Pulmonary Embolism

A pulmonary embolism is a blood clot in the lung that occurs when a clot in another part of the body (often the leg or arm) moves through the bloodstream and becomes lodged in the blood vessels of the lung. This restricts blood flow to the lungs, lowers oxygen levels in the lungs and increases blood pressure in the pulmonary arteries.

Causes #

• When blood collects (or “pools”) in a certain part of the body (usually an arm or leg).

• Pooling of blood usually occurs after long periods of inactivity, such as after surgery or bed rest.

• When veins have been injured, such as from a fracture or surgery (especially in the pelvis, hip, knee or leg).

• As a result of another medical condition, such as cardiovascular disease (including congestive heart failure, atrial fibrillation and heart attack) or stroke.

• When clotting factors in the blood are increased, elevated, or in some cases, lowered.

• Elevated clotting factors can occur with some types of cancer or in some women taking hormone replacement therapy or birth control pills.

• Abnormal or low clotting factors may also occur as a result of hereditary conditions.

Symptoms #

• 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.

Diagnosis #

• Computed tomography (CT) scan.

• Lung scan.

• Blood tests (including the D-dimer test).

• Pulmonary angiogram.

• Ultrasound of the leg – helps to identify blood clots in patients who cannot have an X-ray due to dye allergies or who are too sick to leave their hospital room.

• Magnetic resonance imaging (MRI) of the legs or lungs.

Treatment #

Anticoagulant medications #

• In most cases, treatment consists of anti- coagulant medications (also called blood thinners). Anticoagulants decrease the blood’s ability to clot and prevent future blood clots.

• Anticoagulant medications include warfarin (Coumadin), heparin, low-molecular weight heparin (such as Lovenox or Dalteparin) and fondaparinux (Arixtra).

• Warfarin comes in tablet form and is taken orally (by mouth).

• Heparin is a liquid medication and is given either through an intravenous (IV) line that delivers medication directly into the vein, or by subcutaneous (under the skin) injections given in the hospital.

• Low molecular-weight heparin is injected beneath or under the skin (subcutaneously). It is given once or twice a day and can be taken at home.

• Fondaparinux (Arixtra) is a new medication that is injected subcutaneously, once a day.

• You and your family will receive more information about how to take the anticoagulant medication that is prescribed. As with any medication, it’s important that you understand how and when to take your anticoagulant and to follow your doctor’s guidelines.

The type of medication you were prescribed, how long you need to take it, and the type of follow-up monitoring you’ll need depends on your diagnosis. Be sure to keep all scheduled follow-up appointments with your doctor and the laboratory so your response to the medication can be monitored closely.

Compression stockings #

• Compression stockings (support hose) aid blood flow in the legs and should be used as prescribed by your doctor.

• The stockings are usually knee- high length and compress your legs to prevent the pooling of blood.

• Talk with your doctor about how to use your compression stockings, for how long, and how to care for them.

• It is important to launder compression stockings according to directions to prevent damaging them.

Procedures #

• If a pulmonary embolism is life-threatening, or if other treatments aren’t effective, your doctor may recommend:

• Surgery to remove the embolus from the pulmonary artery.

• An interventional procedure in which a filter is placed inside the body’s largest vein (vena cava filter) so clots can be trapped before they enter the lungs.

Thrombolytic therapy #

• Thrombolytic medications (clot busters), including tissue plasminogen activator (TPA), are used to dissolve the clot.

• Thrombolytics are always given in a hospital where the patient can be closely monitored.

• These medications are used in special situations, such as if the patient’s blood pressure is low or if the patient’s condition is unstable due to the pulmonary embolism.