Pulmonary Embolism

What is pulmonary embolism?

A pulmonary embolism is blockage of the artery that carries blood from heart to the lungs (pulmonary artery). The blockage is typically a blood clot that originates in the veins of the legs and breaks loose, traveling to the heart and on to the pulmonary artery. In most cases, blockage is temporary. In other cases, the blockage can cause chest pain with shortness of breath, cough, and coughing of blood. A massive pulmonary embolism can put enormous stress on the right ventricle and can halt the entire circulation system, causing death rapidly. With pulmonary embolism, there may be death of lung tissue (pulmonary infarction).

Risk factors for pulmonary embolism can include prolonged bedrest or inactivity, surgery, childbirth, stroke, congestive heart failure, frequent air travel, and obesity.

Though only ten percent of pulmonary embolisms result in death, this disorder (also referred to as pulmonary thromboembolism) ties with stroke as the third leading cause of death in the US. Most individuals are over the age of 30.

Diagnosis can be difficult, and experts believe that only ten percent of individuals suffering pulmonary embolism receive appropriate diagnosis and treatment.

How is it diagnosed?

History: The individual usually experiences sudden chest pain, which may radiate to the shoulder. This is often combined with a bluish pallor (cyanosis), a sudden shortness of breath, and very rapid breathing. In severe cases, the individual may faint or cough up blood, and may feel a keen sense of anxiety.

Physical exam: Typical findings include a rapid pulse, breathlessness, fainting, and collapse. Some individuals may present with a low-grade fever, cyanosis, abnormal breathing (rales), and wheezing. Listening to the chest will reveal distinct patterns in heartbeat and blood flow. The individual will usually have a fever, high pulse rate and rapid breathing if the embolism has resulted in an infarction. In cases of massive embolism, the individual is usually in a cold sweat with low blood pressure.

Tests typically include chest x-ray, electrocardiogram, lung scan, and arterial blood gases. A pulmonary angiogram may be ordered.

How is pulmonary embolism treated?

Initially, treatment of pulmonary embolism is focused on relieving the symptoms of the attack with a combination of oxygen, blood thinning drugs, morphine, and fluids. Blood-thinning (anticoagulant) drugs can be used as a preventative measure but not as a cure.

They should not be used with individuals who are susceptible to bleeding due to other medical conditions such as esophageal varices, ulcers, and liver or kidney disease. If the individual remains in critical condition following the embolism and has not responded well to emergency measures, blood clot dissolving medications can be used.

Embolectomy (or surgical removal of the embolus) is rarely necessary. Surgical ligation of the inferior vena cava (vena cava interruption) or umbrella inserted in the inferior vena cava is considered when recurrence of the disease is life threatening in an individual who cannot tolerate anticoagulant therapy or when the person has septic thrombophlebitis of pelvic origin.

Medications

Information	Brand	Generic	Label	Rating
	Plavix	Clopidogrel
	Coumadin	Warfarin

What might complicate it?

Complications include lung collapse (atelectasis), pulmonary hypertension, decrease in cardiac output, infection, and infarction.

Predicted outcome

The outcome of pulmonary edema depends on the underlying cause. Non-cardiogenic (not heart related) pulmonary edema generally responds well to treatment, while cardiogenic pulmonary edema has a variable mortality rate.

Alternatives

Pulmonary edema is easily diagnosed and presents much differently from other conditions resulting in poor gas exchange. The diagnostic challenge is determining if the condition is related to heart disease (cardiogenic) or to other causes.

Appropriate specialists

Internist, cardiologist, pulmonologist, and cardio-thoracic surgeon.

Last updated 22 December 2015