Pulmonary embolism

Symptoms Of Pulmonary Embolism 

The symptoms may vary depending on the size of the clots, involvement of the lungs, and depending upon underlying medical conditions. The following are the most common symptoms of pulmonary embolism (PE):

• Shortness of breath
• Chest pain 
• Rapid or irregular heartbeat 
• Sweating
• Pain or swelling in the leg
• Anxiety 
• Low blood pressure 
• Coughing blood 
• Palpitations 
• Cold clammy and discolored skin (cyanosis)
• Lightheadedness
• Fainting
• Wheezing
  
  

Note: Chest pain is the most common symptom of pulmonary embolism. It is a sharp, stabbing, and aching pain that is difficult to manage an individual facing. 

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Types Of Pulmonary Embolism 

Pulmonary embolism can be classified as follows:

1. Acute pulmonary embolism 

An acute pulmonary embolism, or embolus, is a blockage of an artery in the lung. It develops due to the formation of blood clots in the legs or another part of the body (deep vein thrombosis) that travels to the lungs.

2. Chronic pulmonary embolism 

This type is characterized by blockage of the pulmonary arteries that occurs when prior clots in the vessels do not dissolve over time. This can also happen despite treatment of an acute PE, or as a result of an undetected acute PE.

Causes Of Pulmonary Embolism 

PE occurs when a blood clot gets stuck in an artery in the lungs, blocking blood flow. These blood clots most commonly come from the deep veins of your legs, a condition known as deep vein thrombosis. In most cases, multiple clothes can block a significant portion of the lungs leading to pulmonary infarction (where the portion does not get enough blood and dies). This makes it more difficult for your lungs to provide oxygen to the rest of your body.

Risk Factors For Pulmonary Embolism 

Any individual can develop blood clots, which lead to pulmonary embolism. Certain factors that increase the risk of the disease are:

1. Genetics

Individuals having parents or siblings with venous blood clots or pulmonary embolism are at the highest risk of developing this condition. 

2. Inactivity 

Blood clots are more likely to form during longer than usual periods of inactivity. Sitting at one place for a longer period can lead to slower blood flow in the legs causing blood clots leading to pulmonary embolism.

3. Medical conditions 

Some medical conditions often increase the risk of pulmonary embolism. These include:

• Cancer: Various types of cancers like brain, ovary, stomach, lung, and kidney cancers, can increase the risk of blood clots. People undergoing cancer treatment (chemotherapy) further increase the risk of forming blood clots. 
• Surgery: This is a significant cause of blood clot formation. In many surgeries, medicine is prescribed both before and after, to prevent blood clots. 
• Heart disease: Patients with cardiac disease, such as coronary artery disease, atrial fibrillation (AF), and heart failure (HF), display a higher risk for PE.
• COVID-19: Individuals with severe symptoms of coronavirus, often display pulmonary embolism as one of the complications. The condition occurs when a blood clot formed in the legs travels through the bloodstream to the lungs.

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4. Bone fractures 

Sometimes in the case of a bone fracture, the fat particles from inside the bone can release into the bloodstream. In a few cases, blockages in the blood vessels are caused by substances other than blood clots, such as fat from the inside of a broken long bone, and air bubbles. Read This Now

5. Mutations

Factor V Leiden is a genetic mutation that increases a person’s risk of forming blood clots. The most common complications of this mutation include DVT and PE. But, in many cases, people with this mutation may not develop a blood clot.

6. Other factors 

• Pregnancy: Women are at a higher risk for PE during pregnancy by five times when compared to nonpregnant women.
  
• Smoking: It increases the activation of platelets by a hundred times, which can lead to a significant increase in blood clot formation.
  
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• Obesity: Being overweight or obese can increase the chances of blood clots and deep vein thrombosis. Weight gain changes lead to the thickness of the blood, making it harder to force through the veins and therefore increasing the risk of PE.
  
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Diagnosis Of Pulmonary Embolism

Timely diagnosis of pulmonary embolism can prevent several major health complications. Diagnosis mainly consists of the following:

1. History and physical examination 

A detailed family and medical history can help evaluate the risk factors for pulmonary embolism.

During the examination, patients with PE might have tachycardia (irregular heart rhythms), which is a common but nonspecific finding. Some of the other findings of PE include calf swelling, tenderness, redness, decreased breath sounds, and signs of pulmonary hypertension (which happens when the pressure in the blood vessels l from the heart to the lungs is too high) such as elevated neck veins. 

