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Pulmonary Embolism
PE; Blood Clots in the Lung; Lung Embolism
A pulmonary embolism is a sudden blockage of an artery (blood vessel) in the lung. It usually occurs when a blood clot in a deep vein in the leg or pelvis breaks loose and travels through the blood to the lungs. A pulmonary embolism can be life-threatening. Learn more about the symptoms, treatment, and prevention of pulmonary embolism.
Pulmonary embolism
Image by TheVisualMD
3D Medical Animation still shot Pulmonary Embolism
Image by Scientific Animations, Inc.
Pulmonary embolism is a type of venous thromboembolism (VTE) that occurs when a blood clot breaks loose and travels through the bloodstream to the lungs. Usually, pulmonary embolisms come from blood clots in the deep vein of the leg (deep vein thrombosis (DVT)).
Source: National Heart, Lung, and Blood Institute (NHLBI)
Blood Must Flow
Image by TheVisualMD
Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) are often underdiagnosed and serious, but preventable medical conditions.
Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot forms in a deep vein. These clots usually develop in the lower leg, thigh, or pelvis, but they can also occur in the arm.
It is important to know about DVT because it can happen to anybody and can cause serious illness, disability, and in some cases, death. The good news is that DVT is preventable and treatable if discovered early.
The most serious complication of DVT happens when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism (PE). If the clot is small, and with appropriate treatment, people can recover from PE. However, there could be some damage to the lungs. If the clot is large, it can stop blood from reaching the lungs and is fatal.
In addition, one-third to one-half of people who have a DVT will have long-term complications caused by the damage the clot does to the valves in the vein called post-thrombotic syndrome (PTS). People with PTS have symptoms such as swelling, pain, discoloration, and in severe cases, scaling or ulcers in the affected part of the body. In some cases, the symptoms can be so severe that a person becomes disabled.
For some people, DVT and PE can become a chronic illness; about 30% of people who have had a DVT or PE are at risk for another episode.
Almost anyone can have a DVT. However, certain factors can increase the chance of having this condition. The chance increases even more for someone who has more than one of these factors at the same time.
Following is a list of factors that increase the risk of developing DVT:
The following tips can help prevent DVT:
Everybody should know the signs and symptoms of DVT/PE, their risk for DVT/PE, to talk to their health care provider about their risk, and to seek care immediately if they have any sign or symptom of DVT/PE.
About half of people with DVT have no symptoms at all. The following are the most common symptoms of DVT that occur in the affected part of the body:
If you have any of these symptoms, you should see your doctor as soon as possible.
You can have a PE without any symptoms of a DVT.
Signs and symptoms of PE can include:
If you have any of these symptoms, you should seek medical help immediately.
The diagnosis of DVT or PE requires special tests that can only be performed by a doctor. That is why it is important for you to seek medical care if you experience any of the symptoms of DVT or PE.
Medication is used to prevent and treat DVT. Compression stockings (also called graduated compression stockings) are sometimes recommended to prevent DVT and relieve pain and swelling. These might need to be worn for 2 years or more after having DVT. In severe cases, the clot might need to be removed surgically.
Immediate medical attention is necessary to treat PE. In cases of severe, life-threatening PE, there are medicines called thrombolytics that can dissolve the clot. Other medicines, called anticoagulants, may be prescribed to prevent more clots from forming. Some people may need to be on medication long-term to prevent future blood clots.
Did you know?
DVT does not cause heart attack or stroke. There are two main types of blood clots.
How a clot affects the body depends on the type and location of the clot:
- A blood clot in a deep vein of the leg, pelvis, and sometimes arm, is called deep vein thrombosis (DVT). This type of blood clot does not cause heart attack or stroke.
- A blood clot in an artery, usually in the heart or brain, is called arterial thrombosis. This type of blood clot can cause heart attack or stroke.
Both types of clots can cause serious health problems, but the causes and steps you can take to protect yourself are different.
Source: Centers for Disease Control and Prevention (CDC)
Illustration of a blood clot in a blood vessel
Image by NIH News in Health
Your blood is an amazing, multi-purpose substance. It flows continuously through the body, carrying oxygen and nutrients to your cells. But if you get a scrape or cut, some of this flowing liquid quickly turns to a protective clot.
Clots are tangles of molecules and blood cells that clump together. They help prevent blood loss when the skin breaks open. They also help stop infections from getting inside the body. But when clotting happens inside a blood vessel, it can be dangerous.
Clots can form on the blood vessel walls to help them heal if they get damaged. Afterward, the clots usually dissolve. But sometimes a clot doesn’t get broken down as it’s supposed to. Clots may also form when they’re not needed.
Sometimes, clots break off a vessel wall and travel through the blood to other parts of the body. They may cause a lot of damage, depending on where they block blood flow. Blood clots can potentially harm the brain, heart, lungs, or other organs.
