Pulmonary Embolism Treatment in Delhi, India

A pulmonary embolism is a blood clot in a blood vessel that travels to a lung artery and suddenly blocks the blood flow. It happens when a blood clot breaks loose and makes its way to the lungs through the bloodstream. This serious condition can lead to low blood oxygen levels, permanent lung damage, and harm to other organs from inadequate oxygen supply. PE is one of the most common heart and blood vessel diseases and ranks third behind heart attack and stroke.

Types of Pulmonary Embolism

Submassive Pulmonary Embolism

Involves significant clot burden without hemodynamic instability, posing a risk of right ventricular dysfunction and complications.

Massive Pulmonary Embolism

Characterised by severe hemodynamic instability due to a large clot burden, often leading to right heart strain and potentially fatal outcomes.

Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Develops from unresolved pulmonary emboli causing chronic pulmonary hypertension and right heart failure, necessitating specialised management and sometimes surgical intervention.

Pulmonary Embolism Symptoms

The size and location of the clot in the lung determine the symptoms of PE. The symptoms may include:

• Shortness of breath: Breathing difficulties (shortness of breath) occur even at rest and worsen after intense physical activity.
• Chest pain or discomfort: An individual may feel as if they are experiencing a heart attack. The chest pain or discomfort is frequently acute and felt when they breathe in deeply. This might prevent them from taking a deep breath, and they may also feel it while they cough, bend, or lean over.
• Cough: Coughing, with or without blood, can occur due to the blockage causing fluid to build up in the lungs.
• Rapid heart rate: Individuals experience rapid heart rate as the body increases the heart rate to compensate for the reduced blood flow to the lungs.

Pulmonary Embolism Causes

A pulmonary embolism is a blockage in the blood vessels in your lungs. The most common causes are:

• Deep Vein Thrombosis (DVT): This is the breaking off of a blood clot in your leg's deep veins and is the most prevalent cause of a pulmonary embolism.
• Fat Embolism: It occurs when clumps of fat cells enter the bloodstream and lodge in the pulmonary circulation. It is most commonly caused by a fracture of the pelvis or long bones, as the marrow of these bones contains a lot of fat.
• Air Embolism: An artery, particularly the pulmonary artery, may become blocked if air enters the bloodstream. Almost any kind of surgical operation can cause an air embolism, or it can occur in deep-sea divers who ascend too quickly.

Pulmonary Embolism Diagnosis

Pulmonary embolism (PE) is diagnosed using an individual's medical history, physical exam, and test results.

Medical assessment and history

A doctor diagnoses PE by examining your medical history, identifying risk factors for deep vein thrombosis (DVT), assessing the likelihood of PE, and examining other possible causes of your symptoms.

Imaging studies

Doctors use CT scans to detect blood clots in the lungs and legs. VQ scans use radioactive substances to assess oxygen and blood flow in the lungs, aiding in the detection of PE.

Blood tests

A D-dimer test detects a substance in the blood that is produced when a blood clot breaks down. High amounts of the substance may indicate the presence of a clot. PE is unlikely if your test results are normal and you have minimal risk factors.

Echocardiography

Pulmonary embolisms can affect the heart function. This test uses sound waves to provide a moving image of your heart. Doctors use it to assess heart function and detect blood clots within the heart.

Pulmonary Embolism Treatment

Treating a pulmonary embolism focuses on stopping the blood clot from becoming bigger and preventing the formation of new clots. Treatments can include:

Anticoagulation

These medications, also known as blood thinners, prevent blood clots by inhibiting the growth of existing clots and preventing the formation of new ones.

Thrombolytic

These medications, often referred to as "clot busters," are administered intravenously (IV) to dissolve the clot. Sometimes, they are more effective when administered directly, in a process known as catheter-directed thrombolysis.

Surgical Interventions

The embolectomy procedure is typically reserved for extreme cases where the patient has a very large PE, their condition is unstable, they are unable to receive anticoagulation and thrombolytic therapy because of other medical issues, or they have not responded well to those treatments. In addition, individuals who are unable to take medicine or whose blood thinners are not functioning may have a vena cava filter placed into the vena cava (a large vein that returns blood from the body to the heart).

