Pulmonary Embolism: Diagnosis and Treatments

A pulmonary embolism is a condition of the heart and blood vessels that involves one or more blood clots blocking blood flow to the lungs. This condition is common — it is the third most common heart condition in the world, after heart attacks and strokes. 

However, just because pulmonary embolism is common does not mean that it cannot be life-threatening. While many pulmonary embolisms are manageable and treatable, they can still be life-threatening if the condition is not quickly diagnosed.

Today, Carda is here to talk about pulmonary embolisms, including symptoms, methods for diagnosis, and treatment options. Read on to learn more about supporting lung function and pulmonary recovery with Carda.

What Is a Pulmonary Embolism?

A pulmonary embolism, or PE, occurs when a small mass of material (called an embolus) gets trapped in a pulmonary artery, blocking blood flow to and from the lungs. Most often, the abnormality that gets stuck is a blood clot; however, sometimes, the material can be a small part of a tumor, fat from inside a broken bone, or an air bubble.

The blood clot obstruction typically originates from a large vein in the patient's leg. In this case, the blood clot is called a deep vein thrombosis, or DVT. However, in rare cases, the clot can originate in another part of the body. 

Often, an acute pulmonary embolism diagnosis involves many clots rather than a singular blood clot. When the blood clots travel to the pulmonary arteries and stay there, it can restrict blood flow to the lungs and decrease oxygen levels. As a result, the patient's blood pressure in their pulmonary arteries usually rises. 

Pulmonary embolism can cause a pulmonary infarction, which is when a part of lung tissue dies because it no longer has access to oxygen. Pulmonary infarction also makes it harder for the rest of the body to receive oxygen from the lungs. 

What Are the Symptoms of a Pulmonary Embolism?

Restricted blood flow to the lungs can cause a variety of symptoms, including irregular heartbeat, lightheadedness, fever, excessive sweating, and leg swelling.

The severity of symptoms can range from low to high and depends on how big the embolisms are and how much area of lung tissue they affect. Additionally, if a patient has underlying medical conditions, such as a preexisting heart or lung disease, these are both risk factors that can make the pulmonary embolism much more severe. 

Let's take a closer look at each symptom of pulmonary embolism below. 

Irregular Heartbeat

A pulmonary embolism can affect blood flow circulation throughout the body and reduce oxygen transport, which may lead to pulmonary hypertension and cause heart palpitations and even heart failure. 

Lightheadedness

The restricted blood flow to the lungs can diminish lung function and result in restricted oxygen exchange happening inside each lung. 

The adverse impact on oxygen transport to the rest of the body can cause a sudden drop in heart rate or blood pressure, which can cause lightheadedness and syncope (fainting). 

Fever or Excessive Sweating

When a patient experiences breathlessness and a sudden drop in heart rate or blood pressure, their body might display signs of stress like breaking out in a fever or excessive sweating.

Leg Swelling

A pulmonary embolism can also cause leg swelling or pain, particularly in the lower anterior area of the leg (the same area where pulmonary embolism blood clots typically originate). 

How Is a Pulmonary Embolism Diagnosed?

Diagnosis of pulmonary embolism needs to be prompt because the disease can be life-threatening without rapid treatment. However, physical exams are often not enough.

Healthcare providers typically utilize blood tests or imaging tests to determine a pulmonary embolism diagnosis. Let’s take a closer look at these two diagnosing methods below. 

Blood Tests

A blood sample D-dimer test, which is a clot-dissolving substance, can help rule out a pulmonary embolism diagnosis. If a patient has high D-dimer levels, they could be more likely to have venous thromboembolism (blood clots). 

Additionally, blood tests can tell a provider how much oxygen and carbon dioxide reside in a patient’s blood, in which case a drop in blood oxygen levels could indicate a pulmonary embolism. 

