With most people who experience chest pain and shortness of breath, the early assumption is that they may be having a heart attack. Although that may be the case, there are other causes, just as deadly, that can cause the same or very similar simptoms. As most people know, heart attack, or an acute myocardial infarction, is caused by a thrombus, usually a piece of an atherosclerotic clot, becoming lodged in one of the coronary arteries and stopping the flow of oxygen rich blood. A pulmonary embolism is very similar to a heart attack, but the process takes place in the arteries of the lungs which carry blood to be oxygenated.
These embolisms, often from blood clots in the legs, can cause a wide variety of symptoms. Below you will find an in-depth description of the signs and symptoms of pulmonary embolism, along with risk factors for these blood clot embolisms and preferred treatment. Video links and photos have also been included to help people learn more about Pulmonary Embolism.
Pulmonary Embolism Risk Factors
As with most medical conditions, there are certain factors that can place people at higher risk of experiencing Pulmonary Emboli. The foremost cause of blood clots in the lungs is the existence of Deep Vein Thrombosis. A high percentage (10-15%) of all patients with DVT will experience a clot traveling to a lung. This is due to a thrombus, or small clot, breaking loose from the DVT and traveling through the heart and out to the lungs.
Other risk factors include use of contraceptive pills by smokers, cancer, and genetic or acquired thrombophilias (or blood clotting disorders). These causes generally do not produce very large clots, but can cause a rash of many clots at one time, which can be just as deadly. Lastly, recent surgery is a risk factor, especially surgeries involving long bones. In some cases bone fragments or fatty cells can enter the bloodstream and travel to the lungs. In these cases, fast emergency action is needed due to the inability of conventional means to dissolve these emboli.
Although Atrial Fibrilation, a condition in which the top chambers of the heart do not contract properly, is often considered a high risk for clots resulting in stroke or CVA, its is not generally considered a high risk factor for lung clots (or Pulmonary Embolism). However, recent research shows that PE due to atrial fibrilation should not be ruled out and that some inherent risk does exist.
Signs And Symptoms Of Pulmonary Embolism
The initial sign or symptom of pulmonary embolism is usually trouble breathing. This can range from having trouble moving air, to just feeling like you cannot catch your breath. PE usually does not disrupt your ability to move air unless the clot is large enough to cause inflammation, so a person with an embolism can usually breath well, but just feels like they cannot get enough oxygen. One aspect that differentiates this patient from one who is suffering hyperventilation due to anxiety is generally pale or cyanotic skin in the PE patient, although anyone with hyperventilation should be treated with care. Trouble breathing then leads to fast breathing or Tachypnea.
Along with the breathing difficulty, patients will also experience chest pain. This pain can come in the form of a sharp chest wall pain or a diffuse pain across the chest, but it usually worsens while breathing. Depending on how large the clot is, pulmonic blood pressure can affect the right ventricle of the heart, causing more chest pain and possibly distention of the jugular veins.
Another sign/symptom that is looked for by medical professionals is that of low oxygen saturation. Although this can be seen in pale or cyanotic skin, smaller changes can be seen by using pulse oximetry. This is done when a small clip is placed on the finger, shining a red light through the finger, and thereby measuring the amount of oxygen rich blood in the capillaries.
Overall, a person experiencing PE may also experience weakness, tireness, diaphoresis (extreme sweating), paleness, or even cyanosis (a blue tint to the skin denoting a lack of oxygen). In extreme instances, usually due to larger clots caused by dislodged bits of bone or fatty cells after a surgery, a person can begin to becom cyanotic, or blue, from the nipple line up due to extreme "back up" of un-oxygenated blood. This is generally a sign of a person with too large of a clot to be treated medically.
Treatment For A Blood Clot To The Lungs
The treatment of Pulmonary Embolism should be broken down in to two areas, prehospital care and emergency room or hospital care. Emergency prehospital care should be initiated in any case of Pulmonary Embolism by calling 911. The care given by prehospital providers will be tiered dependant on the vital signs of the patient and their overall general impression. This care will often include moderate to high flow oxygen, and could possibly include CPAP (a device that provides Continuous Positive Airway Pressure) if the patient is experiencing flash pulmonary edema due to pulmonic hypertension.
Due to the chest pain, the patient may be given Aspirin if Heart Attack is of concern, but as many patients with lung clots have specific history pointing to the cause, most of the treatment will focus on Oxygenation in the prehospital setting. These patients would be those who have history of PAD, DVT, or recent surgery and the chest pain is minimal compared to the lack of oxygen and cyanosis.
In the emergency room, the focus of treatment, along with Oxygenation, will be removal of the clot. The initial treatment for most clots in the lung is through anticoagulants which help break down the clot and prevent further clotting, most often a drug called Heparin. This drug will begin to break down most clots by breaking them up into smaller pieces and is often followed by drugs like Warfarin (Coumadin), which may then be prescribed for long term use to prevent new pulmonary emboli.
If the clot has caused a cardiac issue due to causing a back up of blood in the pulmonary arteries and the right side of the heart, the patient my be given a thrombolytic. These drugs, often used in the case of stroke, are used to totally dissolve the clot, but as they can cause a risk of aneurysm or bleeding elsewhere, they are generally not used unless medically necessary.
As a last resort, often if the embolism is not a clot that can be dissolved (made up of fatty cells or bone fragment) or is so large that death is probable, the clot may be surgically removed. As this is a dangerous procedure, it is seldom used and many times those with larger clots that cannot be dissolved do not last long enough to complete this procedure. Often these clots are caused during surgery or trauma.
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Lena Welch from USA on July 16, 2012:
One of the best hubs that I have read on the topic. I am impressed when I sell well written, articulate hubs. This is such an important topic. The scary thing is that many PE patients don't show traditional symptoms. Also, many of us see the doctor multiple times before a diagnosis is found.
For those of you reading this, if you have shortness of breath or chest pain go to the ER. It may save your life!
kat11 from Illinois on July 02, 2011:
Great article and very informative. I didn't know that blood clots could travel to the lungs.
lavender3957 on July 01, 2011:
This ws very helpful information on my part. Very good hub.