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Pulmonary Conditions & Diseases: Pulmonary Embolism

A pulmonary embolism, or ‘PE, is a blood clot that is located in the lungs. As a result of the clot, blood flow and the oxygen it carries cannot reach the lung tissue. Without oxygen, the lung tissue can eventually die, leading to permanent damage. Pulmonary emboli can present in a variety of ways, including asymptomatic events to serious life-threatening scenarios.

These blood clots often originate in the deep veins of the legs and travel upwards, towards the heart. Once they travel through the heart, they get lodged into the smaller, delicate vessels within the lungs. This obstruction forces the heart to work harder, which can eventually lead to heart failure.

What are the signs and symptoms?

  • Shortness of breath
  • Chest pain or tightness
  • Rapid breathing
  • Rapid heart beat
  • Leg swelling (usually one leg more than the other – this is more of an indication of the blood clots in the legs, that are frequently present in patients who have similar clots in the lungs)

What are the risk factors and triggers?

The following conditions can increase the risk of developing a pulmonary embolism:

  • Smoking
  • Active or recent illness or surgery
  • Immobility
  • Cancer
  • Some bleeding/clotting disorders
  • Pregnancy
  • Use of hormones

How is it diagnosed?

  • Medical history
  • Physical Exam
  • Diagnostic Test
    • CT scan of the vessels in the lungs
    • Ventilation-Perfusion scan (‘VQ’ scan – a nuclear medicine alternative for those that cannot receive IV contrast)
    • Chest X-ray
    • Ultrasound of the heart (echocardiogram)
    • Ultrasound of the legs

What is the treatment?

Treatment for an acute pulmonary embolism depends on the severity of the clot and its’ strain on the heart. Therapy usually includes a blood thinner, if there are no contraindications. Additional therapies may be required if there is significant strain on the heart, including intravascular interventions to remove or break up the clot. In patients that cannot tolerate blood thinners, a small filter may be placed in the large vein that enters the heart. This way, blood clots that travel from the legs cannot enter the heart and, subsequently, the lungs. The diagnosis of a pulmonary embolism, or PE, requires close follow up with a pulmonologist, or lung specialist.

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