Pulmonary embolism

The symptoms may vary depending on the size of the clots, involvement of the lungs, and underlying medical conditions. The following are the most common symptoms of pulmonary embolism (PE):

• Shortness of breath
• Chest pain
• Rapid or irregular heartbeat
• Sweating
• Pain or swelling in the leg
• Anxiety
• Low blood pressure
• Coughing blood
• Palpitations
• Cold, clammy, and discolored skin (cyanosis)
• Lightheadedness
• Fainting
• Wheezing

Note: Chest pain is the most common symptom of pulmonary embolism. It is a sharp, stabbing, and aching pain that is difficult to manage for an individual experiencing it. Learn about first aid for chest pain.

PE occurs when a blood clot gets stuck in an artery in the lungs, blocking blood flow. These blood clots most commonly originate from the deep veins of the legs, a condition known as deep vein thrombosis. In most cases, multiple clots can obstruct a significant portion of the lungs, leading to pulmonary infarction, where the affected area does not receive enough blood and dies. This condition makes it more difficult for the lungs to provide oxygen to the rest of the body.

Any individual can develop blood clots, which lead to pulmonary embolism. Certain factors that increase the risk of the disease are:

1. Genetics
   Individuals with parents or siblings who have experienced venous blood clots or pulmonary embolism are at the highest risk of developing this condition.
2. Inactivity
   Blood clots are more likely to form during prolonged periods of inactivity. Sitting in one place for extended periods can lead to slower blood flow in the legs, resulting in blood clots that may lead to pulmonary embolism.
3. Medical conditions
   Several medical conditions can increase the risk of pulmonary embolism, including:
   • Cancer: Various types of cancer, such as brain, ovarian, stomach, lung, and kidney cancers, can heighten the risk of blood clots. Individuals undergoing cancer treatment (chemotherapy) further increase this risk.
   • Surgery: Surgery is a significant cause of blood clot formation. In many cases, medication is prescribed both before and after surgery to prevent blood clots.
   • Heart disease: Patients with cardiac conditions, such as coronary artery disease, atrial fibrillation (AF), and heart failure (HF), exhibit a higher risk for pulmonary embolism.
   • COVID-19: Individuals with severe symptoms of COVID-19 often experience pulmonary embolism as a complication. This occurs when a blood clot formed in the legs travels through the bloodstream to the lungs.
4. Bone fractures
   In cases of bone fractures, fat particles from inside the bone can enter the bloodstream. Blockages in blood vessels may be caused by substances other than blood clots, such as fat from a broken long bone or air bubbles.
5. Mutations
   Factor V Leiden is a genetic mutation that increases a person’s risk of forming blood clots. The most common complications associated with this mutation include deep vein thrombosis (DVT) and pulmonary embolism (PE). However, many individuals with this mutation may not develop blood clots.
6. Other factors
   
   • Pregnancy: Women are at a fivefold higher risk for pulmonary embolism during pregnancy compared to nonpregnant women.
   • Smoking: Smoking increases platelet activation significantly, leading to a higher likelihood of blood clot formation.
   • Obesity: Being overweight or obese can elevate the chances of blood clots and deep vein thrombosis. Weight gain can thicken the blood, making it more difficult to flow through the veins, thereby increasing the risk of pulmonary embolism.

Timely diagnosis of pulmonary embolism can prevent several major health complications. Diagnosis mainly consists of the following:

1. History and physical examination

   A detailed family and medical history can help evaluate the risk factors for pulmonary embolism.

