Monday, February 11, 2013

Symptoms And Treatment Of Pulmonary Embolism

Many people who experience chest pain and shortness of breath assume they may be having a heart attack. Although that may be the case, there are other causes, just as deadly, that can cause the same symptoms. As most people know, heart attack, or an acute myocardial infarction, is caused by a thrombus, usually a piece of an atherosclerotic clot, becoming lodged in one of the coronary arteries and stopping the flow of oxygen rich blood. Pulmonary embolism is very similar to a heart attack, but takes place in the arteries of the lungs.

These embolisms, generally from blood clots in the legs, can cause a wide variety of symptoms. Below you will find an in-depth description of the signs and symptoms of pulmonary embolism, along with risk factors for these blood clot embolisms.

Risk Factors For Pulmonary Embolism

As with most medical conditions, there are certain factors that can place people at higher risk of experiencing Pulmonary Emboli. The foremost cause of blood clots in the lungs is the existence of Deep Vein Thrombosis. A high percentage (10-15%) of all patients with DVT will experience a clot traveling to a lung. This is due to a thrombus, or small clot, breaking loose from the DVT and traveling through the heart and out to the lungs.

Other risk factors include use of contraceptive pills by smokers, cancer, and genetic or acquired thrombophilias (or blood clotting disorders). Lastly, recent surgery is a risk factor, especially surgeries involving long bones. In some cases bone fragments or fatty cells can enter the bloodstream and travel to the lungs. In these cases, fast emergency action is needed due to the inability of conventional means to dissolve these emboli.

Although Atrial Fibrilation, a condition in which the top chambers of the heart do not contract properly, is often considered a high risk for clots resulting in stroke or CVA, its is not generally considered a high risk factor for lung clots (or Pulmonary Embolism.)
Signs And Symptoms Of Pulmonary Embolism
 
The initial sign or symptom of pulmonary embolism is trouble breathing. This can range from having trouble moving air, to just feeling like you cannot catch your breath. Trouble breathing then leads to fast breathing or Tachypnea.

Along with the breathing difficulty, patients will also experience chest pain. This pain can come in the form of a sharp chest wall pain or a diffuse pain across the chest, but it usually worsens while breathing. Depending on how large the clot is, pulmonic blood pressure can affect the right ventricle of the heart, causing more chest pain and possibly distention of the jugular veins.

Overall, a person experiencing PE may also experience weakness, tireness, diaphoresis (extreme sweating), paleness, or even cyanosis (a blue tint to the skin denoting a lack of oxygen).

Treatment For A Blood Clot To The Lungs

The treatment of Pulmonary Embolism should be broken down in to two areas, prehospital care and emergency room or hospital care. Emergency prehospital care should be initiated in any case of Pulmonary Embolism by calling 911. The care given by prehospital providers will be tiered dependant on the vital signs of the patient. This care will often include moderate to high flow oxygen, and could possibly include CPAP if the patient is experiencing flash pulmonary edema due to pulmonic hypertension.

Due to the chest pain, the patient may be given Aspirin if Heart Attack is of concern, but as most patients with lung clots have specific history pointing to the cause, most of the treatment will focus on Oxygenation in the prehospital setting.

In the emergency room, the focus of treatment, along with Oxygenation, will be removal of the clot. The initial treatment for most clots in the lung is through anticoagulants, most often a drug called Heparin. This drug will begin to break down most clots by breaking them up into smaller pieces and is often followed by drugs like Warfarin (Coumadin).

If the clot has caused a cardiac issue due to causing a back up of blood in the pulmonary arteries and the right side of the heart, the patient my be given a thrombolytic. These drugs, often used in the case of stroke, are used to totally dissolve the clot, but as they can cause a risk of aneurysm or bleeding elsewhere, they are generally not used unless medically necessary.

As a last resort, often if the embolism is not a clot that can be dissolved (made up of fatty cells or bone fragment) or is so large that death is probable, the clot may be surgically removed. As this is a dangerous procedure, it is seldom used.

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