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Pulmonary Embolism

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Pulmonary embolism is a blockage in a pulmonary artery from a thrombus (blood clot) that has moved from a deep vein thrombosis (a blood clot that most often develops in the deep veins of the leg). What generally happens is this: Large fragments of thrombi break off and are carried with the bloodstream until they are lodged in the pulmonary arteries. This blocks the flow of blood through the heart, which may lead to death. After ischemic heart disease and stroke, pulmonary embolism is the third leading cause of death from heart disease and may be the most common preventable cause of death in hospitals. It is unsuspected in at least two-thirds of people who die from it. 8

A pulmonary embolism is a blood clot that forms in a vein, travels through your bloodstream, and lodges in your lungs. A pulmonary embolism is a medical emergency because a large embolism, or sometimes many repeated smaller ones, can be fatal in a short time. 1

Pulmonary embolism is difficult to diagnose. Less than 10% of patients who die from pulmonary embolism were diagnosed with the condition. It occurs when emboli block a pulmonary artery, usually due to a blood clot that breaks off from a large vein and travels to the lungs. More than 90% of cases of pulmonary embolism are complications of deep vein thrombosis, blood clots from the leg or pelvic veins. Emboli can also be comprised of fat, air, or tumor tissue.When emboli block the main pulmonary artery, pulmonary embolism can quicklybecome fatal. 12

If your lung arteries become blocked by a blood clot, you may experience high blood pressure in your lungs. As a result, your heart pumps harder than usual. When your heart is continually overworked, it may enlarge, and it may eventually fail to perform. A large pulmonary embolism can cause your lungs and heart to fail. Fortunately, your chances of surviving a pulmonary embolism increase when your physician can diagnose and treat your condition quickly. 1

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. 13

A blood clot that travels through the blood vessels is called an embolus. A pulmonary embolism is a blood clot that blocks an artery in your lungs. It can be a life-threatening problem. 48

Arterial emboli are usually a complication of heart disease where blood clotsform in the heart’s chambers. Gas emboli are caused by rapid changes in environmental pressure that could happen when flying or scuba diving. A pulmonaryembolism is caused by blood clots that travel through the blood stream to the lungs and block a pulmonary artery. More than 90% of the cases of pulmonaryembolism are a complication of deep vein thrombosis, which typically occursin patients who have had orthopedic surgery, in patients with cancer and other chronic illnesses like congestive heart failure. 13

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. 1

A pulmonary embolism is a complication that occurs as a result of deep vein thrombosis. A blood clot that has developed in a vein elsewhere in the body breaks loose and travels through the bloodstream, becoming lodged in an artery in the lung. 34

A total of 160 patients with angiographically documented PE were divided into two groups, each of which received standard heparin or urokinase. Lung scans, pulmonary angiograms and measurements of right heart pressures and blood flow dynamics performed at 24 hours showed significant improvement only in the urokinase group. However, lung scans performed seven days, 14 days, three months and six months later showed no difference between the two groups. 6

About 33% of elderly patients with pulmonary embolism have pleural effusions, which are usually unilateral. About 67% of these effusions are bloody (red blood cell count > 100,000/mL) and must be distinguished from cancer and trauma. Patients with pulmonary embolism and a bloody pleural effusion generally have a pulmonary infiltrate on chest x-ray that suggests hemorrhagic consolidation of the lung parenchyma. The infiltrate usually resolves over several days. About 10% of patients with pulmonary emboli, especially those with severe heart failure, develop pulmonary infarction. The remainder of nonbloody effusions due to pulmonary embolism are exudates with elevated white blood cell counts (up to 75,000/mL) that mimic infected pleural effusions. 5

mm Hg, or a markedly decreased systolic blood pressure in a hypertensive patient suggests the possibility of a massive pulmonary embolism or, in a patient with marginal cardiopulmonary function, a significant embolus. Hypotension is ominous, because decreased aortic diastolic pressure may significantly reduce coronary artery blood flow to the overworked right ventricle, establishing a vicious circle. 5

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. 1

Patients with pulmonary embolism who have severe hypoxemia or any degree of hypotension are considered to be in unstable condition. In these patients, the intrinsic excess capacity and compensatory mechanism of the cardiopulmonary system have been completely overwhelmed, and the risk of sudden death from any additional pulmonary clot load is extremely high. 39

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. 12

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