Pulmonary Embolism
Sudden blockage of a major artery in your lung. Usually due to a blood clot that develops in another part of your body, breaks off and travels in the bloodstream into the lung where it blocks the pumping of your heart and prevents it from taking in oxygen.
The third most common cardiovascular disease after heart attack and stroke.
Call 911
Pulmonary embolism is a medical emergency. If any of the symptoms below occur, seek immediate medical attention.
Medium or long term
After the high-risk period has elapsed (roughly one week), blood clots in your lung will need months or years to completely resolve. You may develop pulmonary hypertension with life-long implications, including shortness of breath and exercise intolerance.
Symptoms
Symptoms usually begin suddenly and may include:
- Sudden shortness of breath.
- Sharp chest pain, often aggravated by coughing or movement.
- Pain in your back.
- Cough with or without bloody sputum.
- Excessive sweating.
- Rapid pulse or breathing.
- Lightheadedness or passing out.
- Blue lips or nail beds.
If you have recently had a blood clot in a leg or arm, you may experience:
- Swelling of the affected leg or arm.
- Leg pain or tenderness that may only occur when you are standing or walking.
- Increased warmth in the swollen or painful area of the affected leg or arm.
- Redness or discoloration of your skin.
- Enlargement of superficial veins in the affected leg or arm.
Causes
A variety of risk factors contribute to the development of pulmonary embolism:
- Surgery, particularly abdominal or orthopaedic surgery, such as hip or knee surgery
- Trauma or bone fracture
- A long period of bed rest or sitting for a long time, perhaps on an airplane or in a car
- Cancer and some cancer treatments, like chemotherapy
- Cardiovascular diseases such as atrial fibrillation, heart failure, heart attack or stroke
- Pregnancy and the first 6 weeks after giving birth
- Birth control pills or hormones taken for symptoms of menopause
- Family history of blood clots
- Inherited blood disorders that make the blood thick, such as thrombophilia
- Inflammatory bowel disease
- Auto-immune diseases, such as lupus or antiphospholipid syndrome
- Smoking
- Obesity
- Placement of vein catheters, pacemakers, or implantable defibrillators
Diagnosis
See a vascular surgeon.
You will be asked questions about symptoms and medical history, including questions about family members. The vascular surgeon will also perform a physical exam.
Tests may be recommended.
- Chest x-ray
- Computerized Tomography Angiogram (CTA)
- Echocardiogram (Echo)
- Ventilation Perfusing Lung Scanning (VQ Scan)
- Ultrasound of your leg veins (Duplex)
- Pulmonary Angiography
- Blood tests: D-dimer, Troponin, BNP (brain natriuretic peptide – hormone) and arterial blood gas analysis
Treatment
Medication
- In most cases, treatment is limited to medication that thins the blood.
- If you have severe symptoms, treatment is typically provided in a hospital, where your condition can be closely monitored. In some cases it may be necessary to remove the clot to prevent shock, cardiac arrest or death.
Clot busters
Clot-busters are one way to immediately remove a clot. Clot busters are taken intravenously, through an IV in the arm (systemic thrombolysis) or through a long catheter (thin tube) that delivers them directly to a clot in the lung (catheter-directed thrombolysis).
Surgery
Mechanical cardiopulmonary support and open surgery to physically remove the clot are the last resort treatment alternatives when other techniques have failed or are contraindicated.