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Pulmonary Embolism
Pulmonary embolism is a SERIOUS disease process in which a blood clot obstructs the flow of blood through a vessel in the lung. Obstruction of blood flow inside the lung can result in irreversible destruction (infarction) of a portion of the lung.he embolus (clot) frequently is released from a vein in a lower extremity. Blood clots can also form along the (inside) walls of the heart. The clot can pass through the bloodstream (uninterrupted) until it lodges inside an artery in the lung (essentially filtered by the lung). The movement of the clot through the bloodstream is known as embolization. This problem is closely related to a condition known as deep venous thrombosis. Deep venous thrombosis (DVT) involves the unwanted formation of a blood clot, usually, in a lower extremity vein. The clot can dislodge and travel through the bloodstream in the manner described above. The majority of pulmonary emboli come from either the veins of the lower extremities, or are released from blood clots that form on the walls of the heart. A number of conditions are associated with an increased risk for pulmonary embolism.
PULMONARY EMBOLISM RISK FACTORS
1. BEDRIDDEN, WHEELCHAIR BOUND, OR ELDERLY PATIENTS
2. PATIENTS IN A RECUPERATIVE PERIOD AFTER SURGERY
3. PREGNANT FEMALES (who are at risk for DVT)
4. PATIENTS WITH PRIOR HISTORY OF DVT OR PULMONARY EMBOLISM
5. PATIENTS WITH A CARDIAC ARRHYTHMIA (atrial fibrillation)
6. PATIENTS WITH A RECENT HEART ATTACK
7. PATIENTS WITH CANCER
8. PATIENTS WITH A BLOOD CLOTTING DISORDER
Common symptoms include a SUDDEN onset of shortness of breath and chest pain which is usually "sharp" and is more severe upon breathing in (pleurisy). Patients usually have a rapid respiratory rate (more than 20 breaths a minute) and a rapid heart rate (100 beats per minute, or more). Examination of the legs may reveal a tender swollen calf (deep venous thrombosis). Evaluation will include history and physical examination. Blood tests (i.e. blood counts, coagulation profile, chemistry, cardiac enzymes) and chest x-ray will be performed. Arterial blood gases will show low oxygen. EKG can show any cardiac irregularity (arrhythmia) or the possibility of heart attack as a potential cause for chest pains. A nuclear scan of the lung, known as a ventilation-perfusion scan will diagnose most pulmonary emboli. Other helpful studies include pulmonary angiogram. Treatment often includes medications (heparin) which can dissolve the unwanted clots and keep further clots from forming. Special clot dissolving or blood thinning medications will be used. This is a serious problem that ALWAYS requires emergency treatment and hospitalization. Overall mortality is approximately 8% for treated cases of pulmonary embolism (8% of patients will die).
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