Pulmonary
Embolism
What is
a pulmonary embolism?
A pulmonary
embolism occurs when a blood clot travels through the bloodstream and becomes
lodged in an artery in your lungs. These blood clots usually form in the deep
veins of the legs or pelvis. If they break loose from the wall of a vein, they
will flow to the lungs. The clot may then block an artery, reducing blood flow
through the lungs and place a strain on the heart.
How
does it occur?
A pulmonary
embolism occurs when a blood clot forms and then breaks off from the wall of a
vein and travels to the lungs. Blood
clots form if blood flows very slowly through the veins or if disease or
medicines cause your blood to clot more easily. Your risk of developing blood
clots increases if:
Ø
You are immobile as a result of surgery,
disability, or illness.
Ø
You have cancer, congestive heart failure, and certain other heart
diseases.
Ø
You have problems with veins such as phlebitis (inflammation of
the wall of a vein) or varicose veins.
Ø
You have a leg or hip fracture.
Ø
You are pregnant.
Ø
You have had a recent stroke or a heart attack.
Ø
You have had blood clots before or there is a family of history of
blood clots.
Ø
You use birth control pills or certain other drugs.
Ø
You smoke cigarettes.
Ø
You are overweight.
Ø
You sit for long periods (such as with prolonged car and airplane
travel).
What
are the symptoms?
Symptoms of
pulmonary embolism may include:
Ø
shortness of breath
Ø
chest pain (often it hurts when you take a deep breath)
Ø
cough
Ø
lightheadedness or fainting.
How is it diagnosed?
The doctor will
examine you and take your medical history. To confirm the diagnosis and
determine how severe any damage is, your doctor will order tests and scans,
which may include:
Ø
chest x-ray
Ø
electrocardiogram, or ECG (a recording of the heart's electrical
activity)
Ø
blood test(s)
Ø
"V/Q" lung scan
Ø
ultrasound scan of legs to look for clots
Ø
pulmonary angiogram (an x-ray using special dye to
look for blockages in the blood vessels of the lungs).
How is it treated?
Blood thinners
are the mainstay of treatment. Initially, you will need a rapid acting
medicine called
heparin or
low-molecular-weight-heparin given by vein or as an
injection under the skin. Eventually you transitioned to a medicine
called warfarin or
Coumadin® that is in tablet form and is a long acting blood
thinner.
You will need to
take blood thinners several months after you leave the hospital and will need
regular blood tests (protime or INR) to adjust
the warfarin dose.
How
long will the effects last?
How long the
effects last will depend on:
Ø
the size and extent of the clot(s)
Ø
how healthy you were before the blood clot
Ø
the underlying reason for the blood clot forming
Many of the
symptoms will improve within days of starting treatment, but you may have less
energy and stamina for several weeks or even months.
How can
I take care of myself?
Follow the
treatment prescribed by your doctor, especially his or her recommendation for
regular blood tests to check how well your blood thinner is working. In
addition:
Don't smoke.
Watch for signs
of swelling or discoloration in your legs.
If you are taking blood thinners:
Ø
Make sure you understand how you are to take the medications and
follow the instructions closely.
Ø
Avoid taking aspirin and other drugs containing nonsteroidal
anti-inflammatories (like ibuprofen and naproxen)
Ø
Avoid contact sports or other activities that are too forceful and
might cause bruising.
Ø
Try to avoid cutting yourself. These medicines will make you bleed
more than usual. To help prevent cuts, consider wearing rubber gloves or garden
gloves for household and outdoor work. Don't walk
barefoot. Use an electric razor for shaving.
What can be done to help prevent a pulmonary embolism?
Get regular
exercise according to your doctor's recommendation.
If you are
bedridden or recovering from major surgery, you may be given
small dosages of a blood thinner to prevent clots from forming due to
inactivity.
If you
travel long distances, be sure to stand and walk frequently (for example, get
up every hour, and move your legs and feet while you are sitting) and consider
wearing elastic support stockings. Don't sit cross-
legged on long trips.
If you are
planning surgery, ask your doctor what can be done to
prevent blood clots.