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24 / 10 / 2017
Pulmonary Embolism
 
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Pulmonary embolism

 
ASTHMA & RESPIRATORY SYSTEM

Respiratory System

 

Pulmonary embolism is a condition that occurs when an artery in your lung becomes blocked. In most cases, the blockage is caused by one or more blood clots that travel to your lungs from another part of your body.

Most blood clots originate in your legs, but they can also form in the veins of your arms, the right side of your heart or even at the tip of a catheter placed in a vein. In rare cases, other types of clots - such as globules of fat, air bubbles, tissue from a tumor or a clump of bacteria - also can lodge in your lungs' arteries.

Smaller clots prevent adequate blood flow to the lungs, sometimes causing damage to lung tissue (infarction). Large clots that completely block blood flow can be fatal.

You're especially at risk of pulmonary embolism if you must rest in bed or remain inactive for long periods of time. You're also at risk if you've had surgery, a stroke or heart attack, have chronic congestive heart failure or if you've fractured your hip or femur. In addition, people with cancer or chronic lung disease and women who use birth control pills are at increased risk.

The encouraging news is that a few simple measures, such as moving around during a long airplane flight, can go a long way toward preventing pulmonary embolism. In addition, treatment with medications that break up clots or prevent new clots from forming can greatly reduce the number of deaths from this serious condition.

Signs and symptoms

The signs and symptoms of pulmonary embolism can vary greatly, depending on how much of your lung is involved, the size of the clot and your overall health — especially the presence or absence of underlying lung or heart disease. Common signs and symptoms include:

  • Sudden shortness of breath, either when you're active or at rest.

  • Chest pain that often mimics angina (chest pain caused by a temporary lack of sufficient blood flow to your heart) or a heart attack. The pain may occur anywhere in the area of your lungs, and sometimes may radiate to your shoulder, arm, neck or jaw. It can be sharp and stabbing or aching and dull. It may become worse when you breathe deeply, cough, eat, bend or stoop.

  • A cough that produces bloody or blood-streaked sputum.

  • Excessive sweating.

  • Rapid heartbeat (tachycardia).

  • Lightheadedness or even fainting (syncope).

A number of other signs and symptoms also may occur with pulmonary embolism, including:

  • Wheezing

  • Clammy or bluish-colored skin

  • Leg swelling

  • Weak pulse

  • Anxiety

Causes

You have two lungs, one on either side of your heart. Each time blood passes through your heart, it travels to your lungs, where it picks up oxygen and releases carbon dioxide — a waste product of metabolism.

Blood vessels known as arteries take the oxygen-rich blood to tissues throughout your body, while veins bring oxygen-poor blood back to the right side of your heart. Capillaries — the smallest blood vessels — connect the veins and arteries.

Blood is constantly being pumped from the right side of your heart to your lungs and back to the left side of your heart. As a result, clots that form in the veins and then break off can migrate through your bloodstream to the right side of your heart and then into the pulmonary arteries, potentially blocking an artery (pulmonary embolism). It can take less than 10 seconds for this whole process to occur. No one knows what causes fragments or even the whole clot to break off and migrate, and it's not possible to predict which clot will break off or when.

A blockage can occur in any small artery, but your lungs are especially vulnerable because all of the blood in your body passes through your lungs every time it circulates. In most cases, a number of clots will develop over a period of minutes or hours and spread to several parts of your lungs. It's unusual to have only one clot.

Your heart is composed of two upper and two lower chambers. The upper chambers (the right and left atrium) receive incoming blood. The lower chambers, the more muscular right and left ventricles, ...A blood clot in a leg vein can break loose and travel through the heart, lodging in a pulmonary artery. There, the clot blocks blood flow to a portion of the lung....The lungs are two spongy organs located in the chest. Air is carried through the trachea to the lungs via larger airways called the bronchi, which subdivide into smaller airways. At the end of the ...

Understanding blood clots
A blood clot is a plug of platelets (colorless blood cells that repair injured blood vessels) enmeshed in a network of fibrin — a type of protein — and red blood cells. Clots are the end result of a complex process that helps stop bleeding after you've been injured. But sometimes clots form when you don't need them.

