Symptoms, Diagnosis & Treatment of Pulmonary Embolism

What are the symptoms of pulmonary embolism?

Symptoms of pulmonary embolism vary widely from no symptoms at all – as many as one-third of cases may be asymptomatic – to sudden death (Thompson, 2016c; Tidy & Hartree, 2014). Some common symptoms of pulmonary embolism include breathlessness, rapid breathing, sharp chest pain associated with deep breathing, coughing up blood, fever, elevated heart and breathing rate, low blood pressure, and leg pain (Chen, 2015; Thompson, 2016b; Tidy & Hartree, 2014).

Symptoms of a massive pulmonary embolism include those listed but also dizziness/collapse, cardiac arrest, and death (Tidy & Hartree, 2014). Massive pulmonary embolism is also more likely to have delayed symptoms (Thompson, 2016c).

While some patients experience some symptoms and not others, almost all patients experience labored or rapid breathing (Thompson, 2016c).  If you or a loved one are experiencing any of the symptoms listed above, inside or outside the hospital, it is important you undergo immediate assessment by a health care provider.

When pulmonary embolism is associated with hypotension, a patient is considered to have a very dangerous form of pulmonary embolism known as hemodynamically unstable pulmonary embolism (Thompson, 2016a). Hemodynamically unstable pulmonary embolism is often caused by massive pulmonary embolism and is more likely to result in death within the first two hours after formation. The threshold for treatment is low. In hemodynamically stable pulmonary embolism– marked by the absence of hypotension – the threat of harm to the patient is lower, and doctors have time to perform a more definitive assessment of the patient.

Women who are pregnant are at increased risk for developing pulmonary embolism during their pregnancy and continuing through six weeks after giving birth.  If you or your loved one is pregnant and you believe suffering symptoms of pulmonary embolism, a detailed medical examination must be performed as soon as possible. (Tidy & Hartree, 2014).

How is pulmonary embolism diagnosed?

Pulmonary embolism is diagnosed in a variety of ways. Abnormal results in laboratory tests, such as arterial blood gases and brain natriuretic peptide (BNP), can help rate the level of suspicion for pulmonary embolism (Thompson, 2016c). More definitive tests include D-dimer, spiral computed tomography (CT), ventilation/perfusion lung scanning (V/Q scan), and pulmonary angiography (Thompson, 2016b):

  • D-dimer tests examine the amount of a substance in the blood called D-dimer. 95 percent of patients with pulmonary embolism have abnormal levels of D-Dimer. Patients with normal D-dimer levels are unlikely to have pulmonary embolism.
  • Spiral CT is the preferred test when the medical center has experience performing it and when suitable for the patient. Spiral CT may be unsuitable for patients who have poor kidney function or allergies to contrast dye. In a spiral CT, an intravenous dye is injected into the patient, which then highlights veins when viewed through an x-ray.
  • V/Q scanning is performed by inhaling and injecting a small amount of a radioactive substance. This test shows the distribution of the substance in the lungs and shows if and where blood flow is blocked.
  • Pulmonary angiography is a highly accurate test for diagnosing pulmonary embolism; however, it is also the most invasive of the tests listed here. A catheter is inserted into a vein in the groin area, and into the lung. Dye is injected which highlights the blood vessels in the lung when viewed through an x-ray.

How is pulmonary embolism treated?

The medical treatment and management of a patient with pulmonary embolism is complex.  Treatment is often dependent on the severity of the pulmonary embolism’s effect on the heart’s ability to pump oxygenated blood throughout the body.

  • Stabilize and monitor

Because pulmonary embolism impairs the lungs ability to filter carbon dioxide from blood and sustain proper oxygenation throughout the body, the lungs and heart can become overexerted and stop working.  It is absolutely critical that doctors and hospitals monitor patients with suspected pulmonary embolism for signs and symptoms of cardiovascular instability or shock.  Also, patients should be treated with IV fluids or drugs designed to increase blood pressure.

Treatment of pulmonary embolism may include anticoagulation used to thin the blood and prevent further clotting, medicine known as thrombolytics which are designed to break up an existing blood clot or clots lodged in the lungs, or surgery to remove a clot.

The most common treatment is anticoagulation medicine, which helps prevent clots from forming or getting larger (Thompson, 2016b). Some cases that involve serious complications require the clot(s) to be dissolved using a medicine administered into the vein – a process called thrombolytic therapy.

If thrombolytic therapy is unsuccessful or infeasible and the patient is in a serious condition, an embolectomy may be performed. In an embolectomy, the pulmonary embolus is removed from the lung using either catheters or through a surgical procedure.

Before determining the type of anticoagulation to administer, or whether to administer anticoagulation at all, doctors and hospitals must do a thorough assessment of the patient’s bleeding risk.  Some patient who are at high risk for suffering internal bleeding should not receive anticoagulation.  Patients who cannot use anticoagulants or have recurrent pulmonary embolism may receive an inferior vena cava (IVC) filter. The IVC filter is placed into a large vein which carries blood directly into the atrium of the heart, the inferior vena cava, by way of a catheter inserted through the groin. The filter blocks the circulation of clots throughout the bloodstream and prevents additional clots from reaching the lung.

What is the prognosis and the long-term treatment for patients with Pulmonary Embolism?

If pulmonary embolism is treated quickly, the chances for full recovery are high.  Still, for patients who suffer a pulmonary embolism and survive, the risk of recurrence is elevated for the next six weeks.  Doctors must make sure these patients remain treated with anticoagulants for 3 to 12 months following the initial pulmonary embolism.  (Thompson, 2016b; Tidy & Hartree, 2014). For people with multiple episodes of blood clots or a permanent clotting risk factor, indefinite anticoagulation treatment is recommended (Thompson, 2016b). Around 33 percent of patients experience a recurrence of pulmonary embolism within 10 years; however, that risk is reduced with the use of anticoagulants (CDC, 2015; Thompson, 2016b).

Learn More About This Topic: Prevention of Pulmonary Embolism

All articles in this blog are the collaborative effort of attorneys Jerry Meyers, Brendan Lupetin, and Gregory Unatin.

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