Surviving the Silent Threat: All About Pulmonary Embolism

Pulmonary Embolism - What Is It?

A pulmonary embolism (PE) happens when a blood clot blocks an artery in the lung, stopping the blood flow. Usually, the blood clot starts in a leg vein and travels to the lung. In some cases, it forms in other parts of the body. This kind of blood clot in the deep veins is called deep vein thrombosis (DVT).

What Are The Risk Factors Of Pulmonary Embolism?

Pulmonary embolism can affect anyone, but certain factors can increase your chances of developing blood clots. Understanding these risk factors is essential for taking proactive measures to protect your health and prevent potential complications.

1. Inherited blood disorder: If you or any of your blood relatives, such as parents or siblings, have experienced venous blood clots or pulmonary embolisms in the past, you may be at a higher risk. Conditions like factor V Leiden deficiency, protein c, and s are common inherited conditions that increase your risk of pulmonary embolism.

2. Medical Conditions and Treatments: Certain medical conditions and treatments can elevate your risk of developing blood clots, including:

• Surgery: Surgical procedures are one of the primary causes of problematic blood clots. Doctors may administer blood thinner medication before and after major surgeries, such as joint replacements, to prevent clots.
• Cancer: Certain cancers involving the brain, ovary, pancreas, colon, stomach, lung, and kidney can increase your risk of blood clots. Chemotherapy further increases this risk. Individuals with a personal or family history of breast cancer taking medications like tamoxifen or raloxifene (Evista) also have a higher risk of blood clots.
• Coronavirus disease 2019 (COVID-19): People with severe symptoms of COVID-19 are at an increased risk of developing pulmonary embolism due to the viral infection’s impact on the body.

3. Extended Periods of Inactivity: Long periods of inactivity can lead to blood clot formation, especially during bed rest after surgery, a heart attack, leg fracture, trauma, or a serious illness. Blood flow in the legs slows down when lying flat for extended periods, increasing the risk of clot development. Similarly, sitting for extended periods during lengthy plane or car trips can also slow blood flow in the legs, raising the risk of clots.

Other Risk Factors:

Several other risk factors can contribute to the likelihood of developing blood clots.

• For reasons not entirely understood, smoking can increase the risk of clots, especially when combined with other risk factors.
• Being overweight has also been shown to play a role, particularly in individuals with other risk factors.
• The use of estrogen-based birth control pills or hormone replacement therapy can increase clotting factors in the blood, especially in those who smoke or are overweight.
• Pregnancy can lead to blood pooling in the legs, increasing the chances of clot formation.

How DVT Leads To Pulmonary Embolism?

DVT can lead to pulmonary Embolism through a process called embolization. Embolization occurs when a blood clot, known as an embolus, breaks loose from its original location and travels through the bloodstream to another part of the body, where it becomes lodged and obstructs blood flow.

Here’s a simple way to understand how DVT can lead to PE:

• Formation of DVT: DVT occurs when a blood clot forms within a deep vein, usually in the leg. The clot partially or completely obstructs the vein, causing blood flow to slow down or stop in that area.
• Embolus Formation: If the DVT remains undetected or untreated, there is a risk that the blood clot can become dislodged from the vein wall.
• Embolus Travel: Once dislodged, the blood clot, now called an embolus, can travel through the bloodstream. It moves towards the heart through the large veins in the body.
• Lodging in the Lung: The embolus eventually reaches the right side of the heart and then enters the pulmonary artery, the blood vessel that carries blood from the heart to the lungs. If the embolus is large enough, it can get stuck in one of the smaller arteries within the lungs, blocking blood flow to that area.
• Pulmonary Embolism: When the embolus blocks blood flow to a portion of the lung, that is what we call a pulmonary embolism.

What Are The Symptoms Of Pulmonary Embolism?

The symptoms of pulmonary embolism can vary depending on how much of the lung is affected, the size of the blood clots, and if there are any existing lung or heart conditions. Here are the symptoms one might experience if they have a pulmonary embolism:

• Sudden onset Shortness of Breath: You may experience sudden and severe shortness of breath, even at rest or after minimal exertion.
• Unexplained Chest Pain: You might feel sharp and intense pain in the chest is a common symptom of PE, and it may resemble the symptoms of a heart attack. The pain may worsen while breathing deeply, coughing, bending, or leaning over.
• Coughing with or without Bloody Mucus: Some people with PE may experience a persistent cough that may produce blood-tinged or bloody mucus.
• Pale or Bluish Skin: The skin may appear pale, clammy, or bluish due to reduced blood oxygen levels. This can be a frightening experience for many.
• Rapid Heartbeat: When the artery in the lungs is blocked, your heart gets affected. It will have to work against that clot to pump blood to the lungs, thus leading to an increased heart rate.
• Feeling Anxious, Lightheaded, or Fainting: In some cases, individuals with PE may experience anxiety, dizziness, or fainting due to reduced blood flow and oxygen supply to the brain.
• Wheezing: Wheezing or abnormal breath sounds may be heard, in patients with PE, indicating potential airway obstruction.

