Pulmonary Embolism (PE)

Content of This Page

1- Introduction

2- Causes

3– Symptoms

4- Stages of The Disease

5- Treatment

6- What Should You Avoid

Prolonged Immobility: Sitting or lying down for long periods, such as during long flights or bed rest, can slow blood flow and increase the risk of clot formation.
Surgery: Major surgeries, particularly those involving the pelvis, abdomen, or legs, can increase the risk of blood clots due to inactivity and changes in blood flow.
Certain Medical Conditions: Conditions like cancer, heart disease, and genetic clotting disorders can increase the risk of blood clots.
Pregnancy: The increased pressure on veins in the pelvis and legs during pregnancy can slow blood flow, making clots more likely.
Hormone Therapy and Birth Control Pills: Estrogen in these medications can increase the tendency of the blood to clot.
Smoking: Smoking affects blood circulation and can increase the risk of blood clots.
Obesity: Excess weight increases pressure on the veins in the pelvis and legs, which can contribute to clot formation.
Injury or Trauma: Injuries that damage veins, such as fractures or severe bruising, can lead to clot formation.

Sudden Shortness of Breath: This is often the first and most noticeable symptom, occurring even at rest.
Chest Pain: The pain is typically sharp and worsens with deep breathing, coughing, or movement. It may feel similar to a heart attack.
Rapid Heart Rate (Tachycardia): A fast heartbeat is a common response to the decreased oxygen levels in the blood caused by a PE.
Cough: This may be dry or accompanied by bloody sputum (coughing up blood).
Lightheadedness or Dizziness: This can occur due to decreased oxygen levels and reduced blood flow.
Sweating: Unexplained, excessive sweating can be a sign of PE.
Leg Pain or Swelling: If the PE is caused by a deep vein thrombosis (DVT), there may be pain, swelling, or redness in the leg where the clot originated.
Clammy or Bluish Skin: A sign of inadequate oxygenation in severe cases.

Clot Size: Small to moderate.
Symptoms: May include mild shortness of breath, chest pain, and a slightly elevated heart rate. Symptoms may be less severe and not immediately life-threatening.
Blood Flow Impact: Limited to a small portion of the lung, with minimal effect on overall blood circulation.
Outcome: Often treatable with anticoagulant medications, and patients usually recover fully with appropriate care.

Clot Size: Moderate.
Symptoms: More noticeable shortness of breath, chest pain, and possibly signs of heart strain, such as a rapid or irregular heartbeat.
Blood Flow Impact: A larger area of the lung is affected, which can start to strain the heart.
Outcome: Requires prompt treatment, which may include anticoagulants, thrombolytics (clot-dissolving drugs), or procedures to remove the clot.

Clot Size: Large, potentially blocking a major artery in the lung.
Symptoms: Severe shortness of breath, sharp chest pain, fainting, very low blood pressure, and shock. This can lead to a rapid heart rate and even collapse.
Blood Flow Impact: Significant portion of the lung and major arteries are blocked, leading to a sudden drop in blood oxygen levels and strain on the heart.
Outcome: This is a life-threatening emergency requiring immediate treatment, such as thrombolytics, surgical intervention, or catheter-based clot removal. Even with treatment, there is a high risk of complications or death.

- Development: A long-term complication of PE, where blood clots do not completely resolve, leading to persistent high blood pressure in the lungs.
- Symptoms: Chronic shortness of breath, fatigue, and exercise intolerance, similar to pulmonary hypertension.
- Outcome: Requires long-term management and may include anticoagulants, medications for pulmonary hypertension, or surgery.

Purpose: Prevent new clots from forming and stop existing clots from growing.
Types:
- Heparin: Often given intravenously or by injection, especially in the hospital setting. It works quickly and is often the first line of treatment.
- Warfarin (Coumadin): An oral anticoagulant that requires regular blood tests to monitor its effect.
- Direct Oral Anticoagulants (DOACs): Medications like rivaroxaban, apixaban, and dabigatran are newer options that do not require frequent blood monitoring.
Duration: Treatment typically lasts 3 to 6 months, but longer courses may be needed for those with ongoing risk factors.

Purpose: Quickly dissolve the clot in cases of severe, life-threatening PE (massive PE).
Types: Drugs like tissue plasminogen activator (tPA) are used.
Risks: Increased risk of serious bleeding, so these are usually reserved for critical situations.

Purpose: Physically remove or break up the clot, especially in cases where thrombolytics are contraindicated or not effective.
Types:
- Embolectomy: Surgical removal of the clot, typically used in emergency situations.
- Catheter-Directed Thrombolysis: A catheter is threaded through the blood vessels to the site of the clot, where medications or mechanical devices are used to break it up.

Purpose: A small device placed in the inferior vena cava (a large vein in the abdomen) to catch clots before they reach the lungs.
Use: Typically for patients who cannot take anticoagulants or who have recurrent clots despite treatment.
Risks: Can lead to long-term complications and is generally used as a temporary solution.

Oxygen Therapy: To ensure adequate oxygen levels in the blood, especially in severe cases.
Pain Management: Medications may be provided to manage chest pain.
Monitoring: Close observation in a hospital setting to manage symptoms and watch for complications.

- Lifestyle Changes: Patients are often advised to stay active, avoid prolonged immobility, and follow a healthy diet to reduce risk factors.
- Regular Monitoring: Blood tests and follow-up appointments to ensure anticoagulation is effective and to monitor for side effects.
- Management of Underlying Conditions: Treating conditions like cancer or heart disease that increase the risk of PE.