CEN Pulmonary Embolism

CEN Pulmonary Embolism

Pulmonary Embolism Overview & Pathophysiology

PE is a blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body through the bloodstream.  PE usually results from a blood clot in the leg that travels to the lung.  The risk of blood clots is increased by cancer, prolonged be rest, smoking, stroke, certain genetic conditions, pregnancy, obesity, and after some types of surgery.  A small proportion of cases are due to the embolization of air, fat, or amniotic fluid.  Pulmonary embolisms affects about 300,000 and 600,000 people a year in the U.S, which results in about 50,000 to 200,000 deaths.  Rates are similar in males and females.  They become more common as people get older.

Because pulmonary embolism almost always occurs in conjunction with deep vein thrombosis, most doctors refer to the two conditions together as venous thromboembolism.  Although anyone can develop a DVT and PE, factors such as immobility, cancer and surgery increases your risk.  A PE can be life threatening, but prompt treatment can greatly reduce the risk of death.  Taking measures to prevent blood clots in your legs will help protect you against a pulmonary embolism.

Signs and Symptoms 

Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the size of the clots and your overall health – especially the presence or absence of underlying lung disease or heart disease.

• Common signs and symptoms include
• Shortness of breath
• Chest pain
• Cough
• Leg pain or swelling or both usually in the calf
• Clammy or discolored skin
• Fever
• Excessive sweating
• Rapid or irregular heartbeat
• Lightheadedness or dizziness

Causes 

Pulmonary embolism occurs when a clump of material, most often a blood clot, gets wedged into an artery in your lungs.  These blood clots most commonly originate in the deep veins of your legs, but they can also come from other parts of your body.

Risk Factors 

Certain medical conditions places you at high risk for PE

• Hear disease
• Cancer

Prolonged immobility such as

• Bed rest
• Long journeys

Surgery is one of the leading causes of blood clots, especially seen after joint replacements of the hip and knee.

Other risk factors are

• Smoking
• Being overweight
• Supplemental estrogen
• Pregnancy

Complications 

Pulmonary embolism can be life threatening.  About 1/3 of people with undiagnosed and untreated pulmonary embolism don’t survive.  PE can also lead to pulmonary hypertension.

Tests and Diagnosis

PE can be difficult to diagnose, especially in people who have underlying heart or lung disease.  For that reason, your physician may order a series of tests to diagnose the presence of a PE

• D-dimer – high levels may indicate the likelihood of blood clots
• Chest X-ray – used to rule out other conditions that may mimic a PE
• Noninvasive Ultrasound
• CT scan of the chest
• Pulmonary angiogram
• MRI

Treatment

Treatment is aimed at keeping the blood clot from getting bigger and preventing new clots from forming.  Prompt treatment is essential to prevent serious complications or death.

• Blood thinners (anticoagulants)
• Clot dissolvers  (thrombolytics)
• Clot removal
• Vein filter

Prevention

• Anticoagulants
• Compression stockings
• Pneumatic compression
• Physical activity
• Leg elevation