How Is A Diagnosis Of Pulmonary Embolism Made?

Diagnosing a pulmonary embolism can be challenging, especially if underlying heart or lung issues exist. Here is the list of tests your doctor will use to diagnose pulmonary embolism:

• CT Pulmonary Angiography (CTPA): CTPA is a highly effective diagnostic imaging test to detect pulmonary embolism. During a CTPA, X-rays create detailed cross-sectional images of the blood vessels in the lungs, providing valuable information about blood clots’ presence, location, and size. The procedure involves injecting a contrast dye into a vein to enhance the visualization of the pulmonary arteries. As the dye circulates through the lungs, it highlights any areas of blood flow obstruction caused by clots. CTPA is considered the gold standard for diagnosing PE because it produces high-resolution 3D images, allowing healthcare professionals to identify and assess the condition’s extent accurately.
• Blood Tests: The D dimer test is one of the most commonly used blood tests to check for the presence of a blood clot. It measures the clot-dissolving substance in the blood. Elevated d dimer levels may indicate an increased likelihood of blood clots, but other factors can also affect them, especially infections.
• Chest X-ray: While a chest X-ray cannot directly diagnose PE, it is useful for ruling out other conditions with similar symptoms. It provides images of the heart and lungs, which may appear normal or show signs of other lung or heart conditions.
• Ultrasound (Duplex Ultrasonography): This is a noninvasive test that uses sound waves to scan veins in the thigh, knee, calf, and arms for deep vein blood clots. The absence of clots reduces the likelihood of DVT, a common cause of PE.
• Ventilation-Perfusion (V/Q) Scan: In conditions when avoiding radiation or contrast material is necessary due to a medical condition, a V/Q scan can be used. During this test, a small quantity of a radioactive substance known as a tracer is injected into a vein in the arm. The tracer maps the blood flow (perfusion) and compares it with the airflow (ventilation) in the lungs. This test is helpful in identifying whether blood clots are responsible for symptoms related to pulmonary hypertension.
• Pulmonary Angiogram: This test provides a clear picture of blood flow in the lungs’ arteries and is the most accurate method for diagnosing PE. It involves inserting a catheter into a large vein, guiding it to the pulmonary arteries directly, and injecting a special dye to visualize the blood vessels through X-rays. Pulmonary angiograms are reserved for cases where other tests are inconclusive due to the procedure’s complexity and potential risks.
• MRI (Magnetic Resonance Imaging) of the lungs: MRI is used in specific cases, such as pregnant individuals, to avoid exposing the baby to radiation or in people with kidney concerns about contrast dye used in other tests. It creates detailed images of organs and tissues using a magnetic field and radio waves, helping diagnose underlying conditions or complications.

How Is Pulmonary Embolism Treated?

If you have a pulmonary embolism, you require immediate medical attention. Breaking up clots and preventing the formation of new ones are the two main objectives of treatment. Both medications and surgeries are available as treatments.

Medications

• Anticoagulants: These are the drugs often known as blood thinners, preventing blood clots from becoming bigger and creating new clots. You might know them as heparin, Lovenox, coumadin, Eliquis, or Xarelto. They may be administered intravenously, as a tablet, or as an injection. The most important thing to remember is these drugs can result in bleeding, mainly if you take aspirin or other medications that thin the blood. Your doctor will discuss with you the risks vs. benefits of being anticoagulation and the risks of bleeding
• Thrombolytics: These medications are clot busters used to dissolve blood clots. They can be prescribed if you have big clots that result in painful symptoms or other critical consequences. Thrombolytics are given when your pulmonary embolism is severe and possibly life-threatening since they can result in life-threatening bleeding. They help to reduce the embolic load quickly and enhance cardiorespiratory blood circulation. However, bleeding is a side effect of thrombolytic therapy that can be fatal, so these drugs are prescribed only after assessing your comorbidities.

Surgery

Surgical management of pulmonary embolism is typically reserved for severe cases or situations where other treatment options are ineffective or contraindicated.