Imaging Tests

In addition to blood tests, the following imaging tests can be helpful in identifying a pulmonary embolism: 

  • A computed tomography (CT) lung scan or pulmonary angiography (CTPA). Pulmonary angiograms are typically invasive intravenous X-rays.
  • A ventilation/perfusion scan (V/Q scan), which is typically used when a CT scan does not properly contrast. 
  • Duplex ultrasonography, typically focused on the leg, to look for blood clots at their source.

On top of these diagnostic tests, an electrocardiogram can also be helpful for identifying heartbeat irregularities that might signal a pulmonary embolism.

Radiology might also want to order a chest X-ray because, although this imaging cannot detect an embolism, it may rule out other conditions with similar symptoms (such as a pneumothorax). 

What Are the Treatment Options for a Pulmonary Embolism?

Fortunately, a pulmonary embolism is a treatable condition. Treatment usually involves prevention: preventing the blood clot from growing as well as preventing any new blood clots from developing. 

Treatment options include surgical procedures, medication, and physical activity. Usually, treatment starts out in a hospital facility. The condition requires close monitoring to ensure that it does not progress beyond manageable levels.

Let’s take a look at each of the treatment options for a pulmonary embolism. 

Surgical Procedures

A surgical procedure to remove the clot or to filter the vein is one treatment option for pulmonary embolism. Both procedures use a catheter, either to thread through the patient’s blood vessels for clot removal or to filter through the inferior vena cava, a vein that extends from the legs to the heart. 

In filtering the inferior vena cava, the provider can help prevent blood clots from making it to the lungs. 

Medication

A more popular approach to pulmonary embolism treatment is medication, usually in the form of an anti-coagulation medication (also called a blood thinner). 

Anticoagulants make it less likely for blood to clot, which is a prophylactic treatment because it can prevent future blood clots from forming and traveling to the lungs. 

Some common anticoagulant medications include Heparin, taken through injection, and warfarin, taken orally. Unfortunately, these anticoagulants (and even some of the newer oral anticoagulants) can have side effects, so it’s important to monitor your patients as they take these medications. 

Physical Activity

Regular physical activity and bed rest are important treatment steps when addressing a pulmonary embolism. Once a patient develops a pulmonary embolism, their risk for future embolisms increases, so staying mobile to help prevent future clots is important. 

Patients should frequently follow up with their healthcare provider, especially if they are at high risk due to factors like obesity. 

Patients should try to move their extremities for several minutes every hour. Additionally, if patients are unable to get up and walk around, then they can wear compression socks to help increase blood flow. 

Pulmonary Rehab

Pulmonary rehabilitation is another treatment option that involves a combination of education, exercise, nutrition, and stress management to aid in recovery from a pulmonary event.

The goal of pulmonary rehabilitation is to help patients return to their normal activities and improve their overall health and well-being while at the same time reducing the risk of future events. 

Carda offers at-home pulmonary rehabilitation programs to make it easy to start heart care from the comfort of one’s own house. With a referral from a physician, it is easy for patients to sign up and start their journey toward improved cardiovascular wellness. 

The Bottom Line

A pulmonary embolism is a medical condition that occurs when blood clot(s) form in the leg and travel to the pulmonary arteries. There, they can cause blockages that restrict blood flow and therefore diminish oxygen transport and circulation. 

A depletion in blood oxygen levels can cause a variety of symptoms, including chest pain, shortness of breath, irregular heartbeats, lightheadedness, fever, excessive sweating, or leg swelling. 

A pulmonary embolism is a fairly common diagnosis but can still be life-threatening if not detected right away. Treatment usually involves medication or sometimes surgical procedures. The recovery process involves regular physical activity, as well as consistent follow-ups with the patient’s healthcare provider. 

Pulmonary rehabilitation is another treatment option that can help patients to self-educate and empower themselves on their condition. Get started with at-home pulmonary rehabilitation and care to help set your patients up for success. 


Sources:

Pulmonary embolism is common and can be deadly, but few know the signs | American Heart Association

Deep vein thrombosis (DVT) - Symptoms and causes | Mayo Clinic

D-Dimer Test | MedlinePlus

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