Pulmonary Embolism: Who Is At Risk
What is a pulmonary embolism (PE)?
A pulmonary embolism (PE) occurs when there is a blockage in the lung (pulmonary) arteries. In a pulmonary embolism, a blood clot breaks off from another part of the bloodstream and travels to the arteries in the lungs.
When a clot is in a deep vein—usually in the thigh or lower leg—the condition is called deep vein thrombosis (DVT). A pulmonary embolism is the most serious complication of a deep vein thrombosis.
Who is at risk of developing a pulmonary embolism (PE)?
People at risk for PE are those who:
- Have been inactive or immobile for long periods of time.
- Have certain inherited conditions, such as blood clotting disorders or factor V Leiden.
- Are having surgery or have broken a bone (the risk is higher weeks following a surgery or injury).
- Have cancer, a history of cancer, or are receiving chemotherapy.
Other risk factors for PE are:
- Being overweight or obese.
- Smoking cigarettes.
- Being pregnant or having given birth in the previous six weeks.
- Taking birth control pills (oral contraceptives) or hormone replacement therapy.
- Having diseases such as stroke, paralysis, chronic heart disease, or high blood pressure.
- Having had recent injury or trauma to a vein.
- Having had severe injuries, burns, or fractures of the hips or thigh bone.
- Being above the age of 60.
If the patient has any of these risk factors and has had a blood clot, he or she should meet with a health care provider so appropriate steps can be taken to reduce personal risk.
How serious is a pulmonary embolism (PE)?
A PE is a very serious condition that can:
- Cause failure of the right heart.
- Cause low oxygen levels in the blood.
- Damage other organs in the body because of a lack of oxygen.
- Cause death if the blood clot gets too large or if there are multiple blood clots.
- Lead to permanent damage of the lung arteries and later high lung pressure (pulmonary hypertension).
Symptoms and Causes
What are the symptoms of pulmonary embolism (PE)?
The symptoms of a PE vary based on the individual and the severity of the blood clot. Symptoms include:
- Sudden shortness of breath
- Problems with breathing
- Chest pain
- Coughing with or without bloody sputum (mucus)
- An arrhythmia (irregular heartbeat)
- Swelling of the leg or along a vein in the leg
- Pain or tenderness in the leg
- Increased warmth in a leg that is swollen or painful
- Red or discolored skin on the affected leg
- Feelings of anxiety or dread
- Bluish skin (cyanosis)
- Lightheadedness or fainting
- Rapid breathing
- Sweating, clammy skin
- Increased heart rate
The patient should see a doctor right away if experiencing any of these symptoms. However, in some cases, it is possible for the patient to have no symptoms with a pulmonary embolism.
Diagnosis and Tests
How is a pulmonary embolism (PE) detected?
A PE is detected based on the patient’s medical history, a physical exam, and test results. The tests used to detect a pulmonary embolism are:
Management and Treatment
How is a pulmonary embolism (PE) treated?
PE treatment usually is given in the hospital. PE can be treated with medicines, procedures, and other therapies. The main goals of these treatments are to stop the blood clot from growing and to prevent any new blood clots from forming.
Treatments consist of anticoagulation drugs, also known as blood thinners. Blood thinners decrease the body’s ability to clot. They are used to stop blood clots from getting larger and to prevent clots from forming. Blood thinners can be given as a pill, an injection, or intravenously (through a vein; IV).
- Heparin is given as an injection or through an IV tube and acts quickly.
- Warfarin (Coumadin®), dabigatran etexilate (Pradaxa®), rivaroxaban (Xarelto®), and apixaban (Eliquis®) are given in pill form and are taken by mouth.
- Thrombolytics are drugs used to dissolve and treat large blood clots. Thrombolytics are used only in life-threatening situations.
Other treatment options
- Vena cava filter: A filter called the vena cava filter is placed inside a large vein called the inferior vena cava. This filter catches the clot before it travels to the lungs, preventing a pulmonary embolism.
How can pulmonary embolism (PE) be prevented?
The following steps can help a patient prevent PE:
- Moving the lower limbs while sitting during long periods of time during travel
- Getting regular exercise
- Eating a healthy diet and drinking plenty of fluids; avoiding excess alcohol and caffeine
- Getting out of bed and moving around as much as possible after a recent surgery or illness
- Not smoking
- Following up with a doctor
If a patient has a history of deep vein thrombosis (DVT) or PE, there are steps to prevent new blood clots from forming. The patient should visit a doctor for regular checkups and use prevention methods as the doctor advises. The patient should contact a doctor right away if having any signs or symptoms of DVT or PE.
What steps can be taken after a pulmonary embolism (PE)?
Persons who have had deep vein thrombosis (DVT) or PE are at higher risk for having the condition again. During and after the treatment, the patient should continue to take steps to prevent DVT and PE. These steps include being aware of the body and checking the legs for any symptoms of DVT. Continued routine check-ups with a doctor should be scheduled. A visit to the doctor is recommended if the patient has any DVT or PE symptoms.