Blood clots in the legs can travel to the lungs to cause a pulmonary embolism (PE). The severity of symptoms can be from mild to severe causing death. Patients with a pulmonary embolism should seek immediate medical treatment.
Definition of a Pulmonary Embolism
A pulmonary embolism is a blood clot in the pulmonary arteries in the lungs.
Anatomy of a Pulmonary Embolism
Blood travels from veins to the heart, and then to the pulmonary arteries and the lungs for oxygenation. Blood clots in the legs (deep vein thrombosis) can travel from the legs to the pulmonary arteries. If the pulmonary arteries are blocked by a clot, blood cannot reach the lungs to be oxygenated.
Causes of a Pulmonary Embolism
The causes of a pulmonary embolism are related to blood clots in the legs (DVT). Patients who have an increased chance of developing blood clots such as those who are obese, undergoing surgery, pregnant, or those with a hypercoagulable clotting issue are at increased risk. People who sit for an extended period of time, such as on a long plane flight or car ride, are at an increased risk for developing a DVT as well. Very rare causes of pulmonary embolisms are amniotic fluid emboli during pregnancy and fat emboli from broken bones.
Symptoms of a Pulmonary Embolism
- Rapid Heart Rate
- Crushing chest pain
- Lightheadedness, dizziness, or fainting
- Impending fear of death
- Shortness of breath
These are all symptoms that should prompt someone to seek medical attention immediately.
Diagnosis of a Pulmonary Embolism
A patient’s symptoms, overall physical condition, and the likelihood of finding a pulmonary embolism will determine the testing necessary. Most patients with extreme shortness of breath are stabilized and then undergo computed tomography to determine if they have a pulmonary embolism. For patients with mild shortness of breath of unknown etiology blood tests and possibly an ultrasound of the legs looking for a blood clot might be all that is necessary. Definitive diagnosis is made with imaging, usually computed tomography.
Prevention of a Pulmonary Embolism
The prevention of a PE will center around preventing the blood clots. Patients with genetic clotting disorders should follow their physician’s advice and take their medications as prescribed. Patients with long periods of immobility such as during long periods of travel should walk as much as possible. For those patients undergoing surgery, your surgeon will choose appropriate recommendations to prevent blood clots. For those patients who cannot tolerate anticoagulation or have had a blood clot on anticoagulation an inferior vena cava filter can be placed to prevent large blood clots from going to the lungs.
Am I At Risk?
Anyone with a clotting disorder is at risk for a pulmonary embolism. In addition, people who spend prolonged periods sitting on road trips and plane flights are also at risk. Finally, some medical states such as pregnancy and obesity also put people at risk.
Treatment of a Pulmonary Embolism
The treatment protocol for a pulmonary embolism depends on patient symptoms. Almost all patients are immediately placed on anticoagulation. Some patients will receive a more powerful clot-busting medication. For those patients with severe disease or those who cannot tolerate a more powerful clot-busting medication, an endovascular procedure may help remove clots from the pulmonary arteries. The extent of the endovascular procedure depends on the patient’s symptoms and overall health. Your vascular surgeon will discuss options depending on your particular situation.
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