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Pulmonary Embolism

When blood clots form in the vein, it is dangerous, as they can travel through the bloodstream and create blockages near the heart and brain.  When a blood clot form and blocks any of the arteries and veins feeding the lungs, it is called a pulmonary embolism.

Symptoms of pulmonary embolism

Common symptoms include:

  • Shortness of breath
  • rapid breathing and/or rapid heartbeat
  • chest pain, which might extend into your shoulder, arm, neck, and jaw
  • anxiety and restlessness
  • coughing or spitting up blood;
  • lightheadedness or fainting

Risk Factors

The clots that form pulmonary embolisms are usually clots that form deep in the leg veins. This condition is called deep vein thrombosis (DVT). DVT usually occurs in your leg or pelvic veins but it can also occur in your arm veins.

Factors that increase the risk of DVT or pulmonary embolism include:

  • Family history of clotting disorders, DVT or pulmonary embolisms
  • Major surgery
  • Standing or sitting still for long periods of time, such as on a long plane trip or car ride
  • Cancer
  • Obesity
  • Smoking
  • Having a history of a heart attack or stroke
  • Pregnancy, taking birth control pills, or hormone replacement therapy

What to Expect at Your Medical Exam

Your vascular surgeon will try to determine if you are at risk for a pulmonary embolism as well as the best method of treatment.

  1. Your vascular surgeon will ask you questions about your:
    1.  general health
    2. medical history
    3.  symptoms
  2. Your vascular surgeon will conduct a physical examination. You will be asked about family and medical history.  Your vascular surgeon will ask you to describe your symptoms; how often they occur, how often and their location.
  3. Your vascular surgeon will listen for sounds of blood flow in your arteries. Your blood pressure will be taken.
  4. After the history and exam, if your vascular surgeon suspects you are at risk, he or she may order several diagnostic tests.

Diagnostic Tools

Your vascular surgeon will probably order some of the following tests:

  • Chest x-ray
  • Electrocardiography (ECG) which measures your heart’s electrical activity;
  • D-dimer enzyme-linked immunosorbent assay, a blood test that shows an increase of a type of protein that may rise after a pulmonary embolism
  • Lung scanning, which measures blood flow in your lungs and your air intake
  • Spiral computed tomography (CT) scan
  • Pulmonary angiography, which shows x ray pictures of the blood vessels in your lungs
  • Duplex ultrasound, which allows your physician to measure the speed of blood flow and to see the structure of your leg veins
  • Venography.  In this test, an x-ray is taken of the legs after contrast dye has been injected.  By watching the flow of this dye through the veins, doctors can diagnose if you are at risk for a pulmonary embolism.

Treatment for pulmonary embolism

The treatment for pulmonary embolisms is a combination of medial and sometimes surgical therapies.  Your vascular surgeon may recommend the following types of treatment:

  • Anticoagulant drug, also called blood thinners are used to treat blood clotting conditions because they prevent clots from forming
  • Thrombolysis is a treatment that can dissolve your clot. Your vascular surgeon injects clot-dissolving drugs through a catheter directly into the clot
  • Inferior Vena Cava filter placement, to trap further clots from the legs may be required if blood thinners are not tolerated
  • Suction thrombectomy, a catheter technique is used to break up the clot.  Your vascular surgeon inserts a catheter into the blocked artery and forces it to dissolve by injecting salt solution into the vein
  • Pulmonary embolectomy is recommended when the clot is very large or immediately life threatening

Your vascular surgeon will advise you regarding the best treatment option for your particular situation.

Continuing Treatment

Your vascular surgeon may recommend you continue using anticoagulant drugs.  In some cases, he or she may recommend using a special metal filter in your vein to prevent new clots from forming.