What Is Pulmonary Embolism?

We often hear of pulmonary embolism as the cause of serious illness among individuals, however, how does this condition actually begin? hat exactly are the most common symptoms that should be looked out for? Let us understand all its aspects in detail here. 

Pulmonary embolism (PE) is marked by the presence of a blood clot in the arteries of the lungs. This occurs when the blood clot from another area of the body typically the leg or arm travels through the veins and places itself in the lung. PE restricts the blood supply to lungs, which also reduces oxygen levels and raises blood pressure in pulmonary arteries.

Read this article further to know the signs and symptoms of PE, its diagnosis, and the prevention strategies that can better help us to keep this problem at bay. 

Overview

Pulmonary embolism involves the blockade of one or more arteries of the lungs by the presence of a blood clot. An embolus is a blood clot that originates in a particular part of the body and then breaks off from it to deposit itself somewhere else in the body. In case of PE, the embolus primarily travels from the legs, or rarely, from other parts of the body. One of the primary symptom to identify PE is chest pain. Other signs include cough and shortness of breath. Its treatment entails dissolving or breaking the formed clot by medical procedures, blood thinners, and other medications.

Prevention is the key to protect oneself from it. This involves an active lifestyle which does not allow for the clot to deposit itself.

Causes of pulmonary embolism

The majority of blood clots that result in pulmonary embolism are produced in the deep leg veins. They may also develop in the deep veins in the pelvis or limbs. Henceforth, this is also referred to as deep vein thrombosis (DVT). In surface veins, blood clots can develop occasionally. But pulmonary embolism from these clots happens infrequently. Other substances may, in uncommon instances, be the source of pulmonary embolism. They comprise small aggregates of infectious material, fat, air bubbles or substances that get into the blood from certain kinds of bone fractures, surgery, trauma, severe burns, medical procedures, foetal fluids, and tumours brought on by quickly expanding cancer cells ¹. 

Signs and symptoms of pulmonary embolism

One of the most common symptoms of pulmonary embolism is sudden shortness of breath. Other common symptoms include reduced blood pressure, a sensation of faintness, dizziness, or lightheadedness, abnormal pulse, chest discomfort (usually worse with breathing), blood in one's cough, and sweating. Symptoms of deep vein thrombosis that might accompany those of PE are pain in the affected limb (may happen only when standing or walking), leg pain, swelling, sensitivity, redness, and/or discoloured skin.

Management and treatment for pulmonary embolism

Optimum management and treatment of PE involves medications which may include blood thinners (anticoagulants) or clot dissolvers (thrombolytics). Upon assessing the severity of the disease, the medical professional may prescribe clot removal surgery as well.

Diagnosis of pulmonary embolism

The diagnosis of PE involves the following techniques:²

• Pulmonary angiogram- Blood vessel stenosis, aneurysms, and blockages are just a few of the conditions that can be assessed using this X-ray picture of the blood vessels. Through a tiny, flexible catheter inserted into an artery, a dye (contrast) is injected. On an X-ray, this dye causes the blood arteries to be visible
• Electrocardiogram (EKG)- One of the simplest and quickest exams available to assess the heart is this one. On the arms, thighs, and specific locations on the chest, electrodes (tiny, sticky patches) are applied. Lead wires are used to link the electrodes to the EKG device. It measures, analyzes, and prints out the heart's electrical activity
• Chest X-ray- The heart and lungs are evaluated using this diagnostic procedure. The size, contour, structure, and anatomical position of the heart, lungs, bronchi (large breathing tubes), aorta, pulmonary arteries, and mediastinum are all visible on chest X-rays
• Ventilation perfusion scan (V/Q scan)- A tiny quantity of a radioactive substance is used to aid in the examination of the lungs during this nuclear radiology test. Ventilation, or the flow of air into and out of the airways and bronchioles, is assessed by a ventilation scan. A perfusion scan analyses pulmonary blood flow
• Computed Tomography (CT Scan)- This imaging procedure creates precise images of the bones, muscles, fat, and organs using X-rays and a computer. The image of the blood arteries in the lungs appears better on a CT scan with contrast. Contrast is a chemical similar to a dye that is injected into a vein to help the organ or tissue being studied appear more clearly on the scan
• Magnetic Resonance Imaging (MRI)- This imaging test creates precise images of the body's organs and structures using a magnetic field, radiofrequency technology, and a computer
• Blood Tests- Blood tests, such as the D-dimer level test, are used to examine the blood's clotting capacity. Testing for genetic abnormalities that may lead to irregular blood clotting may be done as part of additional blood work. To determine the blood's oxygen content, arterial blood gases can be examined
• Duplex Ultrasound- This kind of vascular ultrasonography is used to examine the structure and blood flow within the legs. Ultrasound employs a computer and high-frequency sound waves to create images of the organs, tissues, and blood arteries
• Compression Ultrasonography- The most precise noninvasive DVT diagnosis test is compression ultrasound (CUS) venous imaging. The basic principle behind this technique uses the ideology that normal veins can be compressed easily while those with thrombi cannot. Although radiology and vascular departments still frequently use duplex ultrasound to assess proximal DVT, early research shows that limited CUS examination of symptomatic ambulatory patients, when carried out by skilled sonographers, is highly accurate in confirming or excluding the diagnosis³

Prevention of pulmonary embolism

Keeping blood clots and deep vein thrombosis to a minimum is the greatest strategy to avoid pulmonary embolism. Long-term inactivity, being older than 60, having tumours, smoking, using oral contraceptives or hormone therapy, and having a family history of deep vein thrombosis or pulmonary embolism are all risk factors. The risk of getting pulmonary embolism can be reduced by being as mobile as you can, giving up smoking, and leading an active lifestyle.⁴

Complications of pulmonary embolism

PE can result in major life-threatening issues, including death, especially if the clots are big or several in number. It can lower the blood oxygen levels, inducing hypoxia,  that may cause damage to other tissues as well. Other complications of PE are cardiac arrhythmia and/or arrest and pulmonary infarction, that is, where lung tissue gets damaged due to prolonged absence of oxygen.

FAQs

Who are at risks of pulmonary embolism

The following people are at a risk of developing pulmonary embolism.⁵

• Individuals with a history of blood clots
• Genetic predisposition
• Certain medications like birth control pills and estrogen replacement therapy
• Limited mobility
• Old age
• Obesity
• Smoking
• Pregnancy
• Surgery or injury (especially to the legs)

What can I expect if I have pulmonary embolism

Having pulmonary embolism can start with a sharp pain in the chest. The pain can be felt while taking a deep breath, leaning, or bending.

How common is pulmonary embolism

Although precise epidemiological data are not yet available, the incidence of PE is thought to be between 60 and 70 per 100,000.⁶

When should I see a doctor

In case you experience persistent chest pain, shortness of breath, or witness bloody mucus, you should immediately seek medical advice.

Summary

PE is such a condition that requires immediate medical attention once the symptoms start appearing. To avoid it, one should have an active lifestyle and healthy eating habits. This will prevent the incidence of this disease.