Pulmonary embolism – symptoms, risk factors, diagnosis, treatment

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Pulmonary embolism is a serious disease where the pulmonary artery is narrowed or completely occluded, or has its branches, by embolic material. This disease can have many faces with a different degree of risk – each of them, however, requires appropriate specialist treatment. What are the symptoms of a pulmonary embolism? What is the diagnosis and treatment of pulmonary embolism?

Pulmonary embolism – causes

Pulmonary embolism is also known as pulmonary embolism or pulmonary embolism (Latin embolia artariae pulmonalis, referred to as pulmonary embolism in the English-language literature). It is a life-threatening disease that obstructs the pulmonary artery (or its branches) as a result of narrowing or complete closure of the pulmonary artery. As a consequence, there is a serious pulmonary dysfunction and even necrosis of this organ.

The most common cause of blockage of the pulmonary artery are blood clotswhich detach from thrombus formed in the lower limbs or venous plexuses in the smaller pelvis and reach the lungs with the bloodstream. It also happens – albeit very rarely – that the thrombus comes from the veins of the upper body (e.g. from the subclavian or axillary veins) or from deep veins in the upper limbs. So usually a pulmonary embolism is the result of another disease: thrombosis.

In exceptional cases, however, other factors may lead to pulmonary embolism, such as:

1. air that accidentally entered large veins during their catheterization;
2. lumps of fat that have been drawn into the bloodstream when a bone breaks;
3. drops of amniotic fluid that may have entered the veins during childbirth, if the pregnant woman had premature detachment of the placenta;
4. micro- or macroscopic tumor masses in oncology patients;
5. foreign bodies, such as embolization material used during endovascular procedures, mercury or talc.

It is worth knowing, however, that in some cases doctors are unable to clearly determine where the thrombus causing the pulmonary embolism come from.

Pulmonary embolism can take many forms and is life-threatening to varying degrees. The severity of the disease is determined taking into account the specified individual risk of early death. The level of risk is influenced by diagnostic tests performed within 30 days from the onset of the disease and the diagnosis of possible symptoms of shock and right ventricular failure. Due to the presence or not of the above symptoms, the following can be diagnosed:

1. high-risk pulmonary embolism (mortality in such cases is approx. 30%);
2. low-risk pulmonary embolism, further subdivided into moderate pulmonary embolism (mortality 3-15%) or low risk (mortality less than 1%).

Further methods of treating pulmonary embolism depend on the precise stage of the disease.

Also read: Thrombosis – a silent killer who attacks unexpectedly

Pulmonary embolism – risk factors

Who is particularly at risk of developing a pulmonary embolism? The risk factors in this case are similar to those of venous thrombosis. They include various conditions that can cause ailments belonging to the so-called Virchow’s triad, that is:

1. slowing down of blood flow, appearing as a result of limb immobilization or pressure on the veins;
2. factors that enhance the activity of the coagulation system – the so-called thrombophilia – congenital or acquired;
3. damage to the vascular wall, resulting from trauma or microtraumas during surgical interventions in the lower limb.

The aforementioned ailments may occur in various situations – the following conditions and situations are considered as risk factors for pulmonary embolism:

1. various types of cardiovascular diseases, such as venous thromboembolism (thrombosis), congestive heart failure, previous stroke or an increased number of platelets and related hypercoagulability (thrombophilia)
2. chronic obstructive pulmonary disease in advanced stage;
3. previous pulmonary embolism;
4. obesity;
5. advanced age (the risk of embolism increases significantly after the age of 70);
6. pregnancy and puerperium;
7. use of hormonal contraception, both orally and in the form of patches or disks;
8. immobilization of a long-term nature;
9. neoplastic diseases (especially in advanced stages);
10. bone fractures (especially long bones and pelvic bones);
11. convalescence after surgical procedures and extensive multi-organ injuries;
12. Crohn’s disease;
13. ulcerative colitis (colitis ulcerosa).

Also read: Do you spend too much time in front of the TV? You are putting yourself in a lethal threat

Pulmonary embolism – symptoms

Pulmonary embolism gives a number of different symptoms, but most of them are not clear-cut. A pulmonary embolism may be suspected when the following symptoms appear:

1. strong, prickly pain in the chest, often worsening when you inhale;
2. sudden breathlessness that occurs for no apparent reason, often accompanied by cyanosis;
3. clearly faster work of the heart muscle;
4. faster breathing (from 12 to about 20 breaths per minute);
5. dry cough or, if you have a lung infarction, cough with haemoptysis;
6. fainting, loss of consciousness (in acute conditions – even cardiac arrest);
7. sweating;
8. fever;
9. feeling anxious.