But researchers have made great progress over the last few decades in managing blood clots. They continue to develop new ways to treat and prevent such blockages.
Three main things can lead to dangerous blood clots, explains Dr. Mitchell Elkind, an expert on stroke at Columbia University. “One is an abnormality in the blood that makes it more likely to clot. For example, genetic causes, cancer, or damage from smoking,” he says. “The second is when blood doesn’t flow properly.” This can be a side effect of diseases and disorders of the heart or blood vessels.
The third is damage to the lining of blood vessels. One cause of such damage is cholesterol buildup in the blood. Cholesterol is a waxy, fat-like substance that can clump together to form plaques. If a plaque breaks apart, it can damage the blood vessel.
Blood clots can happen to anyone, at any age. But some people are at increased risk. These include older adults and those with certain heart conditions.
Major surgery or a serious injury also add risk. Obesity, being physically inactive, and some medications can boost the chance of a dangerous clot, too.
“And once you’ve had one blood clot, you’re at high risk of another one,” notes Dr. Nigel Key, an expert on blood disorders at the University of North Carolina.
Some infections may also increase the risk of blood clotting. Recent studies have shown that the virus that causes COVID-19, SARS-CoV-2, can cause blood clots in some people.
Blood clots can occur anywhere in the body. That makes it difficult to find them before they cause a problem, Elkind explains. The symptoms of a blood clot depend on where they are.
A clot blocking blood flow to the brain can lead to a stroke. Strokes can cause sudden difficulty seeing, speaking, or walking. They can also make you feel weak, numb, dizzy, or confused.
A clot that blocks blood flow to the heart can cause a heart attack. The most common signs are crushing chest pain and difficulty breathing. Others range from cold sweats to arm or shoulder pain.
A clot in the lungs can cause shortness of breath, pain when breathing deeply, or even coughing up blood. A clot in a vein deep within the body is called a deep vein thrombosis, or DVT. Symptoms include swelling, pain, warmth, or red or discolored skin. These usually happen in your legs. Long periods of inactivity can increase your risk.
“Compared with a heart attack or stroke, there’s low awareness of the symptoms of deep vein thrombosis,” Key says. Many symptoms overlap with less dangerous conditions, such as a muscle sprain.
If you have symptoms of a blood clot, call your health care provider or 911 immediately. You may need to go to the hospital to have blood or imaging tests.
Treatment depends on where a clot is and how long you’ve had symptoms. Certain drugs can break up and dissolve some types of clots. But they have to be given within a few hours of when symptoms start.
A type of surgery called a thrombectomy can be used to remove clots in large blood vessels. It can be used even if people don’t get to the hospital in time to receive clot-busting drugs. “That’s been a huge benefit for patients,” says Dr. Waleed Brinjikji, an expert on stroke at the Mayo Clinic.
This technique has also let researchers study what clots are made of after they’re removed. “We’re starting to realize how different clots can be,” says Brinjikji.
Different types of clots might benefit from different removal techniques or drugs. So Brinjikji’s team is now testing ways to identify the type of clot before it’s removed. That way they can start to test which treatments work best.
If you have a clot that’s forming, certain medications may help shrink it or stop it from growing. These drugs are called anticoagulants. They’re more commonly known as blood thinners.
Sometimes, people with certain heart conditions are given blood thinners to prevent blood clots from forming. But blood thinners can have side effects, including an increased risk of bleeding. So doctors don’t give them to everyone.
Elkind’s team has been researching which heart conditions may benefit from this type of preventive treatment.
Recent research has shown that blood thinners may help in COVID-19. They might reduce the risk of blood clots and organ damage in people hospitalized with COVID-19. More work is underway to figure out how best to prevent and treat blood clots for those with the disease.
This work will also help researchers better understand how other viruses can affect the blood, Elkind explains. “I think we’re going to learn a lot about how other infections also trigger clotting from studying COVID-19,” he says.
There are many things you can do to decrease your risk of harmful blood clots. See the Wise Choices box for tips.
Source: NIH News in Health
Consequences of Clots
Image by TheVisualMD
Pulmonary embolism occurs when an embolus (blood clot) from a deep vein blood clot breaks loose, travels to the lungs, and blocks an artery within the lung. Blood clots can develop in veins damaged by surgery or trauma, or they can develop as a result of inflammation caused by an infection or injury. Pulmonary embolism can also develop directly in the small blood vessels of the lungs, even if there are no clots in the arms or legs.
Learn more about what causes blood clots to form abnormally in the deep veins.
Source: National Heart, Lung, and Blood Institute (NIH)
Symptoms of Thrombosis
Image by TheVisualMD
You may not have any symptoms of pulmonary embolism. Other times, symptoms come on quickly, within seconds to minutes. Or they may come on more slowly — over days to weeks — and can start off mild, then become more serious as time goes on.