Complications of Pulmonary Embolism

• Pulmonary Infarction: A pulmonary infarction, or the death of lung tissue, is one of the most dangerous complications of PE. It happens when the flow of oxygenated blood to the lung tissue is blocked, preventing it from receiving nutrients. A larger clot usually causes this situation.
• Pulmonary Hypertension: Treating PE is essential because, if untreated, it may result in pulmonary hypertension. That's another word for high blood pressure in the lungs' arteries.
• Recurrent Pulmonary Embolism: Someone who has been diagnosed with PE will likely be recommended to take anticoagulant medication. Certain medications, such as warfarin (Coumadin), aid in the prevention of blood clots that may develop into pulmonary embolisms in the future.
• Post-thrombotic Syndrome: One of the long-lasting consequences of DVT is post-thrombotic syndrome (PTS). Deep vein thrombosis is the underlying cause of this illness, which manifests with persistent pain, swelling, weariness, and heaviness in the affected leg.

Risk Factors for Pulmonary Embolism

Here are the risk factors for pulmonary embolism:

• Prolonged immobility: Prolonged periods of inactivity can lead to blood stasis, increasing the risk of clot formation, which may cause a pulmonary embolism.
• Surgery and trauma: Post-operative (surgery and trauma) patients or those with significant injuries are at higher risk due to immobility.
• Pregnancy and childbirth: Women are more likely to develop thrombus and pulmonary embolism following delivery due to hormonal changes, increased venous pressure, and potential vascular damage.
• Genetic factors and thrombophilia: Inherited conditions affecting blood clotting (thrombophilia) elevate the likelihood of clot formation in veins, increasing the risk of pulmonary embolism.

Prevention of Pulmonary Embolism

• Early mobilisation after surgery: Anticoagulant medications can be given to individuals at risk of blood clots before and after surgery to reduce the risk of clot formation during recovery. Doctors and nurses encourage patients to move around as soon as possible after surgery.
• Compression stockings are recommended to prevent blood clots in the legs. They add extra pressure to the legs, which makes the blood pump more through the veins and muscles.
• Lifestyle changes: Staying active keeps the blood in the legs flowing regularly and prevents the clotting that causes pulmonary embolism. Quit smoking as it harms blood cells and blood vessels and makes an individual more vulnerable to deep vein thrombosis and pulmonary embolism.

Outlook

Understanding pulmonary embolism (PE) is crucial as it can cause serious health complications if untreated. Recognising symptoms like sudden chest pain, difficulty breathing, or coughing with blood is vital for prompt medical attention. PE often stems from deep vein thrombosis (DVT) and can affect anyone, particularly those with prolonged immobility, recent surgery, or genetic predispositions. Treatment involves blood thinners to dissolve clots and prevent new ones. Preventive measures like early mobility after surgery, wearing compression stockings, and staying active can significantly reduce risks. Seeking medical advice promptly and adopting preventive measures are key to managing and potentially preventing PE.

Frequently Asked Questions

1. Can pulmonary embolism occur without any symptoms?

An individual may not have any symptoms of a pulmonary embolism, and the symptoms depend on the size of the clot and the individual's overall health. But as blood flow becomes increasingly blocked, one may experience symptoms.

2. Is pulmonary embolism a life-threatening condition?

Pulmonary embolism is a potentially fatal condition caused by one or more clots blocking blood flow to the lungs. However, prompt treatment significantly lowers the risk of death. Taking precautions to avoid the formation of blood clots in your legs can help protect you against pulmonary embolism.

3. Can pulmonary embolism recur?

Yes, pulmonary embolism can recur, especially in individuals with ongoing risk factors such as inherited clotting disorders, prolonged immobility, or certain medical conditions. Treatment and prevention strategies are crucial.

4. How does age affect the risk of developing pulmonary embolism?

Age is a significant risk factor for pulmonary embolism (PE), with older adults at higher risk due to factors like decreased mobility, comorbidities and vascular changes increasing clotting tendencies.

5. Can pulmonary embolism lead to heart problems?

When the arteries in the lungs get blocked, the heart has to work harder to pump blood through those vessels. This increases blood pressure and eventually weakens the heart.

6. What should I do if I suspect I have pulmonary embolism?

Pulmonary embolism is difficult to detect. Therefore, you should see your doctor immediately if you have any symptoms. They will do a physical exam and inquire about your personal history, including potential risk factors.

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