Most of these clots originate in a vein in your leg or pelvis. The affected vein may be near the surface of your skin (superficial thrombosis) or deep within a muscle (deep vein thrombosis, or DVT). Clots in superficial veins rarely present a problem and often clear on their own. But clots in the deep veins may detach and migrate through your bloodstream to your lungs. Not everyone who has DVT develops a pulmonary embolism.

A blood clot that forms and remains in a vein is called a thrombus. A clot that travels to another part of your body is an embolus. Occasionally other substances — such as pieces of a tumor, globules of fat from fractured bones or air bubbles — may enter your circulation and block arteries. Most clots in the legs begin in veins below the knee, and it's uncommon for these clots to break off and embolize. Eventually, these clots may extend up into the upper leg (thigh), and that's when they tend to be dangerous.

Most blood clots occur for one of the following reasons:

  • Long periods of inactivity. Inactivity caused by prolonged bed rest, long plane rides or car trips decreases blood flow in the veins in your lower extremities, making clots more likely. In some cases, people who are immobilized after surgery, a heart attack or serious injuries are more likely to develop blood clots and pulmonary embolism than people who are able to get up and walk around. In fact, the highest incidence of pulmonary embolism occurs among people in hospitals. But in recent years, attention has also focused on increased rates of deep vein thrombosis and pulmonary embolism among otherwise healthy travelers on long plane trips. Cramped seats with little legroom have contributed to the problem — so much so that deep vein thrombosis is sometimes referred to as "economy class syndrome."

  • Increased levels of clotting factors in the blood. Some types of cancer, especially pancreatic, lung and ovarian cancer, cause increased blood levels of procoagulants — substances that contribute to blood clotting. The female hormone estrogen found in birth control pills and hormone replacement therapy (HRT) also increases the amount of clotting factors in the blood.

  • Certain medical conditions. People who have cardiovascular disease associated with clot formation, such as heart attack (myocardial infarction) or stroke, are more likely to develop blood clots in their veins.

  • Injury to veins. This may occur during certain surgical procedures — especially hip surgery or knee replacement. It may also result from direct injuries to the legs or from leg or pelvic fractures.

Risk factors

Although anyone can develop blood clots and subsequent pulmonary embolism — together known as venous thromboembolism (VTE) — you have a higher risk if you:

  • Are inactive for a long period, such as during lengthy plane or car trips.

  •  Are confined to bed for a prolonged time. This may occur following surgery, a heart attack or leg fracture.

  • Undergo certain surgical procedures, especially hip or knee replacement, some obstetric-gynecologic procedures and extensive abdominal operations.

  • Have certain types of cancer — especially pancreatic, ovarian and lung cancer — that can increase levels of substances that help blood clot. Some studies have shown that in menopausal women with a history of breast cancer, tamoxifen (Nolvadex) and raloxifene (Evista) use may increase the risk of pulmonary embolism.

  • Are overweight.

  • Are pregnant or have just given birth. Pulmonary embolism is the most frequent cause of death associated with childbirth. Many women who have pregnancy-related venous thromboembolism have an inherited clotting disorder.

  • Use birth control pills. Estrogen in birth control pills can increase clotting factors in your blood, especially if you also smoke.

  • Have a previous history of VTE.

  • Have a family history of a tendency to form blood clots.

  • Smoke cigarettes.

  • Have high blood pressure or cardiovascular disease.

When to seek medical advice

See your doctor right away if you develop redness, swelling or tenderness over a vein in one of your legs. This may indicate a blood clot. Because other conditions can also cause these signs and symptoms, your doctor will order tests to confirm a blood clot before proceeding with any treatment. However, you can have DVT and have no symptoms.

Once a clot has reached your lungs, the situation can be life-threatening and you need immediate medical care. About 10 percent of people with pulmonary embolism die within the first hour, so prompt treatment is crucial. Pulmonary embolism is seldom fatal when diagnosed and treated promptly.

Although signs and symptoms of pulmonary embolism vary widely and often resemble those of other conditions, they commonly include sudden shortness of breath, chest pain and a cough that produces blood-streaked sputum.

Pulmonary embolism > 1 > 2 > 3 > 4

 
 
 
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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.

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