PULMONARY EMBOLISM

General Information

DEFINITION--A blood clot or fat cells (rarely) in one of the arteries carrying blood to the lungs. The blood clot begins in a deep vein of the leg or pelvis. A fat embolus usually begins at a fracture site. The embolus moves through the bloodstream, passing through the heart and lodging in the branch of an artery that nourishes the lungs. This blockage decreases breathing ability and sometimes destroys lung tissue.

BODY PARTS INVOLVED--Veins, especially veins in the legs; pulmonary artery and smaller artery branches that nourish the lungs; broken bone.

SEX OR AGE MOST AFFECTED--All ages, but most common in adults.

SIGNS & SYMPTOMS

• Sudden shortness of breath.
• Faintness or fainting.
• Pain in the chest.
• Cough (sometimes with bloody sputum).
• Rapid heartbeat.
• Low fever. These symptoms are often preceded by swelling and pain in the leg.

CAUSES--Deep-vein thrombosis, which can occur anytime that blood pools in a vein.

RISK INCREASES WITH

• Adults over 60.
• Any injury or illness that requires prolonged bed rest.
• Sitting in one position for prolonged periods, as on airplane flights.
• Recent surgery.
• Congestive heart failure.
• Heart-rhythm disturbances.
• Polycythemia; hemolytic anemia.
• Bone fractures.
• Obesity; smoking.
• Pregnancy.
• Use of oral contraceptives, especially in women who smoke.

> Avoid prolonged bed rest during illnesses. Wear elastic stockings during recuperation--

in or out of bed.

• Start moving lower limbs and walking as soon as possible after surgery.
• Don't smoke, especially if you are a woman 35 or older who takes birth-control pills.
• Avoid needless surgery. Get a second opinion.
• When traveling, stand and walk every 1 to 2 hours.
• One aspirin a day may prevent. Ask your doctor.

What To Expect

DIAGNOSTIC MEASURES

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory blood studies to measure coagulation factors and prothrombin time.
• X-rays of the chest.
• Radioactive lung scan and arterial blood gases.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Treatment is aimed at maintaining adequate cardiovascular and pulmonary functions (during resolution of the clot) and preventing recurrence.
• Surgery may be necessary to tie off the big vein leading to the heart and lungs (vena cava) or insertion of a filter to trap recurrent clots (rare).

POSSIBLE COMPLICATIONS

• Rapid death from a large clot that obstructs more than 50% of the blood to the lungs.
• Massive bleeding in the lungs caused by smaller clots.

PROBABLE OUTCOME--Usually curable in 10 to 14 days with intensive care.

How To Treat

GENERAL MEASURES

• Wear elastic stockings or leg wraps with elastic bandages.
• Don't sit with your legs or ankles crossed.
• Elevate your feet higher than your hips when sitting for long periods.
• Elevate the foot of your bed.

MEDICATION--

Your doctor may prescribe:

• Anticoagulant drugs to dissolve and prevent clots. The anticoagulant level must be monitored to keep it in a safe range.
• Oxygen, if needed.
• Antibiotics if septic emboli.

ACTIVITY--Rest in bed until all symptoms and signs of clot inflammation disappear. While in bed, move your legs often to stimulate circulation.

DIET--No special diet.

Call Your Doctor If

> The following occurs during treatment:

Chest pain. Coughing up blood. Shortness of breath. Increased swelling and pain in the leg, despite treatment.