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Pulmonary emboli or
blockage of lung arteries
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- The arterial blood (oxygen-rich
blood) supply to the lungs via the pulmonary artery or one
of its branches can be blocked by matter such as a blood
clot (most common), fat, air, tumor (abnormal growth)
tissue, bone marrow, amniotic fluid (fluid in the womb), or
foreign substances. This is called a pulmonary embolus
(plural emboli).
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- Sudden onset
- One or multiple symptoms
- Cough -- may be blood-tinged
- Shortness of breath
- Chest pain may be worse with
breathing or coughing
- Pain may be on one side and may
worsen with bending forward.
- Anxiety and
restlessness
- Person may faint (syncope)
- Sweating
- Wheezing sound when breathing in or
out
- Rapid shallow breaths
- Bluish coloration of the lips or
skin (cyanosis) due to lack of oxygen in the blood (hypoxia)
- Rapid, pounding, or Racing Heart rate
- Edema in the legs
- Pain in the back of the legs
- Joint pain
- Dizziness
- Pain in the pelvic area
- Sometimes no symptoms appear
- Sudden death may
occur
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- Deep Vein Thrombosis
(DVT) -- blood clots or thrombi sometimes form in the leg
veins (carrying oxygen-poor blood) and occasionally dislodge
(embolize) from the walls of the veins, traveling through
the blood stream into the right side of the heart, then to
the pulmonary artery, where they block the blood supply to
that particular section of the lung. This section of lung
then undergoes an infarction (i.e., it dies).
- Emboli can also arise from clots in
the right side of the heart.
- Pieces of tumors invading the
circulatory system, fat, air, and other foreign substances
can also enter the blood stream and block the arteries
supplying different sections (i.e., 5 lobes) of the lungs.
- Hypercoagulability -- increased
tendency for clot formation is seen in certain conditions
and with certain medications and drugs.
- 95% cases of Pulmonary Embolism are
due to DVT.
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- Symptoms
- Illnesses
- Surgeries
- Habits
- Family history
- Medications
- Allergies
- Rapid heart (tachycardia) and
respiratory rate (tachypnea)
- Cyanosis
- Low Blood Pressure
- Doctor may (using stethoscope) hear
decreased breath sounds over the infarcted area, wheezing,
and friction rub (like sandpaper rubbing together).
- Distended neck veins
- Galloping heart sound
- Tenderness or lump in the back of the leg(Deep Vein Thrombosis)
- Arterial blood gas -- may show
hypoxia.
- Oxygen levels may be normal.
- Other blood tests may be normal,
but levels of Antithrombin III (measures risk for clot
formation) may provide valuable information.
- Chest X-Ray may be normal
or may show wedge-shaped area, one-sided elevation of the
diaphragm (muscle that pulls air into the lungs), fluids,
or collapse.
- Electrocardiogram
(ECG) (records the electrical activity of the heart) may
show characteristic patterns.
- To find the source of the clot or infarcted area in
the lungs, the following tests may be
performed:
- Pulmonary (lung) scanning or
ventilation/perfusion scan (V/Q scan) will show the
infarcted segment.
- Angiography --
injection of a dye into arterial supply will identify
the location of the blockage.
- Echocardiography -- sound used to
find the clot in the heart.
- Spiral CAT scan -- computer
generates picture
- Venous duplex scanning, impedance plethysmography, and Doppler Ultrasound -- look for clots inside the
veins (legs, thighs,
etc).
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- Prolonged bed rest -- after surgery,
elderly with fractures, or illnesses
- Stroke
- Heart Failure
- Pregnancy
- Obesity
- Cancers
- Long air flight travel
- Advanced age
- Diabetes
- Poor circulation to the legs due to Peripheral Vascular Disease
- Burns
- Hospitalization
- Oral contraceptives and
estrogen-containing medications
- Edema or swelling in the legs due to
fluid
- Pelvic fractures (pelvis is the bony region
between the hips)
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- Hospitalization
- Depends on the severity
- Bed rest
- Administer oxygen or fluids as needed
- Pain medication if needed
- Attempt to dissolve the clot
(thrombolysis) and prevent further clot formation with
intravenous (inside the veins) use of heparin and warfarin
(pill form).
- Potent clot busters such as
streptokinase, urokinase, and TPA are also beneficial but
less available and more expensive.
- In patients unable to receive
thrombolytic therapy or are doing very poorly, surgical
removal of the embolus (embolectomy) may be beneficial.
- Some patients with repeated emboli to the lungs or those
who cannot take anticoagulants (clot busters) may need a
surgical procedure to place an umbrella-like filter in the
inferior vena cava (major vein to the heart) to catch the
incoming clots.
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Call 911.
Avoid prolonged bed rest, exercise regularly, walk often
during long air flights, and avoid smoking while on
estrogen-containing drugs.
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