What is Pulmonary Embolism?
Pulmonary Embolism is a health condition in which one or more of the arteries that supply blood to the lungs is occluded by a blood clot. The presentation of Pulmonary Embolism can vary widely from asymptomatic to death. Hence the diagnosis of PE can be a challenge. Prompt diagnosis and treatment are essential for minimising mortality and morbidity associated with the disease because 30% of untreated patients die, while only 8% of patients succumb to therapy.
What are the causes of PE?
Most clinically significant PEs originate as DVTs in the lower extremities or abdominal veins. The DVTs break off and travel to the pulmonary arterial circulation, causing a Pulmonary Embolism.
Other rare sources of an embolus are
1. Air embolism
2. Fat embolism
3. Amniotic fluid embolism
4. Septic embolism
5. Tumor embolism
What are the risk factors for a PE?
It is more prevalent in the following scenarios:
1. Recent immobilisation
2. Myocardial infarction
3. CVA - Cerebrovascular Accident
4. Recent surgery
5. Recent trauma
Additional risk factors
1. Prior DVT
2. Advanced age
3. Any cancer
4. Any inherited Thrombophilias, i.e., insufficient anticoagulation pathways causing a hypercoagulable state
5. Usage of estrogen or hormone replacement therapy
6. Smoking
7. Pregnancy
8. Obesity
What are the symptoms of Pulmonary Embolism?
- Shortness of breath, at rest or with exertion
- Rapid breathing
- Chest pain
- Lower limb pain, calf or thigh pain
- Lower limb swelling, calf or thigh swelling
- Cough
- Unfortunately, PE can sometimes be asymptomatic or present with sudden death.
How can you diagnose Pulmonary Embolism?
PE has a variety of presentations; hence the evaluation and management of PE largely depend on the clinical setting, the likelihood of PE (determined by a few international scoring systems) and the stability of the patient.
Some of the evaluating parameters are,
1. D Dimer - It is a degradation product, a protein fragment that's made when a blood clot dissolves in your body. It reflects the activation of the coagulation system. It is a sensitive test but not highly specific as it can also be normally elevated in a post-operative patient, recent trauma, hospitalised patients and those with critical illnesses.
2. Extremity venous ultrasound (Doppler sonography) is a non-invasive and quick test to detect a DVT. And it can be done with a portable machine.
3. CT Angiography - It is a type of test where a CT Scan is performed after a dye is instilled into the veins to produce pictures of blood vessels in any part of the body. It can accurately detect the presence of a Pulmonary Embolism.
4. Other tests that can aid in the diagnosis of PE include - ECG, ECHO, ABG, Chest Xray and Cardiac troponins.
How is a Pulmonary Embolism treated?
Emergency management - Emergency management in case of a massive PE includes Oxygen supplementation, Analgesics (pain killers) and maintenance of circulation and blood pressure.
Thrombolytic therapy - Use of special medication to break down the blood clots, also called fibrinolytic therapy. It is more rapid compared to anticoagulation.
Anticoagulant therapy - They are medication given to help prevent blood clots; it is slower than thrombolysis. It is used in chronic PE to prevent the progression of the clot.
Surgery - In a massive or life-threatening PE, surgical or catheter embolectomy can be done, where the large sausage-shaped pulmonary emboli are extracted from the main pulmonary arteries surgically, using a forceps after obtaining a cardiopulmonary bypass or via a catheter inserted through a blood vessel.
Are there ways to prevent PE?
Patients with the above-mentioned risk factor need to
1. Exercise their legs frequently to prevent venous stasis
2. Patients unable to actively exercise may benefit from an intermittent pneumatic compression device (in critically ill patients).
3. Use of elastic compression stockings.
4. Anticoagulant therapy, as advised b your doctor
5. An IVC filter can be inserted into the inferior vena cava, a large blood vessel in the abdomen, to prevent the risk of PE in patients with lower limb DVT.
Conclusion
On the whole, necessary steps should be taken to prevent this massive emergency condition, thus reducing the mortality rate. People who are pre-disposed with health conditions that may lead to an embolism should be even more aware of the fact and instances of any signs of illness and approach the physician as fast as possible to prevent the worst.