   During the examination, patients with PE might have tachycardia (irregular heart rhythms), which is a common but nonspecific finding. Other findings of PE include:

   • Calf swelling
   • Tenderness
   • Redness
   • Decreased breath sounds
   • Signs of pulmonary hypertension, such as elevated neck veins
2. Imaging tests

   A few imaging tests may be required to confirm pulmonary embolism. They include:

   • Computed tomographic pulmonary angiography (CTPA): A CTPA is a CT scan that looks for blood clots in the lungs, primarily PE. A CT pulmonary angiogram takes pictures of the blood vessels that run from the heart to the lungs.
   • Chest radiograph (chest X-ray): This imaging test is used to assess the lungs and heart.
   • Ventilation-perfusion scan (V/Q scan): In this test, a small radioactive material is injected into the vein to evaluate the movement of air into and out of the lungs along with the blood flow into the lungs.
   • Electrocardiogram (EKG): An EKG is recorded to detect the electrical activity of the heart to diagnose conditions of pulmonary embolism.
   • Duplex ultrasound (US): This test examines the blood flow in the major arteries and veins in the arms and legs to detect clots.
   • Magnetic resonance imaging (MRI): MRI uses a magnetic field to create detailed images of the organs and tissues in the body and has better sensitivity and specificity in detecting PE.
   • Pulmonary angiogram: This imaging test checks the blood vessels of the lungs using a special contrast dye administered into the blood vessels.
3. Lab tests

   Lab tests that may be conducted include:

   • Arterial blood gas (ABG) analysis: ABG is a blood test used to indicate ventilation, gaseous exchange, and acid-base status. It is rarely used to diagnose PE.
   • Brain natriuretic peptide (BNP): This blood test measures the levels of a protein called BNP made by the heart and blood vessels. Elevated plasma BNP levels have been observed in acute pulmonary embolism (APE).

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Pulmonary embolism is often caused by a blood clot that originally forms in the legs, and it is often difficult to detect a DVT before problems start. Therefore, preventing clots in the deep veins will help prevent pulmonary embolisms. This includes:

• Manage your weight: Obesity puts additional pressure on the veins in the legs, contributing to poor blood flow and the development of blood clots. Eating a balanced diet will help maintain a healthy weight and reduce the risk of blood clot formation. Here is a list of 7 weight loss foods to lose weight naturally. Read Here
• Use compression stockings: These stockings fit tightly around your lower legs and encourage blood to flow more quickly around your body. This simple and inexpensive method compresses the veins and prevents blood from flowing backward. Check out our widest range of compression support products to meet all your needs.
• Start moving after surgery: There is a misconception that you need to lie in bed post-surgery. However, the main reason doctors and nurses encourage you to get up and move is to prevent clots from forming by stimulating blood circulation.
• Try pneumatic compression devices: Intermittent pneumatic compression (IPC) devices help prevent blood clots in the deep veins of the legs. These inflatable sleeves, worn on the calves, are connected to a machine that provides alternating pressure on the legs to improve blood flow.
• Say no to tobacco: Toxic chemicals in cigarettes harm red and white blood cells and blood vessels, making you more susceptible to deep vein thrombosis and pulmonary embolism. Want to quit smoking? Here are a few tips that can help you achieve your goal.

Note: Along with these measures, ensure to keep your legs elevated for at least half an hour, twice a day, avoid sitting with crossed legs, and wear loose-fitting clothes for better blood flow.

Treatment choices for pulmonary embolism (PE) include:

1. Anticoagulants
   In most cases, the treatment involves administering anticoagulant medications (blood thinners). This medication decreases the blood’s ability to clot and prevents future blood clots from forming. These include:
   • Heparin
   • Fondaparinux
   Newer oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) have also been used for anticoagulation in PE.
2. Reperfusion strategies
   Reperfusion therapy is used to restore blood flow through a suspected or known blocked coronary artery immediately upon diagnosis. These include:
   • Catheter-directed treatment: This technique involves the insertion of a catheter into the pulmonary arteries, which is then used for ultrasound-assisted thrombolysis.
   • Vena cava filter: This treatment is used when a person cannot undergo anticoagulation treatment due to medical reasons. It involves placing a small metal device in the vena cava (the large blood vessel that returns blood from the body to the heart) to prevent clots from traveling to the lungs.
   • Thrombolytic therapy: This therapy, known as clot busters, uses medications or a minimally invasive procedure to break up blood clots and prevent new clots from forming.
   • Pulmonary embolectomy: This is a rarely used surgery conducted to remove a PE. This surgery is performed in cases where the embolism is large enough and medications or thrombolytic therapy cannot be used.
3. Compression stockings
   These are designed to apply pressure to the lower legs, helping to maintain blood flow and reduce discomfort and swelling. These stockings are usually knee-high in length and squeeze the legs to prevent blood from pooling.
4. Supportive treatment
   This treatment is given to help the body cope with the ill effects of PE. These include oxygen support to reduce breathlessness, and in some cases, intravenous fluids to support circulation. Close monitoring and care may be provided depending on the patient's condition.

