantinides SV, Reitsma PH, Rodger M, Vonk Noordegraaf A, Klok FA. Pulmonary embolism. Nat Rev Dis Primers. 2018 May 17
- Venous Thromboembolism (Blood Clots). Centers for Disease Control and Prevention. Jun 2022.
- Pulmonary Embolism. National Health Service. April 2020.
- Lavorini F, Di Bello V, De Rimini ML, Lucignani G, Marconi L, Palareti G, Pesavento R, Prisco D, Santini M, Sverzellati N, Palla A, Pistolesi M. Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach. Multidiscip Respir Med. 2013 Dec 19
- Freund Y, Cohen-Aubart F, Bloom B. Acute Pulmonary Embolism: A Review. JAMA. 2022 Oct 4
- Rivera-Lebron B, McDaniel M, Ahrar K, Alrifai A, Dudzinski DM, Fanola C, et al. Diagnosis, treatment and follow up of acute pulmonary embolism: Consensus practice from the Pert Consortium [Internet]. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. U.S. National Library of Medicine; 2019 [cited 2023Feb10].