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Understanding Pulmonary Embolism

pulmonary embolism, pe, symptoms, treatment A pulmonary embolism (PE) is a serious medical condition that occurs when one of the pulmonary arteries in the lungs suddenly becomes blocked. If the blood clot is large enough, it can obstruct the flow of blood to the lungs which can be life-threatening. While obtaining prompt medical attention can greatly improve your chances for survival, the best way to protect yourself against pulmonary embolism is through prevention.[1]

Causes of Pulmonary Embolism

PE is usually caused by a blood clot in the deep veins of the leg that breaks loose and travels through the circulatory system to the lungs. This condition is known as deep vein thrombosis, or DVT.  Sometimes, blood clots form in a vein that’s close to the surface of your skin. This is known as superficial venous thrombosis and seldom leads to pulmonary embolism. In rare cases, other substances – small masses of infectious material, tumors, air bubbles or fat – can block the artery and lead to pulmonary embolism.1

Pulmonary Embolism Symptoms

Symptoms of pulmonary embolism include:

  • Shortness of breath that may come on suddenly
  • Sudden sharp chest pain that may worsen with deep breathing and/or coughing
  • Fast heart beat
  • Fast breathing
  • Palpitations
  • Excessive sweating
  • Increased anxiety
  • Coughing up blood or pink, frothy mucus
  • Fainting
  • Signs of shock (inability to answer questions, losing consciousness, feeling very dizzy or lightheaded, feeling very weak or having trouble standing up, confusion, restlessness, being fearful).

The symptoms of pulmonary embolism often occur with, or may mimic other conditions such as heart attack, asthma, pneumonia or COPD. Some people may even be confused with a panic attack. Some people may not have any symptoms at all. This makes pulmonary embolism difficult to diagnose. Sometimes, your symptoms may be related to DVT, and may include swelling, pain, tenderness, increased warmth and redness or discolored skin of the affected leg.1

Risk Factors for Pulmonary Embolism

Although anyone can get a PE, there are certain factors that place you at greater risk for its development. These include:[2]

  • Prolonged bed rest or inactivity, including taking long trips in a car or airplane
  • The use of birth control pills
  • Recent surgery, including heart surgery
  • Before, during, and after pregnancy
  • Having cancer, stroke or heart attack
  • Hip or femur fractures
  • Previous DVT
  • COPD
  • Recent COPD exacerbation

Diagnosis of Pulmonary Embolism

Although it’s important for someone with a PE to be examined by a doctor, a clinical assessment alone is often unreliable and the consequences of being misdiagnosed can be serious, even fatal.[4] In fact, for patients with COPD, the clinical presentation and symptoms of PE are so similar to COPD that determining the presence of a pulmonary embolism can be difficult without conducting a number of tests.3

After your doctor performs a thorough physical exam which involves asking you questions about your medical history, the following tests may be ordered to help confirm or rule out a diagnosis of PE:1[5]

  • D-dimer blood test – measures a substance in the blood that’s released when a blood clot breaks up. D-dimer levels are usually elevated in people with PE.
  • Other blood tests – including blood tests that check for inherited conditions that put you at greater risk for blood clots. Additionally, because a blood clot in your lungs can lower the amount of oxygen that’s in your blood, a blood test that measures the amount of oxygen and carbon dioxide in your blood may also be ordered.
  • Ventilation/perfusion (VQ) lung scan – a nuclear medicine scan that uses a radioactive substance to examine the flow of air (ventilation) and blood flow (perfusion) in the lungs.
  • Computed tomography (CT) scan – a dye is injected into a vein in your arm that makes the blood vessels in your lungs show up on an X-ray examination. This helps identify the presence of a clot.
  • Pulmonary angiogram – a catheter (flexible tube) is inserted into the groin or arm and threaded through the blood vessels to your lungs. Your doctor uses the catheter to inject dye into the blood vessels. X-rays are then taken that show the flow of blood through the lungs. If a blood clot is found, your doctor may decide to remove it through the catheter or inject a medicine that will dissolve the clot.
  • Duplex ultrasonography – this test, also sometimes called a duplex scan or compression ultrasonography, scans the veins in your legs and sometimes your arms using sound waves. This allows the areas to be checked, in a noninvasive way, for deep vein blood clots. This test is often followed by a CT or venography to confirm the findings.
  • Additional tests – may be ordered to rule out the possible causes of your symptoms and may include an echocardiogram (uses sound waves to check heart function and detect blood clots in the lungs), an EKG (detects and records the electrical activity of the heart), chest X-ray, and chest MRI (uses radio waves and magnetic fields to provide more information about the organs and structures in your body than a simple X-ray).

Treatment of Pulmonary Embolism

The primary goals of treatment for PE are to prevent the development of deep vein thrombosis wherever possible. If you already have DVT, treatment will be focused on keeping the existing blood clot from becoming larger and to keep new clots from forming. To accomplish this, doctors use medication, procedures and other therapies as follows:1

  • MedicationAnticoagulants (blood thinners) are used to prevent the clot from getting larger and to keep new clots from forming. They do not dissolve blood clots that have already formed. The most common types of anticoagulant therapy involves using heparin and warfarin (Coumadin). Because heparin acts quickly and warfarin takes 2-3 days to take effect, your doctor may start you on both, then discontinue heparin once the warfarin begins to work. A newer type of blood-thinning agent – thrombin inhibitors – may be used to treat some types of blood clots in people who are unable to tolerate heparin. Thrombolytics, medications that can rapidly dissolve clots, are sometimes given in the emergency room or the hospital. Because one of the side effects of this type of medicine is sudden bleeding, they are only given in emergency, life-threatening situations.
  • Procedures – your doctor may be able to remove or dissolve a clot by inserting a catheter into your groin or arm and threading it through your blood vessels until it reaches the clot. In rare occasions, surgery may have to be performed to remove a clot.
  • Other therapies – if you’re unable to take blood thinners or they don’t work the way they’re supposed to, your doctor may suggest a vena cava filter, a medical device that prevents blood clots from traveling to your lungs. Graduated compression stockings, as ordered by your doctor, can also be worn on the legs to help prevent the ongoing swelling in your legs from DVT.

