Pulmonary Embolism
What is a "pulmonary embolism"?
Pulmonary embolism is a potentially life-threatening lung disorder that must be taken very seriously. Pulmonary embolism starts with a clot which is usually formed in veins in the lower extremities, like from the umbilicus down into the legs, and that clot will break off and move up the intravena cava through the right side of the heart and go out into the pulmonary artery and either flow into the right lung or left lung and then the effect of the blood vessels getting smaller and smaller will finally entrap that clot and everything beyond that can potentially die, a serious probem. The pulmonary embolism patient will suddenly feel they can't breathe and will feel a sudden pain, this has to be taken care of promptly. A clot to the lung is something very serious to be very concerned about.
What are the most common signs of a pulmonary embolism?
The most common signs of a pulmonary embolism is the sudden onset of a shortness of breath, dyspnea is the word, and can also include a sudden stabbing pain in the lung. And that pain will persist and it will be worse with breathing, and the patient will take a breath. If it includes death of part of a lung, the patient can start coughing up blood. And that's a very, very serious sign.
Who is at most risk for a pulmonary embolism?
There are a lot of people that are at high risk for pulmonary embolism. If you sit on an airplane with the crowded seats that they have now with seatbelt across, you sit there for two or three hours and you develop poor circulation in your legs, the chances of clot forming in those veins because of the poor circulation goes up. If you lay in bed, patients who are chronically ill that will lay in bed for hour after hour, day after day and, then, suddenly get up, go to the bathroom, they could jar loose a clot that has formed in their legs and sudden experience shortness of breath or chest pain. Patients with congestive heart failure can develop pulmonary embolisms. Unfortunately, young healthy women that are on birth control pills have a higher incidence of pulmonary embolism. There are certain congenital, there are certain genetic deformities within the blood stream that will pre-dispose you to forming clots. You can also find pulmonary embolisms will develop in patients who have accoult or hidden cancers, especially in the abdomen. The first manifestation that you'll have, may have a hidden, small pancreatic cancer, for instance, would be a pulmonary embolism. So there's a lot of people that would come under the gun, if you will, as it relates to pulmonary embolisms.
How is a pulmonary embolism diagnosed?
Pulmonary embolism can be diagnosed with what's called a VQ Scan which is a special kind of scan. You can do a pulmonary angiogram which is a quite invasive procedure where you have to put a catheter into a vein, slide it on up into the right side of the heart and then inject some dye into the pulmonary artery. As that dye goes out (it is dye that doesn't really colour anything, but it is dye as far as the radiographic tube is concerned) it shows the outline of that clot. However, the more preferred way these days is to do a very high tech type of CT Scan; the computerized thermography, and it is non-invasive, quite quickly done and has become pretty much the gold standard these days of diagnosing pulmonary embolism. When you want to really make it difficult for medical students, you can ask them, "What is the most common finding on a chest X-ray; the plain, early, usual, chest X-ray, for pulmonary embolism?" and the answer to that question is normal. So, the normal chest X-ray can be seen frequently on the initial radiographic evaluation of pulmonary embolism. Most of the time students don't get that so it's fun to ask that question.
How is a pulmonary embolism treated?
Pulmonary embolisms are treated now very effectively. We have many ways of treating them to include Heparin, which is a medication that is given sub-containously or it can be given by I.V. and it takes care of the initial problem of clotting and then at the same time you start the patient on rat poison . Rat poison is coumadin and it was initially developed to as a rat poison but soon came into the practice of medicane to make blood thinner so that clots won't form . So that initially you take care of the clots that are already there with the Heparin and make sure that no further clots will break loose and go into lung and your run that for about seven to ten days ruffly . In the mean time it takes about a week or so for the Coumadin levels to build up so that the body is antiquagulating properly so that it won't quagulate the blood . Then you send the patient home for three to four months on the rat poison on the Coumadin and The rat poison, or Coumadin has to be monitored carefully because there is alot of things that in your diet , certain medications , that will either make the Coumadin less quagulating or it can over quagulate becuase of medication and food that your eating . you have to track it very closely . What your really doing is giving the patient in the short term course of medication that will give them Hemophilia. You give them another form of disease to help them correct this one disease then they come off of it. If they continue to throw clots into their lung you may have to put a filter into the interior venacava that will filter clots that would be up coming ,but thats uncommon. Some patients who have clotting disorders that are permanent they may have to take Coumadin for the rest of their lives , but that's unusual also.
What complications can result from a pulmonary embolism?
Pulmonary embolisms can cause the ultimate complication, and that's death. If untreated, a very large percentage of patients with pulmonary embolism will die. A second clot formed and then thrown on top of the first one can be frequently fatal. You can cough up blood and you can lose a lot of lung tissue that will become infarcted (that's the term used for cell death) as a result of inadequate blood flow beyond where the clot came to lodge, so that there's a triangular shape of lung tissue beyond the clot that doesn't get proper nutrition, and it can then die. You can also develop pulmonary hypertension, because the surface area of the capillary bed has been compromised, and lessened, because of the little clots that go in. The complications from pulmonary embolism, if treated properly, are uncommon; when they do occur, they can be very, very uncomfortable and very difficult.
