+ Pulmonary Embolus By: Marissa Miuccio

+ What is a Pulmonary Embolism Pulmonary Embolism, or PE, is a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg. A clot that from in one part of the body and travels in the blood stream to another part of the body is called an embolus.

+ Overview PE, most often, is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in deep veins of the body –most often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery. Deep vein clots are not like clots in veins close to the skins surface. Those clots remain in place and do not cause PE.

+ Outlook The exact number of people affected by DVT and PE isn’t known. Estimates suggest these conditions affect 300,000 to 600,000 people in the United States each year. If left untreated, about 30 percent of patients who have PE will die. Most of those who die do so within the first few hours of the event. The good news is that prompt diagnosis and proper treatment can save lives and help prevent the complications of PE.

+ Pathophysiology A pulmonary embolus is most often caused by a blood clot in a vein, especially in the leg or in the pelvis (hip area). The most common cause is a blood clot in one of the deep veins of the thighs. This type of clot is called deep vein thrombosis. The blood clot breaks off and travels to the lungs. Less common causes include: Air bubbles Fat droplets Amniotic fluids Clumps of parasites or tumor cells

+ You are more likely to get this condition if you have a history of blood clots or certain clotting disorders. Other risk factors for a pulmonary embolus include: Burns Cancer Childbirth Family history of blood clots Factors of the hips or thigh bone Heart attack Heart surgery Long term bed rest Staying in one position for a long time, such as a long plane or car ride Sever injury Stroke Surgery (especially orthopedic or neurological surgery) Use of birth control pills or estrogen therapy

+ Who is at risk? Pulmonary embolism (PE) occurs equally in men and woman. The risk increases with age. For every 10 years after 60, the risk of having PE doubles. Certain inherited conditions, such as factor V Leiden, increases the risk of blood clotting and PE. Your risk factor for PE is high if you have DVT or a history of DVT. Your risk for PE is high if you have had this condition before.

+ Who is at risk? Other factors also can increase the risk for PE, such as: Being bedridden or unable to move around much Having surgery or breaking a bone (the risk goes up in the weeks following the surgery or injury Having certain diseases or conditions such as stroke, paralysis, chronic heart disease, or high blood pressure Smoking People who have recently been treated for cancer or who have central venous catheter are more likely to develop DCT, which increase their risk for PE. A central venous catheter is a tube placed in a vein to allow easy access to the bloodstream for medical treatment. Other risk factors for DVT including sitting for long periods, pregnancy and the 6-week period after pregnancy, and being overweight or obese. Woman who take hormone therapy pills or birth control pills are at increased risk for DVT. This risk of developing clots inceases as your number of risk factors increase.

+ Signs and Symptoms Pulmonary embolism symptoms can very greatly depending on how much of your long is involved, the size of the clots (almost never single) and your overall health –especially the presence or absence of underlying lung disease or heart disease. Symptoms include: Shortness of breath – this symptom typically appears suddenly and gets worse with exertion. Chest pain –you may feel like you’re having a heart attack. The pain may become worse when you breath deeply, cough, eat, bend or stoop. The pain will get worse with exertion but won’t go away when you rest Cough –the cough may produce bloody or blood-streaked sputum. Problems breathing Arrhythmia (irregular heart beat) may also be a sign that you have PE.

+ Signs and Symptoms Other signs and symptoms that occur with pulmonary embolism include: Leg pain or swelling, or both, usually in the calf Clammy or discolored skin Excessive sweating Rapid or irregular heart beat Light headedness or dizziness Some people who have PE have feelings of anxiety, light headedness or fainting, rapid breathing, or increase heart rate.

+ Diagnosis Pulmonary embolism is diagnosed based on your medical history, physical exam, and test results. Doctors who treat patients in the emergency room often are the ones to diagnose PE with the help of a radiologist. Your doctor will do a physical exam. During the exam he or she will check your legs for signs of DVT. He or she will also check your blood pressure, your heart, and your lungs. To diagnose PE, the doctor will ask about your medical history to find out: Your deep vein thrombosis and PE risk factors See how likely it is that you could have PE. Rule out other possible causes for your symptoms

+ Diagnosis Many test can help diagnose PE. Which tests you have will depend on how you feel when you get to the hospital, your risk factors, available testing options, and other conditions you could possible have. You may have one or more of the following tests. Ultrasound doctors can use ultrasound to look for blood clots in your legs. Ultrasound uses sound waves to check blood flow in your veins. Commuted tomography scans Doctors can use computed tomography (to-MOG-rah-fee) scans, or CT scans, to look for blood clots in the lungs and legs. Lung ventilation/perfusion scan Doctors can use computed tomography (to-MOG-rah-fee) scans, or CT scans, to look for blood clots in the lungs and legs. Pulmonary angiography For this test, a flexible tube called a catheter is threaded through the groin (upper thigh) or arm to the blood vessels in the lungs. Dye is injected into the blood vessels through the catheter. Blood tests

+ Treatments Pulmonary embolism (PE) is treated with medicines, procedures, and other therapies. The main goals of treating PE are to stop the blood clot from getting bigger and keep new clots from forming. Treatment may include medicines to thin the blood and slow its ability to clot. If your symptoms are life threatening, your doctor may give you medicine to quickly dissolve the clot. Rarely, your doctor may use surgery or another procedure to remove the clot.

+ Medicines Anticoagulants (or blood thinners, decrease your blood's ability to clot. They're used to stop blood clots from getting larger and prevent clots from forming. Blood thinners don't break up blood clots that have already formed. (The body dissolves most clots with time.) You can take blood thinners as either a pill, an injection, or through a needle or tube inserted into a vein (called intravenous, or IV, injection). Warfarin is given as a pill. Heparin is given as an injection or through an IV tube. Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once warfarin starts to work, heparin usually is stopped.

+ Emergency treatment When PE is life threatening, a doctor may use treatments that remove or break up the blood clot. These treatments are given in an emergency room or hospital. Thrombolytics are medicines that can quickly dissolve a blood clot. They're used to treat large clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations. Sometimes a doctor may use a catheter (a flexible tube) to reach the blood clot. The catheter is inserted into a vein in the groin (upper thigh) or arm and threaded to the clot in the lung. The doctor may use the catheter to remove the clot or deliver medicine to dissolve it. Rarely, surgery may be needed to remove the blood clot.

+ Other Treatment If you can't take medicines to thin your blood, or if the medicines don't work, your doctor may suggest a vena cava filter. This device keeps blood clots from traveling to your lungs. The filter is inserted inside a large vein called the inferior vena cava. (This vein carries blood from the body back to the heart). The filter catches clots before they travel to the lungs. This type of treatment can prevent PE, but it won't stop other blood clots from forming. Graduated compression stockings can reduce the chronic (ongoing) swelling that a blood clot in the leg may cause. Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the ankle and become looser as they go up the leg. This causes gentle compression (pressure) up the leg. The pressure keeps blood from pooling and clotting.