Common pulmonary embolism symptoms include:
Less common symptoms of pulmonary embolism include:
Source: National Heart, Lung, and Blood Institute (NIH)
pulmonary embolism
Image by James Heilman, MD
Your healthcare provider will diagnose a pulmonary embolism based on your symptoms, medical history, a physical exam, and various imaging or blood test results.
Source: National Heart, Lung, and Blood Institute (NIH)
V/Q Scan
Also called: Lung VQ Scan, Lung Ventilation/Perfusion Scan, Nuclear Medicine V/Q Scan, Pulmonary Ventilation/Perfusion Scan, Ventilation/Perfusion Scan
A V/Q scan is an imaging test that uses a ventilation (V) scan to measure air flow in your lungs and a perfusion (Q) scan to see where blood flows in your lungs. It is most often used to check for a pulmonary embolism (PE), a life-threatening blockage of an artery in the lungs.
Prothrombin Home Test
Also called: PT/INR Self-Monitoring
If you take blood-thinning drugs such as Coumadin or Warfarin, you may need to test your blood regularly to make sure it clots properly. The PT/INR monitor is a patient self-testing system designed for testing capillary whole blood for clotting time in the comfort of your home.
Chest MRI Test
Also called: Chest MRI Scan, Chest Nuclear Magnetic Resonance, Chest NMR, MRI of the thorax, Thoracic MRI
A chest MRI (magnetic resonance imaging) is an imaging test that uses radio waves, magnets, and a computer to create detailed pictures of the structures in your chest, including your chest wall, heart, and blood vessels.
Chest CT Scan
Also called: Chest CT, Thoracic CT, Chest X-Ray Computer Assisted Tomography, Chest CAT scan
A chest computed tomography (CT) scan is an imaging test that takes detailed pictures of the lungs and the inside of the chest. Computers combine the pictures to create a 3-D model showing the size, shape, and position of the lungs and structures in the chest.
Chest X-Ray Test
Also called: CXR, Chest X Ray, Chest Radiograph, Chest Radiography, Chest Film
A chest X-ray is an imaging test that uses electromagnetic waves to create pictures of the structures in and around the chest. The test can help diagnose and monitor conditions of the heart, lungs, bones, and chest cavity.
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Doppler Ultrasound
Also called: Doppler Study, Doppler Exam, Doppler Ultrasonography, US-D, Ultrasound - Doppler, Duplex Doppler, Duplex ultrasound, duplex ultrasonography
A Doppler ultrasound is an imaging test that uses sound waves to evaluate the blood flow and blood pressure within the arteries and veins of any part of your body. The test shows the speed and direction of blood flow in real time.
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Bromadiolone paste
Image by RoodyAlien
Most people can treat blood clots with medicines at home. Sometimes, more serious blood clots require you to stay in the hospital for treatment.
Your provider will likely prescribe blood-thinning medicines. If you are unable to take blood thinners, other medicines and procedures can help.
If left untreated, pulmonary embolism can cause heart attack, shock, stroke, or death.
As you recover from pulmonary embolism, talk to your provider about steps you can take to stay healthy.
Source: National Heart, Lung, and Blood Institute (NIH)
DVT Prevention & Treatment
Image by TheVisualMD
In rare cases, a surgical procedure to remove the clot may be necessary. Thrombectomy involves removal of the clot in a patient with DVT. Embolectomy involves removal of the blockage in the lungs caused by the clot in a patient with PE.
Source: Centers for Disease Control and Prevention (CDC)
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Thrombosis - What is it and how is it treated?
Image by TheVisualMD
If you are preparing to go to the hospital for a procedure or have other of VTE risk factors, talk with your healthcare provider about a plan for preventing blood clots from forming.
Clotting is one of the body’s natural ways to heal the damage to your blood vessels from surgery. While you wear a cast or stay in bed to heal, the blood circulating in your veins slows because you stop moving as much as usual. This lack of movement raises the likelihood of blood clotting.
The chance of developing VTE is highest in the first 3 months after surgery and lowers with time. Your provider may give you suggestions, including the following, to help prevent VTE.
You may need a combination of these preventive treatments. These approaches to prevention may also be appropriate if you are admitted to the hospital for reasons other than surgery, cannot move for an extended period, or have a condition that makes it more likely that your blood will clot.
Long flights (more than 4 hours) more than double the likelihood of VTE. Follow these tips to lower the chance of VTE during travel.
Source: National Heart, Lung, and Blood Institute (NHLBI)
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Embolism Path from the Leg to the Upper Body
Image by TheVisualMD
A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:
PE can be life-threatening, especially if a clot is large, or if there are many clots.
The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lungs.
Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:
Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg.
It can be difficult to diagnose PE. To make a diagnosis, your health care provider will:
If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.
Medicines:
Procedures:
Preventing new blood clots can prevent PE. Prevention may include:
Source: National Heart, Lung, and Blood Institute (NHLBI)
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