Pulmonary embolism

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Overview

Venous thromboembolism (VTE) and PE is the third most common cause of cardiovascular death after myocardial infarction (MI) and cerebrovascular accidents (CVA). Many PEs are likely undiagnosed and calculating the true incidence remains challenging. However, PE remains a significant cause of preventable in-hospital mortality.Pulmonary embolism (PE) is responsible for approximately 100,000 to 200,000 deaths in the United States each year. With a diverse range of clinical presentations from asymptomatic to death, diagnosing PE can be challenging. Various resources are available, such as clinical scoring systems, laboratory data, and imaging studies which help guide clinicians in their work-up of PE. Prompt recognition and treatment are essential for minimizing the mortality and morbidity associated with PE. Advances in recognition and treatment have also enabled treatment of some patients in the home setting and limited the amount of time spent in the hospital. This article will review the risk factors, pathophysiology, clinical presentation, evaluation, and treatment of PE.

Symptoms

Symptoms of pulmonary embolism vary, depending on the severity of the clot. Although most people with a pulmonary embolism experience symptoms, some will not. The first signs are usually shortness of breath and chest pains that get worse if you exert yourself. You may cough up bloody sputum. If you have these symptoms get medical attention right away. Pulmonary embolism is serious but very treatable. Quick treatment greatly reduces the chance of death.

Symptoms may include:

Sudden shortness of breath -- whether you’ve been active or at rest.

Unexplained sharp pain in your chest, arm, shoulder, neck or jaw. The pain may also be similar to symptoms of a heart attack.

Cough with or without bloody sputum (mucus).

Pale, clammy or bluish-colored skin.

Rapid heartbeat (pulse).

Excessive sweating.

In some cases, feeling anxious, light-headed, faint or passing out.

Wheezing.


Causes

Blood clots can form for a variety of reasons. PEs are most often caused by deep vein thrombosis (DVT), a condition in which blood clots form in veins deep in the body. The blood clots that most often cause PEs begin in the legs or pelvis.


Blood clots in the deep veins of the body can have several different causes, including:


Injury or damage. Injuries like bone fractures or muscle tears can cause damage to blood vessels, leading to clots.

Inactivity. During long periods of inactivity, gravity causes blood to collect in the lowest areas of your body, which may lead to a blood clot. This could occur if you’re sitting for a lengthy trip or if you’re lying in bed recovering from an illness.

Medical conditions. Some health conditions cause blood to clot easily, which can lead to PE. Treatments that involve surgery often lead to short-term bed rest or limited movement, which can make clotting more likely. Also, certain medical therapies for cancer can have side effects such as clotting in the blood. This puts you at risk for DVT and PE.

Risk factors

Being overweight or obese.

Smoking cigarettes.

Being pregnant or having given birth in the previous six weeks.

Taking birth control pills (oral contraceptives) or hormone replacement therapy.

Having diseases such as stroke, paralysis, chronic heart disease, or high blood pressure.

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Complications

Pulmonary embolism can be life-threatening. About one-third of people with undiagnosed and untreated pulmonary embolism don't survive. When the condition is diagnosed and treated promptly, however, that number drops dramatically.

Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in your lungs and in the right side of the heart is too high. When you have obstructions in the arteries inside your lungs, your heart must work harder to push blood through those vessels, which increases blood pressure and eventually weakens your heart.

In rare cases, small emboli occur frequently and develop over time, resulting in chronic pulmonary hypertension, also known as chronic thromboembolic pulmonary hypertension.

Prevention

Exercise regularly. If you can’t walk around due to bed rest, recovery from surgery or extended travel, move your arms, legs and feet for a few minutes each hour. If you know you will need to sit or stand for long periods, wear compression stockings to encourage blood flow.

Drink plenty of fluids, like water and juice, but avoid excess alcohol and caffeine.

If you need to be stationary for long periods of time, move around for a few minutes each hour: move your feet and legs, bend your knees, and stand on tip-toe.

Do not smoke.

Avoid crossing your legs.

Do not wear tight-fitting clothing.

Lose weight if you are overweight.

Elevate your feet for 30 minutes twice a day.

Talk to your doctor about reducing your risk factors, especially if you or any of your family members have experienced a blood clot.