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Pulmonary embolism

Definition


Disease: Pulmonary embolism Pulmonary embolism
Category: Respiratory diseases
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Disease Definition:

Pulmonary embolism is a condition that occurs when one or more arteries in your lungs become blocked. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from another part of the body (most commonly, legs).
This condition can take place in otherwise healthy people as well. Signs and symptoms of pulmonary embolism differ from one  person to another; though commonly include sudden and unexplained shortness of breath, chest pain and a cough that may bring up blood-tinged sputum.

Pulmonary embolism can be life-threatening, but prompt treatment with anti-clotting medications can greatly reduce the risk of death. Taking measures to prevent blood clots in the legs also can help protect someone  against pulmonary embolism.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Depending on how much of the lung is involved, the size of the clot and the overall health of the affected person (specifically if there’s an underlying lung disease or heart disease involved), symptoms of pulmonary embolism can differ.

Common signs and symptoms include:

  • Breathlessness. This symptom typically appears suddenly, and occurs whether one is active or at rest.
  • Chest pain. It’s similar to the feeling of having a heart attack. It might worsen while breathing deeply, coughing, bending, stooping or eating. The pain will get worse with exertion but won't go away when a person rests.
  • Cough. The cough may produce bloody or blood-streaked sputum.


The followings are other signs and symptoms that can occur with pulmonary embolism include:

  • Leg swelling
  • Wheezing
  • Lightheadedness or fainting
  • Excessive sweating
  • Clammy or bluish-colored skin
  • Weak pulse
  • Rapid or irregular heartbeat

A person should Seek immediate medical care when experiencing unexplained shortness of breath, chest pain or a cough that produces bloody sputum.

Causes:

When a clump of material, most often a blood clot, gets wedged into an artery in the lungs, Pulmonary embolism occurs.  These blood clots most commonly originate in the deep veins of the legs. They can also come from other parts of the body. This condition is called deep vein thrombosis (DVT).

Sometimes, other substances can form blockages within the blood vessels inside the lungs. Such as:

  • Part of a tumor.
  • Air bubbles.
  • Fat from within the marrow of a broken bone.


Solitary pulmonary embolism seldom takes place. Mostly, multiple clots are involved. The lung tissue served by each blocked artery is deprived of fuel and might die, which is why it becomes harder for the lungs to be able to supply the rest of the body with oxygen. Since pulmonary embolism almost always takes place in conjunction with deep vein thrombosis, some doctors refer to the two conditions together as venous thromboembolism (VTE).

The following factors can increase the risk of blood clots, even though blood clots and subsequent pulmonary embolism might occur in anyone:

Prolonged immobility
Blood clots are more likely to form in the legs during periods of inactivity, such as:

  • Bed rest. Being confined to bed for an extended period after surgery, a heart attack, leg fracture or any serious illness makes the person far more vulnerable to blood clots.
  • Long journeys. The current of blood flow might be slowed due to sitting in a cramped position throughout lengthy plane or car trips that leads to the formation of clots in the legs.

Age
There’s an increased risk of developing clots for aged people, such as those with:

  • Valve malfunction. The blood is kept moving in the right direction through very small valves within the veins that tend to degrade as one gets older. When these valves don't work properly, blood pools and sometimes forms clots.
  • Dehydration. An increased risk of dehydration involves people who are older, which may thicken the blood and make clots more likely.
  • Medical problems. Older people might have medical problems that expose them to independent risk factors for clots (such as cancer, joint replacement surgery or heart disease).


Family history
There’s an increased risk of going through future clots in case a person or any of his\her family members have had blood clots or pulmonary embolism in the past. may be due to inherited disorders of clotting that can be measured in specialty labs.

Surgery
Surgery can be mainly identified as the primal reason behind the formation of blood clots, particularly joint replacements of the hip and knee. Tissue debris might enter the bloodstream and help cause a blood clot during the preparation of the bones for the artificial joints. Simply being immobile during any type of surgery can lead to the formation of clots. The risk is higher with the length of time one is under general anesthesia.  

Medical conditions
Heart disease. High blood pressure and cardiovascular disease make clot formation more likely.

  • Pregnancy. The weight of the baby pressing on veins in the pelvis can slow blood return from the legs. Clots are more likely to form when blood slows or pools.
  • Cancer. Certain cancers (particularly pancreatic, lung and ovarian cancers) can increase levels of substances that help blood clot, and chemotherapy further increases the risk. Women with a history of breast cancer who are taking tamoxifen or raloxifene also are at an higher risk of blood clots.

 

Lifestyle

  • Smoking. Tobacco use predisposes some people to blood clot formation though it isn’t known why, particularly when combined with other risk aspects.
  • Being overweight. Being overweight might raise the risk of blood clots, especially in women who smoke or have high blood pressure.
  • Supplemental estrogen. The estrogen in birth control pills and in hormone replacement therapy can increase clotting factors in the blood, particularly when one is a smoker or is overweight.

Complications

Complications:

Pulmonary embolism can be life-threatening. About one-third of people with undiagnosed and untreated pulmonary embolism don't survive. That number drops dramatically If the condition is diagnosed and immediately treated.

Pulmonary embolism can also lead to pulmonary hypertension (a condition in which the blood pressure in the lungs is too high). In the case of experiencing obstructions in the arteries inside the lungs, heart must work harder to push blood through those vessels. This increases the blood pressure within these vessels and can wear out a section of your heart.

Treatments:

Prompt treatment of pulmonary embolism is essential to prevent serious complications or death.

Medications

  • Anticoagulants. Heparin works quickly and is often administered with the use of a needle. Warfarin comes in pill form. Both keep new clots from forming though it takes a few days before warfarin starts showing its effect. Bleeding gums and easy bruising can be included within its side effects.
  • Clot dissolvers (thrombolytics). There are medications that can dissolve clots rapidly, even though these clots usually dissolve on their own. Since these clot-busting medications can cause abrupt and severe bleeding, they usualy are reserved for life- threatening situations.


Surgical and other procedures

  • Clot removal. In the case of having an immensely large clot in the lung, removing it might be suggested using a thin flexible tube (catheter) threaded through the blood vessels.
  • Vein filter. This procedure which is commonly reserved for people who are unable to take anticoagulant medications or when these medications aren’t effective for them, is performed by a catheter that is additionally used to position a filter in the main vein (known as the inferior vena cava) that leads from the legs to the right side of the heart. This filter can block clots from being carried into the lungs.

Prognosis:

Not available

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