Pulmonary embolism (pūkahukahu poketoto) is a blockage in one of the blood vessels in your lungs. It most commonly happens when a blood clot that has formed in the leg travels to the lungs where it gets lodged in a blood vessel.
Pulmonary embolism can be life-threatening because the clots block blood flow to the lungs. However, quick treatment greatly reduces the risk of death.
Taking steps to prevent blood clots in your legs is key to helping protect against pulmonary embolism.
What causes pulmonary embolism?
Most often pulmonary embolism is caused by blood clots that travel to the lungs from the deep veins of the legs. Rarely, the clot can come from another part of the body.
Blood clots that form in the deep veins of the body are known as deep vein thrombosis (DVT). They often develop after long periods of inactivity, such as when you are immobilised after surgery or illness.
Sometimes blockages in the blood vessels are caused by substances other than blood clots, such as:
- fat from the marrow of a broken long bone (example, from a fracture)
- air bubbles (example, from injections or surgical procedures, scuba diving or injury to the lung)
- part of a tumour.
What is my risk of pulmonary embolism?
Many factors that increase your risk of developing DVT, also increase your risk of pulmonary embolism. The more risk factor you have, the greater your risk. Identify your risk factors with a self-assessment quiz.
|Being inactive for long periods of time||
|Surgery and injury (trauma)||
|Increased hormones (oestrogen and progestin)||
See also: Who is at risk of DVT
What are the symptoms of pulmonary embolism?
The symptoms of pulmonary embolism can be different for different people, depending on the size of the clots, how much of your lung is involved and whether you have underlying lung or heart disease.
Pulmonary embolism can be life-threatening
Seek immediate medical attention if you experience any of the symptoms below:
|Shortness of breath||This symptom typically appears suddenly and always gets worse with exertion.|
|Chest pain||You may feel like you're having a heart attack. The pain may become worse when you breathe deeply, cough, eat, bend or stoop. The pain will get worse with activity or exertion but won't go away when you rest.|
|Cough||The cough may produce bloody or blood-streaked phlegm or spit.|
Other signs and symptoms that can occur with PE:
- Swelling or leg pain of one or both legs, usually in the calf.
- Cold, damp skin that turns bluish grey.
- Excessive sweating.
- Fast or irregular heartbeat.
- Lightheadedness or dizziness.
How is pulmonary embolism diagnosed?
Pulmonary embolism can be difficult to diagnose, especially in people who already have heart or lung disease. For that reason, your doctor will ask you about your symptoms and is likely order one or more of the following tests:
Your doctor may order a blood test for the clot-dissolving substance D dimer. High levels may suggest an increased chance of blood clots. Blood tests also can measure the amount of oxygen and carbon dioxide in your blood. A clot in a blood vessel in your lungs may lower the level of oxygen in your blood.
This shows images of your heart and lungs on film. Although X-rays can't diagnose PE and may even appear normal when pulmonary embolism exists, they can rule out conditions that seem just like pulmonary embolism.
Your doctor may also perform other tests such as CT scan, electrocardiogram (ECG), ultrasound and MRI to rule out any other causes of your symptoms.
How is pulmonary embolism treated?
The main aim of treatment is to prevent the clot from getting any bigger and prevent new clots from forming. Because pulmonary embolism is life threatening, immediate treatment is vital. Treatment options include:
Anticoagulants (or 'blood thinners')
Anticoagulant medications "thin" the blood, by decreasing its ability to clot. They prevent new clots from forming and existing clots from growing larger. Common examples of anticoagulant medications are:
You may require regular blood tests to check how well the anticoagulants are working and if dosage changes for warfarin are required. Anticoagulant treatment usually continued for at least 3 months to be fully effective in treating a pulmonary embolism. In some cases, it may be required on a long-term basis.
Clot dissolvers (thrombolytics)
While clots usually dissolve on their own, there are medications given through the vein that can dissolve clots quickly such as alteplase. Because these clot-busting drugs can cause sudden and severe bleeding, they usually are reserved for life-threatening situations.
Filters are placed in a large vein to stop any more blood clots from reaching the lung. This procedure does not need an anaesthetic and can be done at the bedside. Filters are useful if anticoagulant treatment on its own is not enough, or for patients who cannot have anticoagulant treatment for some reason.
Removal of the clot in the lung, by surgery is only considered, as a last resort for very ill patients, because the operation carries a significant risk of death. It would only be considered as an option if you had a massive pulmonary embolism which, in itself, gave a high risk of death if it were not treated. This is a major operation because it involves surgery inside the chest, close to the heart. It requires a specialist hospital and surgical team.
What is the outlook (prognosis) for a pulmonary embolism?
A pulmonary embolism is a serious condition and can have a high risk of death but this is greatly reduced by early treatment in hospital.
- If a pulmonary embolism is treated promptly, the outlook is good, and most people can make a full recovery.
- The outlook is less good if there is an existing serious illness which helped to cause the embolism such as in advanced cancer.
- A massive pulmonary embolism is more difficult to treat and is life-threatening.
- The most risky time for complications or death is in the first few hours after the blockage occurs.
- There is a high risk of another pulmonary embolism occurring within 6 weeks of the first one. This is why treatment is needed immediately and is continued for about 3 months.
- Acute pulmonary embolism ESC Clinical Practice Guidelines, 2014
|Andy McLachlan is a cardiology nurse practitioner with clinical experience in long-term condition support and management, acute cardiology and adult cardiac intensive care nursing. He leads a team of nurses at Middlemore Hospital managing a range of cardiac nursing interventions and runs clinics to help support people back to health following cardiac events, interventions or surgery.|