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Embolism

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A pulmonary embolism is the sudden blocking of one of the arteries of the lung by matter in the blood, such as a blood clot, fat, fragments of a cancerous tumor or an air bubble. The blockage prevents enough oxygen-rich blood from reaching the tissues of the lung, causing lung tissue to die (pulmonary infarction). Smaller clots are sometimes broken up by the body, so damage is minimal. If the clot is large, it can strain the heart or even cause death. 1

Pulmonary embolism is the sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot. In most cases, the clots are small and are not deadly, but they can damage the lung. But if the clot is large and stops blood flow to the lung, it can be deadly. Quick treatment could save your life or reduce the risk of future problems. 2

Normally, your blood flows from the right side of your heart to your lungs where it picks up oxygen. The left side of your heart then pumps this oxygen-rich blood through a system of blood vessels called arteries. Once your blood has delivered the oxygen to various parts of your body, it enters another network of blood vessels called the veins. Your veins carry the now oxygen-poor blood back to your heart, which pumps your blood to your lungs to pick up oxygen again. If a blood clot forms in a vein, commonly a deep vein in your leg, it can move with the blood flow back to your lungs and lodge there. This blood clot is called a pulmonary embolism. 3

The most common type of pulmonary embolism is a blood clot, usually one that forms in a leg or pelvic vein (see Venous Disorders: Deep Vein Thrombosis (DVT)) when blood flow slows down or stops, as may occur in the leg veins when a person stays in one position for a long time. People who have been on prolonged bed rest and those recovering from major surgery are at risk. Those sitting for long time periods without moving around (as may happen during air travel) are at slightly increased risk. Far less often, blood clots form in the veins of the arms or in the right side of the heart. Once a clot breaks free into the bloodstream, it usually travels to the lungs. 4

In a pulmonary embolism, a common illness, blood flow is blocked at a pulmonary artery. When emboli block the main pulmonary artery, and in cases where there are no initial symptoms, a pulmonary embolism can quickly become fatal. According to the American Heart Association, an estimated 600,000 Americans develop pulmonary emboli annually and 60,000 die from it. 5

A pulmonary embolism is difficult to diagnose. Less than 10% of patients whodie from a pulmonary embolism were diagnosed with the condition. More than 90% of cases of pulmonary emboli are complications of deep vein thrombosis, blood clots in the deep vein of the leg or pelvis. 6

Air bubbles may form emboli if a catheter in one of the large veins (central veins) is inadvertently opened to air. Air emboli may also form when a vein is operated on (such as when a blood clot is being removed) or when a person is being resuscitated (because of the force of chest compressions). An additional risk is underwater diving (see Diving and Compressed Air Injuries: Pulmonary Barotrauma). 7

The type of clot that is likely to cause a pulmonary embolism usually originates in the veins deep in your muscles. This condition is called deep vein thrombosis (DVT). DVT usually occurs in your leg or pelvic veins; although less commonly it can also sometimes occur in your arm veins. 8

Infected material may also form emboli and travel to the lung. Causes include intravenous drug use, certain heart valve infections, and inflammation of a vein with blood clot formation and infection (septic thrombophlebitis). 9

An embolism can be diagnosed through the patient’s history, a physical exam,and diagnostic tests. For arterial emboli, cardiac ultrasound and/or arteriography are ordered. For a pulmonary embolism, a chest x ray, lung scan, pulmonary angiography, electrocardiography, arterial blood gas measurements, and venography or venous ultrasound could be ordered. 10

In most cases, pulmonary embolism is caused by a blood clot in the leg that breaks loose and travels to the lungs. A blood clot in a vein close to the skin is not likely to cause problems. But having blood clots in deep veins (deep vein thrombosis) can lead to pulmonary embolism. 11

If you have a pulmonary embolism, your physician or vascular surgeon may administer an anticoagulant drug called heparin intravenously as initial treatment. Anticoagulants are sometimes called blood thinners. They don’t literally thin your blood, but they help prevent your blood from clotting too easily. Heparin helps prevent clots from forming and keeps clots you already have from growing. Eventually, your body breaks up the clot that has caused your pulmonary embolism. 12

If you have a large pulmonary embolism, or you have another medical condition, your physician or vascular surgeon may recommend more aggressive treatments. A treatment called thrombolysis can dissolve your clot. In this procedure, your vascular surgeon injects clot-dissolving drugs through a catheter directly into the clot. A catheter is a long, thin tube that your vascular surgeon inserts into a puncture in the skin over a blood vessel. Thrombolysis has a higher risk for bleeding complications and stroke than anticoagulant therapy but may be effective more quickly, a feature that may be important if the pulmonary embolism is large. 13

In you are unable to receive anticoagulant therapy or thrombolysis, your vascular surgeon may attempt to remove the clot using a catheter technique. Using this technique, called suction thrombectomy, your physician guides a catheter through your blood vessels to your pulmonary embolism. The catheter shoots a salt solution into the blocked artery. The water pressure pulls the clot toward the tip of the catheter and breaks up the clot. Your vascular surgeon may, as another option, use a catheter attached to a mechanical device such as a rotating head to break up a clot. 14

Pulmonary angiography is the most reliable test for diagnosing pulmonary embolism but it is not used often, because it carries some risk and is expensive,invasive, and not readily available in many hospitals. Pulmonary angiographyis a radiographic test which involves injection of a pharmaceutical “contrast agent” to show up the pulmonary arteries. A cinematic camera records the blood flow through the lungs of the patient, who lies on a table. Pulmonary angiography is usually performed in a hospital’s radiology department and takes30 minutes to one hour. 15

    References

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May 8, 2008 | Filed Under Diseases By Name 

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