Pulmonary Embolism Overview
Pulmonary embolism is the sudden obstruction to an artery in the lung, typically by a blood clot, which has migrated to the lung from a deep vein thrombosis of the leg. This affects more than 300,000 people each year in the United States.
To a smaller degree, obstructions can consist of air bubbles, amniotic fluid, tumors or fat (let loose into circulation when bones are fractured)
When small, the clots can cause lung damage, but when large, clots can prevent circulation of blood to the lungs, which is fatal. Seeking immediate medical attention means the difference between life and death. Read more in this pulmonary embolism patient education guide.
- Sharp pain in the chest, which intensifies with a deep breath, or cough
- Cough up pink, foamy mucus
- Sudden shortness of breath
- Tachycardia (rapid heart rate)
- Faintness or lightheadedness
Risk of occurrence stems from:
- Inactivity – bedridden, sitting on long car or plane rides, post-surgery
- Drugs – hormone therapy, contraceptive pills
- Over 70 years of age
- Certain medical conditions-stroke, cancer, congestive heart failure
- Surgery in the recent past- involving abdomen, brain, hips and legs
- Familial tendency
Written by Barbara Hales, MDShow All
Doctors Who Treat Pulmonary Embolism
As a pulmonary embolism is diagnosed, treated and managed, you may encounter the following team of doctors and specialists. Having a team of doctors or specialists with varied expertise will more accurately help diagnose the possibility of having a pulmonary embolism. Read more in this patient education guide.
- Internists - specializes on prevention, diagnosis and treatment of illnesses in adults. This doctor will examine and diagnose respiratory difficulties
- Nurse Practitioner - focuses on prevention, wellness and education of patients about health and health choices.
- Family Physician (General Practitioner) – deals with prevention, discovery and treatment of illnesses in all age categories. The doctor may examine and diagnose pulmonary embolus. Further treatment may be done or a referral given at this point to the hematologist.
- Pulmonologist - specialist that focuses on conditions of the respiratory tract and respiratory diseases (lung or breathing problems) It is a branch of internal medicine with fellowship training. These doctors diagnose and treat problems with the lungs.
- Respiratory Therapist – not usually a physician but part of the team, this therapist concentrates on treating breathing disorders. They utilize mechanical ventilators and oxygen therapy to increase the lung function of the patient.
- Hematologist – deals with the prevention, diagnosis, treatment and management of blood, blood conditions and blood disorders. This type of physician is adept at diagnosing and treating blood clots within all the vessels of the circulatory system.
How to Prepare for Your Pulmonary Embolism Doctor Visit
As you prepare to talk to your doctor about a pulmonary embolism, it is very important to follow certain steps to get maximum benefit from your healthcare provider.
Compile the following:
- Family history
- Significant past medical history
- Any lab results in possession from the last year
Because most pulmonary screening tests require the individual to inhale and exhale deeply, one must not eat a heavy meal prior to the exam. Also, refrain from smoking for 4-6 hours prior to the test.
Let the physician know if you are pregnant in case any x-rays are ordered.
For MRIs: Jewelry, hairpins, glasses, hearing aids and dentures should be left home or removed. Do not eat for 6 hours prior to the exam.
Questions to Ask Your Doctor About Pulmonary Embolism
Below is a list of questions to discuss with your doctor so you can make informed decisions about your pulmonary embolism.
Questions About My Diagnosis
- Can this diagnosis be confused with other conditions?
- What causes blood clots? Can I prevent blood clots from reoccurring?
- What tests would confirm this diagnosis?
- What is pulmonary embolism?
- Will this condition reoccur? Am I at a higher risk for reoccurrence?
- Can this condition be fatal?
- What are the complications of a pulmonary embolus?
- Does this reflect a heart condition?
Questions About My Treatment
- Is there medication that can cure my condition?
- Will I always need to take medication (life-long)?
- What can I take or do to make me asymptomatic?
- Is there physical activity or exercise to improve this?
- Will wrapping my leg improve the problem?
- How long will it be before my symptoms go away?
Questions About My Lifestyle and Family
- Does this run in families?
- Will I need a caretaker or someone with me at home?
- Will I be able to drive? Will I have to avoid long car rides or plane rides?
- Will I be able to work?
- Are there activities that I should avoid?