In previously diagnosed venous thrombosis, pulmonary embolism may also be preceded by swelling and pain in the calf. Neither of these symptoms should be taken lightly – immediate medical attention is needed. Pulmonary embolism is an immediate life-threatening condition and may be fatal without the intervention of a physician. It is also worth realizing that in some cases pulmonary embolism may be asymptomatic – then the risk of death is very high.

The frequency of pulmonary embolism symptoms and their severity depends on the degree of clogging of the pulmonary artery bed with blood clots and the overall efficiency of the cardiovascular system. In people diagnosed with heart failure, symptoms are more severe and the risk of death increases significantly. In young people who were healthy up to the point of the embolism, symptoms may be milder.

Also check: Many COVID-19 patients die of thrombosis

Pulmonary embolism – diagnosis

You should also be aware that the symptoms do not always give the correct picture, which is why pulmonary embolism can be difficult to diagnose. Similar symptoms appear, for example, with:

1. heart attack and acute coronary syndromes;
2. pneumonia and pleurisy;
3. aortic dissection;
4. chronic obstructive pulmonary disease;
5. asthma;
6. pneumothorax;
7. intercostal neuralgia.

Therefore, when a pulmonary embolism is suspected, it is necessary to perform a number of specialist tests. Imaging tests, such as computed tomography and arteriography, are the basis for the diagnosis of pulmonary embolism. Thanks to them, it is possible to identify the presence of blood clots within the pulmonary artery and in its branches.

Initially, CT angiography of the pulmonary arteries is usually performed, i.e. a spiral computed tomography, which facilitates the assessment of the degree of patency of the pulmonary fundus in both pulmonary arteries. According to some specialists, first lung perfusion scintigraphy should be performed (administration of a radioactive isotope, which enables the assessment of the degree of blood supply to the lung tissue), but due to the low availability of this procedure, it is rarely included in the diagnosis of pulmonary embolism.

When a pulmonary embolism is suspected, the following are also performed:

1. laboratory blood and urine tests, in particular determination of plasma D-dimers, markers of myocardial damage such as cardiac troponins, and BNP and NT-proBNP natriuretic peptides;
2. ECG;
3. Chest X-ray – allows you to see areas of non-aerated lung, as well as fluid in the pleural cavities;
4. echocardiography – helps to determine whether there are signs of an overload of the right ventricle and dilation of the pulmonary artery – symptoms characteristic of an embolic sudden increase in pressure);
5. Ultrasound of the deep veins of the lower extremities – to confirm or rule out venous thrombosis;
6. pulmonary arteriography with catheterization – allows to assess the limitation of the flow of contrast in the vessel or its absence (due to low availability and high invasiveness, this examination is rarely performed).

Pulmonary embolism – treatment

Pulmonary embolism is treated in different ways depending on the severity with which the patient is present.

When pulmonary embolism is not complicated and is not life-threatening, the so-called pulmonary embolism is usually used. anticoagulant treatment methods. It is based on the administration of drugs that inhibit the coagulation system. In the first stage of such treatment, low molecular weight heparin is administered, i.e. a drug that inhibits one of the clotting factors. Oral drugs with a similar effect are usually started later. Usually, it is associated with the need to constantly monitor the state of the coagulation system by measuring the level of INR.

If pulmonary embolism is severe and associated with shock or right ventricular failure, treatment must be started. life-saving treatments. The patient is usually placed in the intensive care unit, connected to a ventilator and assisted by the administration of oxygen. In some cases, the patient is put into a pharmacological coma.

In some patients it is also used thrombolytic treatment. It is based on a series of procedures focused on dissolving clots with the help of a drug that is inserted through a catheter directly into the pulmonary artery. It is used in severely ill patients, if the administration of heparin for several hours is unsuccessful. However, thrombolytic treatment is an invasive method that can cause severe bleeding complications – so it is not used only in life-threatening conditions.

In such severe cases, when other treatments fail, surgical procedures are also performed surgical removal of clots from the pulmonary arteries (pulmonary embolectomy) or by fragmenting the thrombus with the help of a catheter. However, they can only be performed when there is clear evidence of severe pulmonary embolism. Due to the fact that such procedures require the use of extracorporeal circulation, they are performed only in highly specialized centers with appropriate equipment and personnel.

After a pulmonary embolism, it is worth checking your blood regularly. Order your Blood Coagulation Monitor – INR QLabs® Q1 PL measuring device for home measurements.

Also check: Can the asymptomatic course of the coronavirus damage the lungs?

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