• Catheter-assisted thrombus removal: This minimally invasive procedure involves inserting a catheter through a blood vessel, usually in the groin, and guiding it to the site of the blood clot in the lungs. Using specialized tools attached to the catheter, the clot is carefully broken down or suctioned out, restoring blood flow to the affected lung tissue.
• Vena cava filter: A small, cone-shaped medical device inserted into the vena cava, the large vein that carries deoxygenated blood from the lower body to the heart. The primary purpose of this filter is to prevent blood clots from traveling to the lungs and causing a potentially life-threatening condition known as pulmonary embolism. Vena cava filters are typically recommended for individuals at high risk of developing blood clots but cannot tolerate or respond to standard blood-thinning medications. The filter works by trapping large blood clots that may form in the lower extremities, preventing them from reaching the lungs. A vena cava filter is inserted through a minimally invasive procedure, usually using a catheter to place the filter into the vena cava. Over time, the filter may be removed if the risk of blood clots subsides or if there are concerns about potential long-term complications. While vena cava filters can be life-saving for some patients, their use is carefully considered and individualized based on each patient’s medical condition and risk factors.

What Are The Complications Of Pulmonary Embolism?

Pulmonary embolism poses a significant risk to life. Approximately one-third of individuals with an undetected and untreated pulmonary embolism do not survive. Yet, the mortality rate decreases significantly when the condition is identified and managed promptly. The most common complications of pulmonary embolism are:

• Pulmonary Hypertension: When blood clots obstruct the pulmonary arteries for an extended period, it can lead to increased lung pressure, causing pulmonary hypertension. This condition increases the work that your heart has to do and can lead to heart failure if left untreated.
• Right Ventricular Dysfunction: Severe pulmonary embolism can impair the function of the right ventricle, the heart chamber responsible for pumping blood to the lungs. This dysfunction can cause a decrease in the output of your heart and potentially lead to shock.
• Pulmonary Infarction: Large blood clots may completely block blood flow to a portion of the lung, causing lung tissue to become deprived of oxygen. This can result in pulmonary infarction, leading to localized lung tissue damage.
• Pleural Effusion: Pulmonary embolism may cause inflammation in the lining of the lungs (pleura), accumulating fluid in the pleural space, known as pleural effusion. This can, in turn, cause chest pain and difficulty breathing.
• Recurrent PE: There is always a chance that you have it again, especially if the underlying risk factors are not adequately managed. Most commonly, recurrent PE is seen in people with inherited conditions that went undiagnosed.
• Hemoptysis: In some instances, pulmonary embolism can cause lung bleeding, leading to coughing up blood, a condition known as hemoptysis.

What Are The Measures To Prevent Pulmonary Embolism?

Preventing blood clots in the deep veins of the legs is essential for avoiding pulmonary embolism. You can take the following measures to prevent pulmonary embolism:

• Blood Thinners: These medicines are administered before and after surgery, as well as to hospitalized individuals with certain medical conditions like heart attack, stroke, or cancer complications. Those who cannot mobilize immediately must be careful and take their blood thinners on time.
• Early mobilization: Early movement after surgery can prevent pulmonary embolism and expedite overall recovery. Thus, motivate yourself to move after your surgery.
• Leg Elevation: Elevating the legs, particularly during rest and at night, can effectively reduce clot risk. Raising the bottom of the bed four to six inches with blocks or books can also be helpful.
• Pneumatic Compression Device: These are the devices that are placed on the thighs or calf, They have a mechanism to automatically inflate and deflate that massages and squeezes leg veins, improving blood flow from the leg to the heart and reducing the risk of formation of DVT.

How To Prevent Blood Clots During Travel?

It is essential to make sure that you follow this advice for your next travel to ensure that you do not have a pulmonary embolism:

• Staying Hydrated: Drink plenty of water to prevent dehydration, a risk factor for blood clots. Avoid alcoholic beverages, which contribute to fluid loss and the formation of blood clots in a predisposed individual.
• Frequent Movements: Take breaks during long-haul travel, walk around the airplane cabin, or perform knee bends if driving.
• Seat Exercises: Make ankle movements and raise toes up and down every 15 to 30 minutes while seated.
• Support Stockings: Compression stockings can be worn to promote leg circulation and fluid movement, reducing clot risk during travel.

Questions For Your Doctor

Here are some questions that you may consider asking your doctors:

1. What could have caused my pulmonary embolism?
2. Is the clot large or small, and how severe is my condition?
3. How long will I need to take blood thinners or other medications?
4. Are there any lifestyle changes I should make to reduce the risk of future blood clots?
5. Can I continue my regular activities and exercise routines while undergoing treatment?
6. What should I do if I experience new or concerning symptoms during treatment?
7. Are there any dietary considerations I should consider while on blood thinners?
8. Is it safe for me to travel or fly, considering my condition?
9. Are there any alternative treatment options or complementary therapies that may help support my recovery?

References

1. https://my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism#symptoms-and-causes
2. https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647
3. https://medlineplus.gov/pulmonaryembolism.html