Common Tests to Diagnose Pulmonary Embolism
The first approach to diagnosing pulmonary embolism is a thorough examination and a review with the patient regarding onset of symptoms, and what activities makes the symptoms worse. After a presumptive examination, the following tests can be done.
|Ultrasound (sonogram)||Enables visualization of organs and blood vessels||After lying down on the table, the technician places clear water-based gel on your leg in the affected area.A hand-held probe is then moved back and forth over the area, transmitting sound waves. The echoes of these waves creates an image on a computer monitor||. Normal blood flow through vessels. No tumors or obstructions seen|
|Spiral CT Scan||Contrast material views blood flow through organs and blood vessels.The scan also checks for tumors, obstructions and cysts.||You will be asked to lie on a table attached to the CT scanner. This machine like a giant doughnut and sends X-ray pulses through the body when the table is slid inside.Each pulse, which consists of less than one second, takes an image of a thin slice of the body part or organ scanned. These images are then loaded onto a computer program.
Contrast material (iodine dye) is typically injected to make organs and body parts more visible on the scans. The dye is inserted either through an IV or by drinking it.
|No tumors, obstructions, clots are seen. Normal blood flow is visualized, flowing through the vessels and organs.|
|Electrocardiogram(EKG, ECG)||Measures the electrical impulses that comprise and control heart rhythms.||After lying on an examination table, electrodes (small adhesive pads) are attached to the skin of the chest, arms and legs.Wires are attached from the electrodes to a machine that converts electrical action into paper tracings forming a cardiac impulse pattern. This is then measured and any abnormalities are detected.||A normal EKG is a pattern with a P wave followed by a QRS wave, with an interval rest period whereupon the pattern recurs.
P wave rate = 60-100 bpm
P height < 2.5 mm in lead II
P width < .11 in lead II
PR interval= .12-.20 s
QRS complex < .12 s
Normal ST segment= no elevation or depression
|MRI||Detects tumors, obstructions, organ injury, tumors, abnormal bleeding, inflammation and joint damage||You are asked to lie on your back on a table with head, torso and arms strapped down to prevent movement. The table then slides into the tunnel-like space that contains a magnet.You may hear banging or tapping noises from the magnet movement but are often offered piped in music to soothe you and mask the noise.
Images are taken in body cross sections using a magnetic field and pulses of radio wave energy.
The test usually takes 30-60 minutes and is painless
|No enlargements, tumors or clots are seen|
|Chest X-Ray||Visualizes the lungs, heart and blood vessels, looking for masses, obstructions, and abnormal sizes. Heart failure can be detected.||You are asked to lie on an x-ray table (which has a special plate under you) and beams are passed through your body onto the plate. Depending on the density of the various tissues, different shades appear on the plate.If a biopsy is necessary, a needle is inserted and guided to the area of tumor where tissue is suctioned out and then sent to the pathologist. The needle is removed and you may then get up and off the table||No narrowing or obstruction of blood vessels.No tumors/masses
Consistent blood flow
Proper filling of atria and ventricles
Clear lungs with proper inflation
|Arterial Blood Gases||Measures the content of oxygen, carbon dioxide and pH (for acidity)May also look at:
||A tourniquet is applied with pressure to the arm. After using an antiseptic wipe, a syringe with needle is inserted into the artery in the artery above your wrist and sent on ice for analysis to the laboratory.||PaO2=80-10 mmHgPaCO2=35-45 mmHg
Total CO2=25-30 mmol/L
-3 to +3 mmol/L
|Pulse Oximetry||Measures the blood’s oxygen saturation*Not as good as the arterial blood gas analysis||A sensor is placed on a fingertip through which light of two wavelengths is passed. This is sent to a photodetector. The changing absorbance of the wavelengths is measured, determining the oxygenation of hemoglobin.||Normal is 95-100%|
Medications and Treatment for Pulmonary Embolism
Prompt treatment is critical to prevent serious complications from a pulmonary embolism. The following treatments and medications may be used.
How It Works
|Anticoagulants(Blood thinners)||Anticoagulants are administered intravenously or in pill form for 3 months to stifle clot growth, while the body starts to absorb and shrink the clot. They also prevent new clots from forming.|
|Thrombolytics||Used when symptoms can be fatal. These drugs dissolve clots rapidly, but may cause hemorrhage.|
|Embolectomy||Surgical clot removal – done only when symptoms may be fatal|
|Vena Cava Filter||Used rarely, a tube is inserted in the vena cava to facilitate blood return to the heart and inhibit clots from entering the lungs|
|Compression Stockings||Helps blood flow and diminishes new clot formation in the legs|