Pulmonary Embolism

What is pulmonary embolism?

Pulmonary (PUL-mo-ner-ee) embolism (EM-boh-lizm) is the sudden blockage of an artery (blood vessel) in the lungs by an embolus. An embolus is usually a blood clot, but may also be fat, air, or tumor cells that are in the blood stream. With a pulmonary embolism, a blood clot may break loose from the blood vessels of the legs. The clot goes to the lungs where it plugs or blocks a blood vessel. The embolism can cut off the blood supply to that part of the lungs. Pulmonary embolism is a serious condition. Chances of survival are better with early diagnosis and treatment.

What causes pulmonary embolism?

The most common cause of a pulmonary embolism is a blood clot. The blood clot breaks loose from the deep veins in the legs or pelvis. Fatty clots from a bone break or an amniotic fluid embolus during childbirth are other causes. The following conditions may increase your chances of having pulmonary embolism:

• Being overweight.
  
  
• Certain inherited blood diseases, such as thrombophilia and hyperhomocysteinemia.
  
  
• Medical conditions, including having a pulmonary embolism in the past, deep venous thrombosis (DVT), cancer, and heart problems.
  
  
• Pregnancy and childbirth.
  
  
• Recent surgery, especially joint replacement, major abdominal (stomach), and OB/GYN procedures.
  
  
• Sitting or lying in one position for a long time. Examples are traveling by plane or when you have to stay in bed for a long time.
  
  
• Smoking.
  
  
• Taking birth control pills.

What are the signs and symptoms of pulmonary embolism?

The most common signs and symptoms include:

• Fast heartbeats.
  
  
• Sudden shortness of breath.
  
  
• Sudden chest pain that becomes worse with deep breathing.
  
  
• Trouble breathing or fast breathing.

• Bluish nails.
  
  
• Cold or pale skin and sweating a lot.
  
  
• Coughing up blood.
  
  
• Fainting.
  
  
• Fever.

How is pulmonary embolism diagnosed?

You may need the following tests:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Computed tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your lungs. Your caregivers look at the pictures of your lungs. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps the clot show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• Pulmonary angiogram: A pulmonary angiogram is done to check for problems with blood flow in your heart and lungs. A catheter (long, thin, bendable tube) is placed in a vein in your neck, under your collarbone, or in your groin. The groin is the area where your abdomen meets your upper leg. The catheter is then pushed into the pulmonary artery. Dye is put into the catheter. Chest x-rays are taken after the dye goes to your heart and lungs. The dye helps the blood vessels show up better on these x-ray pictures. Tell your caregiver if you are allergic to shellfish, as you may also be allergic to the dye used for this test.
  
  
• Doppler ultrasound: This is a test that uses sound waves to see your veins on a TV-like screen. A doppler ultrasound study may also be called a duplex scan. Caregivers look for clots in the veins near the area of your pain and redness. You also may be able to hear your blood flow during this test.
  
  
• V/Q Scan: This is a ventilation (V) and perfusion (Q) test. This test is also called a VP scan. A V/Q scan is a two-part test which takes pictures of your lungs to look for certain lung problems.
  
  
  • During the perfusion part of the test, radioactive dye is put into your vein (blood vessel). The blood carries the dye to the blood vessels in your lungs. Pictures are taken to see how blood flows in your lungs.
    
    
  • During the ventilation part of the test, you breathe in special gas. Pictures are taken to see how well your lungs take in oxygen.

How is pulmonary embolism treated?

You may have any of the following:

• Medicines:
  
  
  • Clot busters: This medicine helps break apart clots. It is given IV and may be given at the same time as other blood thinners. This medicine could save your life because blood clots in the heart, lungs or brain can kill you. Be careful because you may bleed or bruise easily.
    
    
  • Blood thinners: This medicine helps stop clots from forming in your blood.
    
    
  • Warfarin: Warfarin is a type of medicine that helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Using warfarin may cause you to bleed or bruise more easily. If you are taking warfarin:
    
    
    • Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. Doing this can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
      
      
    • Many medicines cannot be used when taking warfarin. Talk to your caregiver about all of the other medicines that you use. Tell your dentist and other caregivers that you take warfarin. Wear a bracelet or necklace that says you are taking this medicine.
      
      
    • You will need to have regular blood tests while taking warfarin. Your caregiver uses these tests to decide how much medicine is right for you to take. Take warfarin exactly how your caregiver tells you to. Tell your caregiver right away if you forget to take the medicine, or if you take too much.
      
      
    • Talk to your caregiver about your diet. Warfarin works best when you eat about the same amount of Vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods.
  
  
• Surgery: Surgery may be done in people who have bleeding problems and who have problems with medication. Examples are a catheter thrombolysis, embolectomy, or putting filters in large blood vessels of the body to catch clots.

How can I decrease my chances of getting blood clots?

• Lose weight if you are overweight. Talk to your caregiver about a weight loss plan if you are having trouble losing weight.
  
  
• Start an exercise program. Talk with your caregiver about the best exercise program for you and when you can start.
  
  
• Do not smoke. Talk to your caregiver about ways to stop smoking if you are having trouble quitting.

Where can I find support and more information?

Having a pulmonary embolism may cause you or those close to you to feel frightened and anxious. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information:

• American Lung Association
  1301 Pennsylvania Ave. NW
  Washington , DC 20004
  Phone: 1- 202 - 785-3355
  Phone: 1- 800 - 548-8252
  Web Address: www.lung.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

When should I call my caregiver?

Call your caregiver if:

• The skin on any part of your legs or hips turns purple in color.
  
  
• You have more questions or concerns regarding your condition, medicines, or care.

When should I seek immediate care?

Get help immediately or call 911 if:

• You lose consciousness (faint).
  
  
• You feel that your heart is beating very fast.
  
  
• You have convulsions (seizures) or migraines (very bad headaches).
  
  
• You have slurred speech, increased sleepiness, or problems seeing, talking, thinking, or remembering.
  
  
• You have weakness or cannot move your arm or leg on one side of your body.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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