Pulmonary Embolism(PE)

A pulmonary embolism (PE) is a life-threatening medical emergency where a blood clot or other substance, most commonly a clot from the leg, gets stuck in one of the main arteries leading to the lungs. This blockage cuts off blood flow to a part of the lung, which can prevent the heart from pumping properly and lead to a life-threatening lack of oxygen. Prompt diagnosis and treatment are crucial to prevent severe complications or death. 

Common causes

Most pulmonary embolisms are caused by a blood clot traveling from another part of the body, a condition called deep vein thrombosis (DVT). Risk factors for a DVT developing include: 

  • Immobility: Long periods of bed rest after surgery, a broken bone, or a long plane or car ride can cause blood to pool and clot in the legs.

  • Surgery or trauma: Major surgery, especially on the hips, knees, or abdomen, as well as severe fractures, can increase the risk of clots forming.

  • Cancer and other diseases: Conditions like cancer, heart disease, or certain inflammatory disorders increase the likelihood of blood clots.

  • Pregnancy: Hormonal changes and pressure on veins during and after pregnancy can increase the risk of DVT.

  • Medications: Estrogen-based medications, such as birth control pills or hormone replacement therapy, can increase the risk.

  • Other substances: In rare cases, the blockage is caused by something other than a blood clot, such as fat from a broken bone, air bubbles, or pieces of a tumor. 

Signs and symptoms

The signs of a PE often appear suddenly and can vary depending on the size of the blockage and the person's overall health. Symptoms include: 

  • Sudden shortness of breath: This is the most common symptom and can occur even at rest.

  • Sharp chest pain: This pain is often worse when you take a deep breath, cough, bend, or lean over.

  • Rapid or irregular heartbeat: The heart may race or feel like it's pounding.

  • Coughing: A persistent cough may occur, sometimes bringing up bloody mucus.

  • Lightheadedness or fainting: A sudden drop in blood pressure can cause a person to pass out.

  • Other symptoms: Dizziness, excessive sweating, and leg pain or swelling (from a related DVT) are also possible. 

It is crucial to seek immediate medical attention if you suspect a PE. Call 911 or your local emergency number right away. 

Diagnosis

Because the symptoms of a PE can mimic other conditions like a heart attack or pneumonia, a doctor will perform tests to get an accurate diagnosis. 

  • D-dimer blood test: This test measures a substance released when a clot is dissolving. High levels can suggest the presence of a clot, but a definitive diagnosis requires further testing.

  • CT pulmonary angiogram (CTPA): This is the most common test used to diagnose a PE. It involves injecting a special dye and taking a detailed photo of the arteries in the lungs to find the blockage.

  • Ventilation-perfusion (V/Q) scan: This test uses a small amount of radioactive material to check how air and blood are flowing through the lungs. It is sometimes used when a CT scan is not possible.

  • Duplex ultrasound: An ultrasound may be performed on the legs to check for a deep vein thrombosis (DVT), which is the most common source of a PE. 

Treatment

The main goals of PE treatment are to dissolve the existing clot, prevent new ones from forming, and support the patient's breathing and blood pressure. 

Medications

  • Blood thinners (Anticoagulants): These are the most common treatments for PE. They prevent the clot from getting bigger and stop new clots from forming while the body slowly absorbs the existing one.

  • Clot-busting medications (Thrombolytics): For large, life-threatening clots, doctors can give a more powerful medication to dissolve the clot quickly. These carry a higher risk of bleeding and are typically reserved for severe cases. 

Procedures

  • Catheter-assisted clot removal: In some cases, a doctor can use a thin, flexible tube (catheter) to reach the clot and either deliver medicine directly to it or use a tool to break it up and remove it.

  • Vena cava filter: If a patient cannot take blood thinners, a filter can be placed in the body's main vein (vena cava) to catch any clots before they reach the lungs. 

Following treatment, a person may need to take blood thinners for several months and make lifestyle changes to prevent future clots. 

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