2. Imaging tests

With physical and medical examination, a few imaging tests may be required to confirm pulmonary embolism. They include:

• Computed tomographic pulmonary angiography (CTPA):.A CTPA is a CT scan that looks for blood clots in the lungs (mainly PE). A CT pulmonary angiogram takes pictures of the blood vessels that run from the heart to the lungs.
  
  
• Chest radiograph (chest X-ray): This imaging test is used to assess the lungs and heart.
  
  
• Ventilation-perfusion scan (V/Q scan): In this test, a small radioactive material is injected into the vein which helps in evaluating the movement of air into and out of the lungs along with the blood flow into the lungs. 
  
  
• Electrocardiogram (EKG): This is one of the simplest tests used for the evaluation of the heart. An EKG is recorded to detect the electrical activity of the heart to diagnose conditions of pulmonary embolism.
  
• Duplex ultrasound (US): The duplex or doppler ultrasound test examines the blood flow in the major arteries and veins in the arms and legs to detect clots.
  
  
• Magnetic resonance imaging (MRI): This test is a medical imaging technique that uses a magnetic field to create detailed images of the organs and tissues in your body. MRI has better sensitivity and specificity in detecting PE. 
  
  
• Pulmonary angiogram: A pulmonary angiogram is an imaging test to check the blood vessels of the lungs. The procedure is done with a special contrast dye administered into the blood vessels.
  

3. Lab tests 

• Arterial blood gas (ABG) analysis: ABG is a blood test that is used to indicate ventilation, gaseous exchange, and acid-base status. It is rarely used to diagnose PE.
  
  
• Brain natriuretic peptide (BNP): This is a blood test that measures the levels of a protein called BNP that is made by the heart and blood vessels. In a few individuals, there have been elevated plasma BNP levels in acute pulmonary embolism (APE).

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Prevention Of Pulmonary Embolism 

Pulmonary embolism is often caused by a blood clot that originally forms in the legs, and it is often difficult to detect a DVT before problems start. Therefore, preventing clots in the deep veins will help prevent pulmonary embolisms. It includes things such as: 

1. Manage your weight

Obesity puts additional pressure on the veins in the legs, which can contribute to poor blood flow and the development of blood clots. Eating a balanced diet will help in maintaining a healthy weight, and reduces the risk of blood clot formation.

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2. Use compression stockings

These stockings fit tightly around your lower legs and encourage the blood to flow more quickly around your body. This is a very safe, simple, and inexpensive way that squeezes or compresses the veins and prevents blood from flowing backward. 

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3. Start moving after surgery

There is a misconception that you need to lie in bed post-surgery. But, the main reason why doctors and nurses push you to get up and move is to prevent clots from forming by stimulating blood circulation.
 

4. Try pneumatic compression devices 

Intermittent pneumatic compression (IPC) devices are used to help prevent blood clots in the deep veins of the legs. These are the inflatable sleeves that you wear on your calves (lower legs) that are connected to a machine that provides alternating pressure on the legs to improve blood flow. 

5. Say no to tobacco

Toxic chemicals in cigarettes harm red and white blood cells and blood vessels and make you more susceptible to deep vein thrombosis and pulmonary embolism. 

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Note: Along with these make sure to keep your legs elevated at least for half an hour, twice a day, avoid sitting with crossed legs and wear loose-fitting clothes for better blood flow.

Doctor To Visit

The doctors that can be your best option to treat and manage pulmonary embolism are:

• Pulmonologists 
• Cardiologists 
  
  

A pulmonologist is a doctor who specializes in treating lung conditions. The doctor diagnoses and treats diseases of the respiratory system.
A cardiologist is a doctor who specializes in the study or treatment of heart diseases and heart abnormalities. 

Note: The treatment of PE may include medication management by a cardiologist, which may help in prescribing one or more blood thinning or clot-dissolving medications.

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Treatment Of Pulmonary Embolism 

Treatment choices for pulmonary embolism (PE) include:

I. Anticoagulants

In most cases, the treatment involves administering anticoagulant medications (blood thinners). This medicine decreases the blood’s ability to clot and prevents future blood clots from forming. These include:

• Heparin
• Fondaparinux 
  
  

Newer oral anticoagulants (NOACs) and vitamin K antagonists (VKA) have also been used for anticoagulation in PE.
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II. Reperfusion strategies

Reperfusion therapy is used to restore blood flow through a suspected or known blocked coronary artery immediately upon diagnosis. These include:

1. Catheter-directed treatment: This technique involves the insertion of a catheter into the pulmonary arteries, which is then used for ultrasound-assisted thrombolysis. 
   
