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Pulmonary embolus Causes and Risks:
Pulmonary emboli are caused by clots from the venous circulation, from the right side of the heart, from tumors that have invaded the circulatory system, or from other sources such as amniotic fluid, air, fat, bone marrow, and foreign substances. Most are caused from clots originating in the lower extremities called deep vein thrombosis ( DVT ), and many resolve on their own. A pulmonary embolism affects as many as 5 out of 10,000 people in the U.S. each year, and sudden death can occur as a result of pulmonary embolism. The risk factors include prolonged bed rest or inactivity, oral contraceptive use, surgery, child birth, cancer , stroke , heart attack , heart surgery, and fractures of the hips or femur.
Prevention:
Early detection and treatment of DVT (clots of the legs) of patients who are at risk by early walking and activity after surgery can reduce the risk for pulmonary embolus. Other clot-preventive measures include leg exercises and elastic support stockings as appropriate. Subcutaneous heparin therapy (low doses of heparin injected under the skin) may be used for those on prolonged
bedrest.
Symptoms:
- cough
- begins suddenly
- may produce bloody sputum (significant amounts of visible blood or lightly blood streaked sputum)
- sudden onset of shortness of breath at rest or with exertion
- splinting of ribs with breathing (e.g., bending over or holding the chest)
- lightheadedness
- fainting
- dizziness
- chest pain
- under the breastbone or on one side
- sharp, stabbing, burning, aching or dull, heavy sensation
- may be worse at night
- may radiate to the shoulder, arm, neck, jaw, or other area
- may be worsened by breathing deeply, coughing, eating, bending, or stooping
- sweating
- anxiety
- breathing, rapid
- rapid heart rate ( tachycardia )
Additional symptoms that may be associated with this disease:
Signs and Tests:
Tests to evaluate the function of the lungs: Tests to detect the location and extent of embolism : Tests to detect DVT (a common cause): An ECG may show abnormalities caused by strain on the heart.
This disease may also alter the results of the following tests:
Treatment:
Emergency treatment and hospitalization are necessary. Definitive treatment consists of dissolving the clot by thrombolytic therapy. Anticoagulant therapy is preventive by inhibiting further clot formation.
Thrombolytic therapy (clot-dissolving medication) includes streptokinase, urokinase, or TPA. Anticoagulation therapy (clot-preventing medication) consists of heparin by intravenous infusion initially, then oral warfarin (Coumadin), or subcutaneous heparin may be started concurrently. Oxygen therapy is required to maintain normal oxygen concentrations until the acute injury to the lungs has resolved.
Surgery in patients at great risk for recurrent embolism is sometimes indicated.
Prognosis:
The death rate is 30% with undiagnosed pulmonary embolism. After diagnosis and treatment, the death rate drops to 3%.
Complications:
Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms of pulmonary embolus occur.
This is an illustration of the major features of the lungs and bronchial tree. The inset is of the alveoli. They are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
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