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Pulmonary embolism Causes, Symptoms and Treatment

What is pulmonary embolism?

A pulmonary embolism is the obstruction of one or more arteries irrigating the lung. This blockage is most often caused by a blood clot (phlebitis or venous thrombosis) that travels to the lungs from another part of the body, very often from the legs.

Pulmonary embolism can occur in healthy people.

Pulmonary embolism can be extremely dangerous for your health. Rapid treatment with anti-coagulant medications can significantly reduce the risk of death.

Causes of pulmonary embolism

A blood clot that forms in a deep vein of a leg, pelvis or arm is called deep vein thrombosis. When this clot or a portion of this clot travels through the bloodstream to the lungs, it can cause blockage of the pulmonary circulation, this is known as pulmonary embolism.

Occasionally, pulmonary embolism can be caused by fat from the bone marrow of a broken bone, air bubbles, or tumor cells.

How to diagnose it?

In people with lung disease or cardiovascular disease, it can be difficult to identify the presence of pulmonary embolism. A series of tests, including blood tests, chest X-rays, lung scans, or CT scans of the lungs can help identify the cause of the symptoms.

Symptoms of pulmonary embolism

  • Intense chest pain, which may resemble the symptoms of a heart attack and persists despite rest.
  • Sudden shortness of breath, difficulty breathing or wheezing, may occur at rest or during exercise.
  • Cough, sometimes accompanied by blood-stained sputum.
  • Excessive perspiration (diaphoresis).
  • Swelling usually in one leg.
  • A weak, irregular or very fast pulse (tachycardia).
  • A blue color around the mouth.
  • Dizziness or fainting (loss of consciousness)

Possible complications

When the blood clot is bulky, it can block blood flow to the lungs. Pulmonary embolism can lead to:

  • The death.
  • Permanent damage to the affected lung.
  • Low blood oxygen level
  • Damage to other organs due to lack of oxygenation.

People at risk of pulmonary embolism

Older people are at higher risk of developing clots because of:

– The deterioration of the valves in the veins of the lower limbs, which ensure the adequate circulation of blood in these veins.

– Dehydration which can thicken the blood and cause clots.

– Other medical problems, such as cardiovascular diseases, cancer, surgery or arthroplasty (the replacement of a joint). Women and men who have already developed blood clots or deep vein thrombosis (phlebitis).

People whose family members have already developed blood clots. Hereditary disease can cause some blood clotting disorders.

Prevent embolism

Why prevent?
Most people recover after a pulmonary embolism. However, a pulmonary embolism can be extremely dangerous and can lead to death if it is not taken care of immediately.

 

Can we prevent?
Preventing the formation of blood clots, mainly in the legs, remains one of the main measures to prevent pulmonary embolism.

 

Basic preventive measures
Prolonged inactivity can promote blood clots in the legs.

  • Stay active: walk a little each day.
  • When sitting or lying down for extended periods of time, do exercises on the spot, for example: stretch, flex and circle with the ankles. Press your feet against a hard surface. Point the toes.
  • During long seated trips (plane, car), get up every two hours, walk a little and drink water.
  • Even after surgery, do not stay in bed. As much as possible, get up and walk.
  • Keep your legs uncrossed and both feet on the ground.
  • Avoid wearing socks or tight socks.
  • In some cases, such as varicose veins, wear support stockings that help circulation and movement of fluids.
  • Drink a lot. Dehydration promotes the development of blood clots. Water is the best liquid to prevent dehydration. Avoid alcohol and beverages containing caffeine.

People admitted to hospital for a heart attack, stroke, complications of cancer or burns may be at risk for clot formation.

Anticoagulant therapy, such as heparin injection, may be given as a preventive measure.

 

Measures to prevent recurrence
In some people who are at risk for complications or recurrence of pulmonary embolism, a filter can be installed in the inferior vena cava. This filter helps to prevent the progression of clots formed in the veins of the lower limbs to the heart and lungs.

 

Risk Factors for Pulmonary Embolism

  • Long periods of inactivity , for example during prolonged bed rest following surgery, a fracture or other serious illness, during long journeys, for example by plane or car. An immobile position slows the blood circulation in the veins, which helps to form clots in the legs.
  • A surgery . Surgery is one of the main causes of blood clot development, especially the replacement of a knee joint or hip joint. Some tissue debris can enter the circulation and cause clots to form. Staying still during any type of surgery can lead to clot formation. The risk increases with the duration of general anesthesia.
  • Certain diseases, such as cardiovascular diseases or high blood pressure (hypertension), promote the formation of blood clots.
  • The pregnancy. The weight of the baby puts pressure on the veins of the pelvis, which can slow down the circulation in the legs, promoting the formation of blood clots.
  • Some cancers (especially pancreatic, ovarian, and lung cancers) and chemotherapy may promote blood clots. Women who are treated for breast cancer with tamoxifen or raloxifene are at higher risk of developing blood clots.
  • Smoking.
  • Obesity or overweight.
  • Estrogen supplements. Estrogen in contraceptive pills and hormone replacement therapy (after menopause) may increase the risk of developing blood clots.

Treatments for pulmonary embolism

Pharmaceuticals

Anticoagulants . Heparin acts quickly and is usually given as an injection. Warfarin (Coumadin®) is taken in tablet form and acts in a few days. These drugs help dissolve clots and prevent the formation of new clots. Treatment should generally be followed for 3 to 6 months.

Thrombolytics . Thrombolytic drugs can accelerate clot dissolution. This type of medication can in some cases cause sudden and violent bleeding; they are usually reserved for emergency situations when the patient’s life is in danger.

Surgical interventions

Clot elimination. When the clot in the lungs is very large and the patient is in shock, the doctor may decide to remove the clot. He inserts a thin, flexible tube (catheter) into the blood vessels to suck the clot. This procedure does not always succeed.

The installation of a vena cava filter. In patients who cannot take anticoagulant medication or who do not function effectively, a vena cava filter can be used. Using a catheter, a filter is installed in the main vein (the inferior vena cava) that leads the legs to the right side of the heart. This filter blocks clots moving through the bloodstream to the lungs.

Surgery (embolectomy) . When a patient is in shock and the thrombolytic drugs are not functioning quickly enough, emergency surgery may be required. The doctor tries to quickly remove as much blood clots as possible. This situation rarely occurs.

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