Pulmonary embolism (patient information)

For the WikiDoc page for this topic, click here

Editors-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org] Synonyms and keywords: PE; Venous thromboembolism; lung blood clot; blood clot-lung; embolus; tumor embolus; embolism-pulmonary

Overview
Pulmonary embolism (PE) is a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg. The clot blocks blood flow to part of the lung. If a blood clot is large, or if there are many clots, PE can cause death.

What are the symptoms of Pulmonary embolism?
Signs and symptoms vary from person to person. However, the common symptoms are:


 * Chest Pain
 * Under the breastbone or on one side
 * May feel sharp or stabbing
 * May also be described as a burning, aching, or dull, heavy sensation
 * May get worse with deep breathing, coughing, eating, or bending
 * You may bend over or hold your chest in response to the pain


 * Sudden cough
 * May possibly cough up blood or bloody mucus


 * Rapid heart rate


 * Shortness of breath that starts suddenly

Other symptoms that may occur:
 * Anxiety
 * Bluish skin discoloration (cyanosis)
 * Clammy skin
 * Dizziness
 * Leg pain, redness, and swelling
 * Lightheadedness or fainting
 * Low blood pressure
 * Sweating
 * Wheezing

What causes Pulmonary embolism?
A pulmonary embolism is most often caused by a blood clot in the vein, especially a vein in the leg or in the pelvis (hip area). The most common cause is a blood clot in one of the deep veins of the thighs. This type of clot is called a deep vein thrombosis (DVT). The DVT breaks off and travels to the lungs.

Less common causes include air bubbles, fat droplets, amniotic fluid, or clumps of parasites or tumor cells, all of which may lead to a pulmonary embolism.

Risk factors for a pulmonary embolism include:
 * Burns
 * Cancer
 * Childbirth
 * Family history of blood clots
 * Fractures of the hips or thigh bone
 * Heart attack
 * Heart surgery
 * Long-term bed rest or staying in one position for a long time, such as a long plane or car ride
 * Severe injury
 * stroke
 * Surgery (especially orthopedic or neurological surgery)
 * Use of birth control pills or estrogen therapy

People with certain clotting disorders may also have a higher risk.

Who is at highest risk?
There is increased risk of PE in many conditions which are
 * Thrombophilia is a condition in which blood has an increased tendency to clot. Thrombophilia can be Inherited or Acquired. Acquired Thrombophilia occurs in association with other medical conditions like Polycythimia vera or Antiphospholipid Antibody


 * There are many other condition that increases the risk of PE
 * Pregnancy
 * Obesity
 * Smoking
 * Cancer
 * Heart failure
 * Previous PE
 * Medications like OCP,tamoxifen,Hormone Replacement Therapy

When to seek urgent medical care?
Pulmonary embolism can be potentially life threatening and one should seek medical care when suffering from symptoms of Pulmonary embolism. Severe sharp chest pain, shortness of breath, blood in sputum, raised heart rate may be ominous signs.

Diagnosis

 * CT scan
 * Angiography
 * V/Q Scan
 * Echocardiogram

Treatment options
A pulmonary embolism will require emergency treatment; consequently you will have to stay in the hospital and will receive oxygen. In cases of severe, life-threatening pulmonary embolism, treatment may involve dissolving the clot. This is called thrombolytic therapy. Clot-dissolving medications include:
 * Streptokinase
 * T-plasminogen activator (t-PA)

Blood thinners are given to prevent clots. This is called anticoagulation therapy. Heparin or heparin-type drugs are usually tried first. They can be given through a vein (by IV) or by injection under the skin.
 * The most common blood thinners are heparin and warfarin (Coumadin).
 * Fondaparinux (Arixtra) is a newer blood thinner used under special circumstances.

Warfarin is later given in pill form. When you first start taking warfarin, you will need frequent blood tests. This will help your doctor properly adjust your dose. You will likely need to take the warfarin for several months.
 * Patients who have reactions to heparin or related medications may need other medications.
 * Patients who cannot tolerate blood thinners or for whom they may be too risky may need a device called an inferior vena cava filter (IVC filter). This device is placed in the main vein in the belly area. It keeps large clots from traveling into the blood vessels of the lungs. Sometimes a temporary filter can be placed and removed later.

Other medications to treat a pulmonary embolism may include:
 * Anticoagulants - to prevent clot formation.
 * Thrombolytic - to remove the already formed clot.
 * Inferior vena cava filter-that prevent the clot, formed in legs, to reach the lungs.
 * Embolectomy- which removes the clot that’s already formed.

Where to find medical care for Pulmonary embolism?
Directions to Hospitals Treating Pulmonary embolism

What to expect (Outlook/Prognosis)?
It is hard to predict the outlook of a person recovering from a pulmonary embolism. It will depend on the cause of the initial problem, such as cancer, major surgery, or an injury.

Death is possible in people with a severe pulmonary embolism.

Possible complications
It is a potential lethal condition if the main artery is blocked. If left untreated, about 30 percent of patients die. Most of those who die, do so, within the first few hours of the event.

Other possible complications:
 * Heart failure or shock
 * Heart palpitations
 * Pulmonary hypertension
 * Severe difficulty breathing
 * Severe bleeding (usually a complication of treatment)
 * Sudden death

Support Group
In a support group, members provide each other with various types of nonprofessional, nonmaterial help to Pulmonary embolism patients. The help may take the form of providing relevant information, relating personal experiences, listening to others' experiences, providing sympathetic understanding and establishing social networks. A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy. To read more about PE Support group, click here.

Video
Below video demonstrate how a clot from leg can travel up to lungs and cause Pulmonary embolism.