What is a pulmonary embolism?
A pulmonary embolism (PE) is a blood clot in the lung that occurs when a clot in another part of the body (often the leg or arm) moves through the bloodstream and becomes lodged in the blood vessels of the lung. This restricts blood flow to the lungs, lowers oxygen levels in the lungs and increases blood pressure in the pulmonary arteries.
If a clot develops in a vein and it stays there, it’s called a thrombus. If the clot detaches from the wall of the vein and travels to another part of your body, it’s called an embolus.
What causes pulmonary embolism?
Pulmonary embolism can happen:
- When blood collects ("pools") in a certain part of the body (usually a vein in the arm or leg). Pooling of blood is most common after you have been inactive for a long time, such as after surgery or bed rest.
- When your veins are injured, such as from a broken bone or surgery (especially in the pelvis, hip, knee or leg).
- As a result of another medical condition, such as cardiovascular disease (including congestive heart failure, atrial fibrillation and heart attack) or stroke.
- If you have higher than normal (or lower than normal in some cases) levels of clotting factors in your blood. Some types of cancer and the use of hormone replacement therapy or birth control pills can cause an increase in these levels. Abnormal (high or low) levels can also be caused by hereditary conditions.
Who is at risk of developing a blood clot?
Your risk of having a blood clot is higher if you:
- Have been inactive or haven’t moved for a long period of time due to bed rest, surgery, or traveling.
- Have a personal or family history of a blood clotting disorder, such as deep vein thrombosis (DVT) or PE.
- Have a history of cancer or are getting chemotherapy.
- Have a history of heart failure or stroke.
- Are overweight or obese.
- Have had a recent trauma or injury to a vein, possibly from a recent surgery, broken bone or varicose veins.
- Are pregnant or have given birth in the last 6 weeks.
- Are taking birth control pills (oral contraceptives) or hormone replacement therapy.
- Have a central venous catheters in your arm or leg.
If you have any of these risk factors and you have had a blood clot, please talk with your healthcare provider to create a plan to reduce your risk of a PE.
What are the symptoms of pulmonary embolism?
Most people with a PE have symptoms, but some do not, which is why it is important to talk to your doctor about your risk. Symptoms depend on how bad the clot is and can include:
- Sudden shortness of breath (while active or resting).
- Unexplained sharp pain in your chest, arm, shoulder, neck or jaw. The pain may be similar to symptoms of a heart attack.
- Pale, clammy or bluish-colored skin.
- Rapid heartbeat (pulse).
- Cough with or without bloody sputum.
- Excessive sweating.
- In some cases, feeling anxious, light-headed, faint or passing out.
- Wheezing.
If you have any symptoms of a pulmonary embolism, get medical help right away!
How serious is a pulmonary embolism?
If you have a PE, it is extremely important to get the right diagnosis and treatment. Without it, a PE can cause heart damage and, depending on the size of the PE, even death.
How do I know if I have a PE?
Your doctor will order testing to check for a PE. Common tests include:
- Computed tomography (CT) scan.
- Lung scan.
- Blood tests (including the D-dimer test).
- Pulmonary angiogram.
- Ultrasound of the leg (instead of a CT scan when a CT scan cannot be done).
- Magnetic resonance venous imaging (MRV) of the lungs.
What treatments are available?
Typical treatment for a PE takes place in the hospital. This lets your healthcare team keep a close eye on you and how you’re doing. But, not all patients need to stay in the hospital.
Medications
Anticoagulants: Your treatment will likely include anticoagulant medications ("blood-thinners"). Anticoagulants make it harder for your blood to clot. They prevent future blood clots but do not destroy the clots you already have.
There are several types of anticoagulants available, and depending on the type you take, you may need to have regular blood tests. Your doctor will talk to you about the medication(s) best for you. You will get detailed information about your prescribed information. Please make sure you ask your doctor or pharmacist any questions you have about the medication or how to take it. Do not start or stop taking any medication without first asking your doctor.
Thrombolytic therapy: Thrombolytic medications, also known as "clot-busters", dissolve the blood clot. You may need this treatment if your blood pressure is low or if the PE is causing your condition to be unstable. This type of medication is given in the hospital so your healthcare team can keep a close eye on our condition.
Catheter-directed therapy (CDT): Your doctor may consider using catheter-directed therapy (CDT) for your pulmonary embolism depending on the seriousness of your blood clot. This procedure requires the placement of catheters directly into your pulmonary arteries where lower doses of thrombolytic therapy (clot buster) are given.
Procedures
If your PE is life-threatening, or if other treatments don’t work, you may need surgery to remove it. Surgery is only used when thrombolytic therapy is not an option and you are critically ill.
If you cannot receive blood thinners due to bleeding or recent surgery or trauma, an Inferior Vena Cava (IVC) filter may be necessary. Your doctor may use an interventional procedure to place a filter that traps clots before they get to the lungs from the legs. The filter is put in place using a long, thin tube called a catheter. The catheter is inserted into a vein in your groin or neck and guided to the vena cava (the body’s largest vein).
Compression stockings
Compression stockings (support hose) help blood flow in your legs. They add pressure to the veins in your legs, which keeps blood from pooling in your veins.
Compression stockings come in different sizes, lengths and pressures. Your doctor will prescribe the right type for you. The most commonly prescribed length is worn below the knee. It is important to wash compression stockings as directed to prevent damage.
How to reduce your risk of a pulmonary embolism
If you are at risk of having a PE, you can reduce your risk by following these tips:
- Get regular exercise. If you need to sit or stand for long periods of time, move your arms, legs and feet for a few minutes each hour. Your doctor may also prescribe compression stockings to improve blood flow.
- Drink plenty of fluids, especially water. Avoid drinking too much alcohol and caffeine.
- Don't smoke.
- Don't wear tight-fitting clothing.
- Lose weight if you are overweight or obese.
- Talk to your doctor about other ways to reduce your risk, especially if you or any of your family members have had a blood clot.
Care after a pulmonary embolism
Be sure you understand your plan of care, including medications and the need for follow-up and lab visits. Most patients need to take blood thinners for 3 months or longer after they first get treatment. Follow all of your doctor’s recommendations and keep all appointments to prevent another PE.
