Pulmonary embolism

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What is it about ?

A pulmonary embolism is a blood clot that gets stuck in a blood vessel in the lungs. This clot (thrombus) prevents blood flow to the alveoli in the lungs, where the blood takes charge of oxygen.

In most people, the clot has formed in another part of the body, often in a deep vein in the thigh or calf (deep vein thrombosis (DVT) of the thigh or calf). We then speak of venous thromboembolism (TEV). Under the pressure of the blood flow, the clot, or part of it, can break off and travel to the heart via the bloodstream. From there, it can block a pulmonary artery and, in the worst case, cause part of the lung to atrophy. The risk of death increases as the resulting pressure on the heart increases.

Pulmonary embolism is rare in a person who has no risk factors.

The most important risk factors are

  • history of thrombosis or pulmonary embolism,
  • obesity,
  • severe infection,
  • heart failure,
  • use of birth control pills or hormones during menopause,
  • pregnancy,
  • prolonged immobility (bed rest, plaster cast, long plane flight, etc.),
  • recent surgery,
  • Cancer,
  • hereditary bleeding disorders.

What is its frequency?

Each year, there is 0.5 to 1 case of pulmonary embolism per 10,000 people. If you have had a pulmonary embolism in the past, your risk of relapse is 30% within 5 years. If the pulmonary embolism was due to immobilization (for example after surgery or a cast), the risk of relapse is 3%.

How to recognize it?

Complaints of pulmonary embolism depend on the size of the clot and where it is located. The complaints are usually shortness of breath (dyspnea), chest pain, cough, coughing up blood, dizziness. In severe cases, other symptoms may occur: very rapid breathing, a fast beating heart, fainting, or bluish discoloration of the lips and fingers.

In case of deep vein thrombosis in the calf or thigh, the leg turns red, it is painful and swollen. There is a build-up of fluid (edema). When you press your finger on the swollen area, the finger mark remains visible. Sometimes the superficial veins in the leg are dilated.

How is the diagnosis made?

Based on your history (cancer or history of embolism) and the presence of certain symptoms (swollen leg, heart rate greater than 100 beats per minute), the doctor will estimate your risk of pulmonary embolism.

Most often, an embolism originates from the leg. This is why sometimes an ultrasound of the leg is done in the first place to see if there is a clot. If this is the case, you are usually then prescribed a CT scan of the chest.

If there is no clot in the leg, further examinations are necessary (CT scan or scintigraphy).

If there is a low to moderate risk, the doctor will order certain blood tests. If the results are good, no further examination is necessary and you can have peace of mind. On the other hand, if they are not good, the examinations mentioned above will be carried out.

In some cases, a simple chest x-ray and an ECG of the heart may also be abnormal.

What can you do ?

You can act on the risk factors for pulmonary embolism. So here are some tips from prevention.

Avoid sitting or standing for a long time. However, if you have no choice, for example for your work, try to get up and walk every 20 minutes.

Even in the event of illness, you should strive to move a minimum:

  • In the event of immobilization due to a cast, you can, for example, change your posture regularly and move all the muscles that still can. Ask the physiotherapist for advice;
  • In case of travel (by plane) (especially when the trip lasts more than 6 hours). Travelers without known risk factors are advised to wear loose clothing, drink enough water, move the ankles to contract the calf muscles, or walk a little. High risk patients should follow the advice above and wear antithrombosis stockings. Considering the atmospheric pressure in the cabin of an airplane and the dryness of the air, the risk of venous thromboembolism (VTE) is further increased, it is better to be especially careful when traveling by plane, but these measures are also valid for long journeys by car, bus and train. An anticoagulant can also be used in patients with known thrombophilia (coagulation disease) or who have a history of VTE. An injection half an hour before the flight provides 12 hours of protection. Aspirin is not recommended.

If you have some varicose veins or if you have a history of thrombosis in your leg, you can wear elastic stockings (compression stockings) to reduce the risk of thrombosis.

If you have risk factors, it is recommended that you avoid pill. Talk to your doctor about which contraception is best for you. Hormones during menopause are also not recommended.

And finally, it is important to lose weight if you are overweight.

What can your doctor do?

If the doctor suspects a pulmonary embolism, he will refer you to the hospital urgently. As the consequences of a pulmonary embolism can be serious, treatment with anticoagulants will be started right away, even before knowing the diagnosis. This treatment helps to absorb existing clots and prevents new clots from forming.

Once the diagnosis is confirmed with certainty, treatment is definitively started: either elimination of the clot by medication (thrombolysis) or by surgical intervention, or development of treatment with anticoagulants. Two anticoagulants are started at the same time, one by injection, the other in tablet form.

After your hospitalization, you should see your general practitioner regularly. The frequency and type of follow-up depend on the type of anticoagulant you received in the hospital. Treatment lasts 6 months or more.

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Source

Foreign clinical practice guide ‘Pulmonary embolism’ (2000), updated on 20.03.2017 and adapted to the Belgian context on 21.02.2019 – ebpracticenet