   
2. Vena cava filter: This treatment is used when a person cannot go for anticoagulation treatment due to medical reasons. It involves placing a small metal device in the vena cava (the large blood vessel that returns blood from the body to the heart) to keep clots from traveling to the lungs.
   
   
3. Thrombolytic therapy: This therapy is called clot busters which use medications or a minimally invasive procedure to break up blood clots and prevent new clots from forming. 
   
   
4. Pulmonary embolectomy: This is a rarely used surgery conducted to remove a PE. This surgery is performed in cases, where the embolism is large enough and medicines or thrombolytic therapy cannot be used. 

III. Compression stockings

These are designed to apply pressure to the lower legs and help to maintain blood flow and reduce discomfort and swelling. These stockings are usually knee-high in length and squeeze the legs to prevent the blood from pooling.

IV. Supportive treatment

The treatment given to the body to cope with the ill effects of PE. These include oxygen support being given to the patient to reduce breathlessness, and in a few cases, intravenous fluids being administered to support circulation. In some cases, close monitoring and care are given to the patient depending upon the state of the patient. 

Home Remedies For Pulmonary Embolism 

Home remedies might not cure the blood clots permanently, but they can provide relief from the symptoms of PE. These include:

1. Garlic(Lahsun): Garlic helps in blood thinning and reduces blood clot formation in the arteries. It is advisable to eat garlic bulbs on an empty stomach in the morning. 
   
   
2. Neem: A few studies have demonstrated that neem has good or moderate clot-breaking properties. Small leaves of neem can be consumed daily to see the results.
   
   
3. Turmeric (Haldi): Turmeric extract has shown benefits in dissolving blood clots in some studies. Turmeric can be taken by adding it to a glass of warm milk and consumed immediately. 
   
   

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4. Tulsi: Tulsi extract has shown moderate to good activity in breaking down clots. Tulsi can be taken by chewing fresh tulsi leaves or drinking tulsi tea for its benefits. Tulsi tea can be prepared by boiling fresh or dried tulsi leaves in some water and straining the leaves.
   
   
5. Cayenne pepper: It has a high amount of salicylates. These salicylates have powerful blood-thinning effects and can be used to treat blood clots. 

Complications Of Pulmonary Embolism

If left untreated, pulmonary embolism can lead to the following complications:

1. Pulmonary infarction (PI)

Pulmonary, or lung, infarction (PI) refers to the death of lung tissue due to a lack of blood supply. According to research in 2021, it has been noted that 30 percent of individuals having PE show signs of PI.

2. Pleural effusion

PE is one of the most common causes of pleural effusion (water on the lungs). Pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. The symptoms include sharp chest pain, cough, and shortness of breath. 

3. Cardiogenic shock

It is a life-threatening condition in which your heart is unable to pump enough blood suddenly. This can ultimately lead to a drop in blood pressure and pulse rate leading to brain injury or organ failure.

4. Bleeding by taking blood thinners

Treatment of PE involves the administration of anticoagulants for resolving blood clots. In cases, where the blood becomes too thin, a minor cut can cause too much bleeding.

5. Cardiac arrest 

A PE increases the risk of cardiac arrest by many folds. Cardiac arrest further increases the risk of death by 95%. 

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Living With Pulmonary Embolism 

Recovery from pulmonary embolism can vary based on the severity of the condition and the treatment. The major treatment takes place in the hospital and after leaving the hospital, a patient may be required to take medicines for six months or longer. Certain tips to keep in mind if you have PE include:

1. Following up regularly

Studies suggest that individuals with pulmonary embolism should visit their doctors every 2 weeks for 3 months post-PE.

• The routine follow-up visits scheduled by the doctor should never be missed as this can help the doctor to conduct imaging tests. This helps the doctor to check for signs of new blood clots forming in the legs that can lead to PE. 
• Taking all the medicines prescribed by the doctor on time. 

2. Preventing recurrence

The doctor may recommend combining medication and lifestyle changes simultaneously to manage the long-term risks of a recurrence of deep vein thrombosis which leads to PE. To prevent recurrence the doctor may include:

• Staying physically active
• Drinking more fluids
• Maintaining a healthy weight
• Quitting smoking
• Avoiding the use of oral contraceptives.

3. Avoiding injuries

Suitable caution must be taken if you are taking anticoagulants as this can lead to serious bleeding risk. Your doctor may suggest avoiding foods rich in vitamin K, alcohol, and over-the-counter medicines (such as aspirin).