This article will discuss the acute condition of pulmonary embolism, a life-threatening condition. Symptoms include shortness of breath, cough, chest pain, and leg swelling, among others. This article will also review the causes, diagnostic workup, and management of this condition.
What Is Pulmonary Embolism?
Pulmonary embolism (PE) is a sudden-onset, potentially life-threatening condition. It is the result of a blood clot traveling or forming in the blood vessels of the lungs. This clotting can lead to permanent damage to the lungs, low oxygen levels in the rest of the body, and damage to other organs due to this low oxygen level. A pulmonary embolism can also be a chronic condition. People who are prone to clotting for genetic or acquired reasons are at higher risk of PE.
There are a number of diagnostic tests for determining if you have a PE, including blood tests and imaging of the chest. Symptoms include shortness of breath, a cough, chest pain, and leg swelling.
Treatment is required in a timely manner, and may involve medications or procedures.
Call 911 immediately. This is a medical emergency that requires immediate diagnosis and treatment.
Pulmonary Embolism Symptoms
There are a number of non-specific symptoms associated with PE including:
- Shortness of breath: In the case of PE, you can still move air into your lungs but the blood cannot flow through the pulmonary vasculature to pick up the oxygen. This results in low oxygen levels and subsequent shortness of breath.
- Cough: People with a pulmonary embolism may have a dry cough due to irritation of lung tissue or a cough productive of blood as the lung tissue starts to undergo decomposition due to lack of oxygen.
- Chest pain: This chest pain is usually worse with breathing.
- Leg swelling: While not all PE’s originate from the leg, many are the result of a migrating deep vein thrombosis (DVT). Someone with a DVT will have a swollen, painful calf usually only on one side.
While shortness of breath is the most common symptom of PE, you may also experience the following:
- Dizziness, lightheadedness
- Irregular heartbeat
There are a number of tests used to make the diagnosis of pulmonary embolus.
- History and physical exam: The first part of the diagnosis will include a history and physical exam to determine if you are at an increased risk for blood clots.
- Chest X-ray: One of the first imaging tests performed in the workup of shortness of breath is a chest X-ray. This imaging of the chest will show if there is displacement of heart or lungs or congestion of the vasculature.
- Wells Score: If PE is considered to be a possible cause of your shortness of breath, your healthcare provider will likely calculate your Wells Score. This score takes presenting symptoms and risk factors (e.g. immobilization, cancer) into account to determine the likelihood that you have a PE.
- Further low risk tests: If you are found to be low-risk using these criteria, a d-dimer test is performed.
- Further moderate risk tests: Moderate risk is managed with a d-dimer test of CT angiogram scan.
- Further high risk tests: High-risk individuals undergo CT angiogram without d-dimer testing. Additionally, if a blood clot from the legs is suspected as the source, an ultrasound of the legs examining the vasculature in that region will likely be performed.
When to See a Doctor for Pulmonary Embolism
If you are experiencing shortness of breath, cough, chest pain, or leg swelling, you should consult a healthcare provider. If these symptoms are severe enough to cause extreme shortness of breath or loss of consciousness, care should be sought immediately.
Pulmonary Embolism Causes
The underlying cause of blood clots, including ones that travel to the lungs resulting in a pulmonary embolus, is described in the field of medicine as “.” This triad includes stasis, or immobilization, damage to blood vessel walls, and predisposition to clotting. Immobilization is often associated with people who have been seated for extended periods of time for travel purposes or people who have been admitted to the hospital and have been lying in the bed for long periods of time. Damage to blood vessel walls can occur for a number of reasons, including plaque buildup and smoking. The predisposed risk for clots includes both genetic alterations in the body’s natural clotting process or acquired risk factors like cancer, birth control pills, pregnancy, and smoking.
Pulmonary Embolism Treatments
Treatment for PE is determined by the severity of the clot as well as your clinical presentation. The following interventions are used in the management of PE:
- Anticoagulation: Blood thinners are used to keep the blood from clotting. If you are found to have a PE, you will likely be started on blood thinners to prevent new clots from forming and to prevent the current clot from getting bigger. The specific blood thinner and duration of treatment is determined by a including the location of the clot, the risk for a future clot, and risk for future bleeding.
- Fibrinolytics: This medication is used for breaking up a current clot. These can cause excessive bleeding and are only used for pulmonary embolisms that pose a life-threatening danger.
- Inferior Vena Cava (IVC) filter: This may be used to prevent clots from migrating from the legs to the lungs if you cannot tolerate anticoagulation therapy (e.g. high risk of bleeding). This filter is implanted in the vena cava, the blood vessel that returns blood from the lower portion of the body to the heart and is intended to catch clots as they dislodge from the vessels of the legs.
- Pulmonary embolectomy: This is a surgical procedure used in life-threatening pulmonary embolism if you cannot tolerate anticoagulation or fibrinolytic therapies.
- Percutaneous thrombectomy: Using X-ray imaging, a catheter can be guided through the blood vessels to the site of the clot. When the catheter reaches the clot, it can be used to extract the clot from the vessel or administer clot-busting drugs to the affected area.
The prevention of pulmonary embolism is centered on avoidance of risk factors for “Virchow’s triad” described above. Additional preventative methods listed below should also be kept in mind.
- If you are traveling: Individuals taking long flights should make an effort to walk about the cabin of a plane or make frequent stops if driving in a car.
- Wear compression socks: Compression socks can also be used while traveling to promote blood flow.
- Be mindful of medication use: People should also be aware of medications that can predispose them to clots, such as birth control pills.
- Avoid smoking
- Maintain a healthy, active lifestyle: Obesity can also predispose to clotting.
- If you have had a previous clot: People who have previously had a blood clot may be prescribed anticoagulation by their physician to prevent the formation of future clots.
Questions Your Doctor May Ask to Determine Pulmonary Embolism
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Are you sick enough to consider going to the emergency room right now?
- Do you have a cough?
- Have you experienced any nausea?
- Do you currently smoke?
- Pulmonary Embolism. U.S. National Library of Medicine: MedlinePlus. Updated Aug. 10, 2018.
- Pulmonary Embolism. Johns Hopkins Medicine Health Library.
- The Pretravel Consultation. Center for Disease Control and Prevention. Updated June 13, 2017.
- Waldron, B, Moll, S. A Patient’s Guide to Recovery After Deep Vein Thrombosis or Pulmonary Embolism. Circulation. 29 April 2014;129(17):e477-e479.