Home remedies might not cure blood clots permanently, but they can provide relief from the symptoms of pulmonary embolism (PE). These include:

• Garlic (Lahsun): Garlic aids in blood thinning and reduces blood clot formation in the arteries. It is advisable to consume garlic bulbs on an empty stomach in the morning.
• Neem: Several studies have demonstrated that neem possesses good to moderate clot-breaking properties. Small leaves of neem can be consumed daily to observe the results.
• Turmeric (Haldi): Turmeric extract has shown benefits in dissolving blood clots in some studies. It can be taken by adding it to a glass of warm milk and consumed immediately.
• Tulsi: Tulsi extract has shown moderate to good activity in breaking down clots. It can be consumed by chewing fresh tulsi leaves or drinking tulsi tea, which can be prepared by boiling fresh or dried tulsi leaves in water and straining the leaves.
• Cayenne Pepper: Cayenne pepper contains a high amount of salicylates, which have powerful blood-thinning effects and can be used to treat blood clots.

If left untreated, pulmonary embolism can lead to the following complications:

• Pulmonary infarction (PI): Pulmonary, or lung, infarction (PI) refers to the death of lung tissue due to a lack of blood supply. According to research in 2021, it has been noted that 30 percent of individuals with PE show signs of PI.
• Pleural effusion: PE is one of the most common causes of pleural effusion (fluid accumulation in the lungs). Pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. Symptoms include sharp chest pain, cough, and shortness of breath.
• Cardiogenic shock: This is a life-threatening condition in which the heart is unable to pump enough blood suddenly. It can lead to a drop in blood pressure and pulse rate, resulting in brain injury or organ failure.
• Bleeding from anticoagulant use: Treatment of PE involves the administration of anticoagulants to resolve blood clots. If the blood becomes too thin, even a minor cut can cause excessive bleeding.
• Cardiac arrest: A PE significantly increases the risk of cardiac arrest, which further elevates the risk of death by 95%.

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Recovery from pulmonary embolism can vary based on the severity of the condition and the treatment. The major treatment takes place in the hospital, and after leaving the hospital, a patient may be required to take medications for six months or longer. Certain tips to keep in mind if you have pulmonary embolism include:

1. Following up regularly
   Studies suggest that individuals with pulmonary embolism should visit their doctors every 2 weeks for 3 months post-PE. The routine follow-up visits scheduled by the doctor should never be missed, as this can help the doctor conduct imaging tests. This helps check for signs of new blood clots forming in the legs that can lead to pulmonary embolism. It is also important to take all prescribed medications on time.
2. Preventing recurrence
   The doctor may recommend combining medication and lifestyle changes simultaneously to manage the long-term risks of a recurrence of deep vein thrombosis, which leads to pulmonary embolism. To prevent recurrence, the doctor may include:
   
   • Staying physically active
   • Drinking more fluids
   • Maintaining a healthy weight
   • Quitting smoking
   • Avoiding the use of oral contraceptives
3. Avoiding injuries
   Suitable caution must be taken if you are taking anticoagulants, as this can lead to a serious bleeding risk. Your doctor may suggest avoiding foods rich in vitamin K, alcohol, and over-the-counter medications (such as aspirin).