When a blood clot forms in a blood vessel somewhere in the body, part of it can break off and travel to the lungs causing a pulmonary embolism (PE). This can cut off the flow of blood. PE is a medical emergency and may cause death.
Often, the blood clot is 1 that formed in a deep vein of the leg. This is called deep vein thrombosis (DVT).
Health care providers use the term venous thromboembolism (VTE) to describe both PE and DVT. They use the term VTE because the 2 conditions are very closely related. And, because their prevention and treatment is are also closely related.
What causes a pulmonary embolism?
The most common cause of a pulmonary embolism is a blood clot (thrombus) in a large leg vein of the leg that breaks off and travels to the lungs (embolus).
An embolus may be from clots in other parts of the body. Or they may be made up of other solids, liquids, or gases that travel to the lungs. For example, 1 may be made up of fat or air bubbles.
What are the risk factors for pulmonary embolism?
The following may increase your chance of pulmonary embolism:
Blood clotting disorder
Not moving for long periods of time, like being hospitalized, flying or riding long distances, or paralysis
Previous blood clots
Age over 60 years
Cancer and cancer therapy
Certain medical conditions, like heart failure, chronic obstructive pulmonary disease (COPD), high blood pressure, and inflammatory bowel disease, like ulcerative colitis or Crohn's disease
Certain medicines, like birth control pills or hormone replacement therapy (estrogen)
Other vein conditions
What are the symptoms of a pulmonary embolism?
The following are the most common symptoms of a blood clot in the lungs:
If you have the symptoms that may mean a blood clot in your lungs, call 911 or get emergency help.
Symptoms of a blood clot include pain, redness, or swelling in the leg, arm, or other area. If you have these symptoms, call your health care provider.
The symptoms of a pulmonary embolism may look like other medical conditions. Always see your health care provider for a diagnosis.
How is pulmonary embolism diagnosed?
A blood clot in the lungs is often difficult to diagnose. It may look like other conditions and diseases. Your health care provider will do a complete medical history and physical exam. Other tests may include:
Chest X-ray. Images are taken to check the lungs, as well as the heart.
Ventilation-perfusion scan (V/Q scan). A tiny amount of radioactive material is used to check the lungs. The test checks the movement of air and the blood flow in the lungs.
Pulmonary angiogram. Dye (contrast) is injected to make highlight the blood vessels in the lungs.
Computed tomography (also called CT or CAT scan). X-rays and computer technology are used to produce detailed images of the lungs. CT with contrast may also be done.
Magnetic resonance imaging (MRI). Large magnets, radiofrequencies, and computer-produced, detailed images of organs and structures within the body.
Duplex ultrasound (US). A type of ultrasound procedure done to check the blood flow in blood vessels.
Blood tests. To check the blood's clotting status. This may include a test called D-dimer level. Other blood tests may include checking for inherited (genetic) disorders that affect blood clotting. Arterial blood gases to check the amount of oxygen in the blood may also be done.
Electrocardiogram (ECG or EKG). A simple procedure used to evaluate the heart. Abnormalities can be seen with acute pulmonary embolism.
Treatment of pulmonary embolism
Specific treatment will be determined by your health care provider based on:
How old you are
Your overall health and medical history
How sick you are
How well you can handle specific medicines, procedures, or therapies
How long the condition is expected to last
Your opinion or preference
Treatment for a blood clot in the lungs includes:
Blood thinners (anticoagulants). These medicines decrease the ability of the blood to clot. Examples include warfarin and heparin. Other anticoagulants may also be used, including rivaroxaban, apixaban, dabigatran and enoxaparin.
Clot busters (thrombolytic therapy). These medicines can be delivered through a catheter, or given intravenously (IV) to break up the clot.
Percutaneous thrombectomy. In this procedure, a catheter is inserted to remove the clot
Inferior vena cava filter. In this procedure, a small filter is placed in the vena cava. This is the large blood vessel that returns blood from the body to the heart. The filter helps to prevent clots from traveling to the heart and lungs. These filters may be used if you can’t take anticoagulants or if you develop more clots even with treatment.
Surgical embolectomy. This is surgery to remove a blood clot in the lungs. This procedure is not often done.
Prevention of pulmonary embolism
An effective way to prevent a blood clot in the lungs is to prevent blood clots from forming in other parts of the body. This is especially important during hospitalization. Methods include:
Medicine. Anticoagulants and/or aspirin are often given to prevent blood clots.
Compression stockings. Elastic stockings that help keep blood flowing.
Sequential compression device (SCD) or intermittent pneumatic compression (IPC). Sleeves are placed around the legs. They are attached to a devise that also helps keep blood flowing with gentle pressure. Remove the sleeves so that you do not trip or fall when you are walking, like when you use the bathroom or shower. If you need help removing the sleeves, ask the nurse or aid.
Walking. Getting up and moving as soon as possible after surgery or illness.
Avoid sitting, standing, or lying down for long periods without moving your legs and feet:
When traveling by car, make frequent stops to get out and move around.
On long airplane, train, or bus rides, get up and move around when possible.
If you can’t get up, wiggle your toes and tighten your calves to keep your blood moving.
Take good care of your heart and blood vessels:
If you smoke, you should stop. Talk with your health care provider about ways to quit.
Be active. Try to get 30 minutes of exercise on most days. If you are not exercising, talk with your health care provider about getting started.
Keep a healthy weight. If you are overweight, talk with your health care provider about improving your diet, increasing your activity level, and other ways to lose weight.
Treatment and prevention of DVT will probably continue after you leave the hospital. It is important to follow all instructions from your health care providers during and after your time in the hospital.
When to seek medical advice
If you have symptoms that may mean a blood clot in your leg, arm, or another area, call your health care provider. And, call your health care provider if you have signs or symptoms of bleeding. For example, you may have blood in your urine, bleeding with bowel movements, nose bleeds, bleeding gums, a cut that will not stop bleeding, or bleeding from your vagina.
If you have symptoms that may mean a blood clot in your lungs, call 911. Also, call 911 if you have heavy or uncontrolled bleeding. There is an increased risk of bleeding while taking blood thinners.