Pulmonary embolism is a common and dangerous condition that occurs when blood clots (deep venous thrombosis, or, DVT) break loose and travel from where the clots formed—mostly the leg veins (or, uncommonly, veins elsewhere)—to the pulmonary arteries, which conduct blood from the heart to the lungs. Sometimes these clots are small and may not cause clinical symptoms, because the surface area of the lungs, when opened out, would cover the surface of two tennis courts! However, occasionally, a pulmonary embolism can be massive and rapidly fatal.
Risk Factors
Rarely, patients inherit conditions that increase clotting. The risk of forming blood clots in the leg veins is highest in patients who:
• have had recent surgery (especially hip and knee replacement),
• are immobilized, or
• have cancer.
In addition, smoking, pregnancy and long distance air travel (sometimes termed “economy class syndrome”) also can promote clot formation in the leg veins.
Symptoms and Diagnosis
Patients who are at risk of pulmonary embolism may experience sudden shortness of breath or chest pain and should report these symptoms immediately. Coughing up blood is a late symptom.
Doctors apply a risk scoring system and use a combination of blood tests and imaging with CT scan and/or an echocardiogram (a test using sound waves through the chest wall) to make a rapid diagnosis, so that effective treatment with intravenous blood thinners can be administered. It is a mark of how dangerous pulmonary embolism can be that treatment with an intravenous blood thinner is often started even before the pulmonary embolism is definitely confirmed by imaging tests.
Prevention and Treatment
The most important strategy in this disease is preventing DVT.
Movement and Medication
Limiting the occurrence of blood clots is achieved by:
• getting the patient up and walking, or by mechanical devices that squeeze the legs and help circulate the blood better; and
• blood thinning medications of various types. The blood thinners are most often injectable, but new oral medications are being adopted. When being treated with medications, it is critically important not to miss even one prescribed dose!
Mechanical Filter
In some circumstances, a mechanical “filter” can be placed in the main veins that collect blood from the upper and lower body and channel it to the right side of the heart, which pumps the blood to the pulmonary arteries on its way to the lungs.
When Traveling
Getting up and moving is a simple but highly effective strategy, and travelers on long trips by air or road should make sure to get up and move about regularly.
Surgery
In rare cases, blood thinners cannot be used and emergency open chest surgery is the only way to remove life-threatening clots. We have saved a number of patients with this dramatic operation. Recently, another option has been developed in which a tube is advanced through the veins at the groin and acts like a vacuum cleaner to hoover out the clot and then return the liquid blood sucked out during the process back into the patient.
It Takes a Team
Achieving the best results for pulmonary embolism takes a dedicated multidisciplinary team comprising cardiothoracic surgery and pulmonary medicine specialists. Beth Israel Medical Center now offers such a team, whose members work together to diagnose and treat patients with suspected pulmonary embolism, applying the most up-to-date and evidence-based approach and technology.
To find an excellent doctor who is right for you, please call our Physician Referral Service at 866.804.1007.