How to Prevent Pulmonary Embolism

The first step in preventing pulmonary embolism is to know whether you’re at risk for DVT. As always, if it is possible to eliminate any risk factors, that is advisable. Mitigating your risk is your first stop in preventing pulmonary embolism. Once you understand your risk factors, you can take the following steps to lower your risk:

  • Exercise your lower leg muscles when traveling and while sitting for an extended period of time.
  • After surgery or an illness that has left you bedridden, get out of bed as soon as possible and move around. Engaging in movement helps prevent blood clots from forming.
  • Take blood thinners as prescribed by your doctor.
  • Visit your doctor for regular checkups.

If you know you are already at risk of developing pulmonary embolism, talk to your doctor about any additional steps you may need to take to reduce your risk. Regular tests or screenings may be necessary to prevent and diagnose any potential clots, allowing you to get treatment as soon as possible. Early intervention with pulmonary embolism is essential for a positive outcome.5

If you have signs and symptoms of DVT or PE—particularly if you are at a higher risk for PE because of COPD, cancer, heart attack, stroke or recent surgery or fractures—contact your doctor immediately or seek emergency medical care.

Frequently Asked Questions: Pulmonary Embolism

Can COPD cause pulmonary embolism?
COPD is recognized as a moderate risk factor for pulmonary embolism. Because people with COPD are frequently immobile, particularly after an exacerbation, they are at a higher risk of developing deep vein thrombosis and pulmonary embolism. Additionally, because people with COPD are more likely to receive a CT as part of their COPD diagnosis, it may also be that COPD patients are found to have PE more frequently as a result.3

Is COPD a risk factor for pulmonary embolism?
Yes it is. People with COPD are particularly at risk for PE after an acute exacerbation. This is in part because of the immobilization that often comes with a COPD exacerbation, which is already one of the risk factors. If you have a COPD exacerbation, talk to your doctor about how you can exercise your leg muscles—particularly if getting up and walking is not an option yet.

Is coughing a sign of pulmonary embolism?
Yes, it can be. If a blood clot travels, usually from the legs, to the lungs, it often causes the sudden onset of shortness of breath and a dry cough. This cough may also produce bloody or blood-tinged phlegm. Chest pain may also accompany these symptoms and may be particularly intense when coughing.5[6] If you experience these symptoms, seek emergency medical treatment right away, as pulmonary embolism can be life-threatening.

What causes pink frothy sputum?
Pink frothy sputum is most commonly associated with pulmonary edema, which is the buildup of excess fluid in the air sacs in the lungs. With pulmonary edema, coughing up pink frothy sputum may be accompanied by difficulty breathing, a feeling of suffocating when lying down, gasping for breath or wheezing, cold and clammy skin, bluish lips, an irregular or rapid heartbeat and anxiety or sense of restlessness. However, pink frothy sputum can also be a symptom of pulmonary embolism. Both conditions can be life-threatening, and so this symptom should warrant immediate action. If you cough up pink frothy sputum, seek medical attention right away. If you have any of these other symptoms in conjunction with the pink frothy sputum, seek emergency medical attention immediately.[7]

How serious is a pulmonary embolism?
Pulmonary embolism is a serious medical condition and can be life-threatening. Approximately one-third of people with undiagnosed, and therefore untreated, pulmonary embolism do not survive. Pulmonary embolism can also lead to a condition called pulmonary hypertension. With this condition, the blood pressure in the right side of your heart and in your lungs is too high because the clot in your lungs makes your heart work harder than it should have to.5 If you experience any of the symptoms of pulmonary embolism, do not hesitate to get medical attention. The sooner the problem can be diagnosed and treated, the better. If you have COPD, make sure you are aware of the symptoms of PE so that you can act quickly if you suspect you may be experiencing pulmonary embolism. Be particularly cognizant of these symptoms following a COPD exacerbation.

Sources:

[1] Kearon, Clive. “Diagnosis of Pulmonary Embolism.” CMAJ : Canadian Medical Association Journal = Journal De L’Association Medicale Canadienne, U.S. National Library of Medicine, 21 Jan. 2003, www.ncbi.nlm.nih.gov/pmc/articles/PMC140429/.
[2] “Pulmonary Embolism | Deep Vein Thrombosis.” MedlinePlus, U.S. National Library of Medicine, 8 Dec. 2020, medlineplus.gov/pulmonaryembolism.html.
[3] Bertoletti, Laurent. “The Paradoxical Association between Pulmonary Embolism and COPD.” European Respiratory Society, European Respiratory Society, 1 July 2017, erj.ersjournals.com/content/50/1/1700959.
[4] “Risk Factors.” The Lung Association, Canadian Lung Association, 19 Aug. 2014, www.lung.ca/lung-health/lung-disease/pulmonary-embolism/risk-factors.
[5] “Pulmonary Embolism.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 June 2020, www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647.
[6] “Learn About Cough.” American Lung Association, American Lung Association, 23 Feb. 2021, www.lung.org/lung-health-diseases/warning-signs-of-lung-disease/cough/learn-about-cough.
[7] “Pulmonary Edema.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 20 Oct. 2020, www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009.

 
 

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