Putting Down Pulmonary Embolism

It’s late at night and you can’t fall asleep. You have shortness of breath and a hacking cough where your chest feels tight. You have been coughing up blood. Could you have a pulmonary embolism?

Pulmonary embolism describes when a blood clot (called an embolus) suddenly blocks a blood vessel in the lungs. A small pulmonary embolus can happen without any symptoms. A large pulmonary embolus can suddenly threaten your life.

To better understand this condition, you need to understand the circulation of blood in your body. Blood carries nutrients (like oxygen and sugar) to the cells of your body and removes waste material from the cells. The blood circulates because of the pumping action of the heart.

There are two circuits. One circuit pumps oxygen-poor blood to the lungs, where it picks up oxygen. The second circuit pumps oxygen-rich blood throughout the body through pipes called arteries. When oxygen leaves the blood to enter the cells, the blood becomes oxygen-poor. That oxygen-poor blood returns to the heart through pipes called veins.

Blood flows more slowly through veins than through arteries. Sometimes clots form in the slowly moving blood, especially if the flow is slower than usual. This is a condition called deep vein thrombosis (DVT).

Usually, DVT occurs in the veins of the legs. Part of the clot can break away and travel through the veins to the heart, and then on to the lungs. There, it travels through progressively narrower blood vessels. When the size of the clot is larger than the width of the blood vessel, it gets stuck in the blood vessel.

DVT may cause pain or swelling of the legs. It is usually the result of extended inactivity. If you are inactive for many hours during a long airplane flight or prolonged bed rest, for example, blood flow in your legs may slow. DVT is more likely in people who are bedridden and those recovering from surgery.

Symptoms of pulmonary embolism can include chest pain and unexplained shortness of breath or coughing.

Some factors that may increase the risk of developing clots that may result in pulmonary embolism include:

·       Age – The risk increases with age, especially after age 60.

·       Family history – A family history of clotting problems elevates your risk of blood clots.

·       Long periods of inactivity – Sitting during lengthy plane or car trips, bed rest for an extended time, such as after surgery, injury, or during a serious illness, slows blood flow in your veins.

·       Blood vessel changes that occur with age – Tiny valves in large veins that help blood move in the right direction may deteriorate with age, causing blood to pool and possibly form clots.

·       Certain medical conditions – If you have a previous blood clot, you increase your risk of having another one. Also, other major risk factors include hospitalization for major surgery or a serious medical illness, extended bed rest, trauma and bone fractures, neurological disorders that impair leg use, autoimmune disorders, and previous DVT or clots in veins closer to the skin surface. Active cancer and chemotherapy likewise increase risk, some cancers, especially cancers in the pancreas, brain and lung, as well as lymphoma, influence substances in the blood that promote clotting and chemotherapy can further increase the risk. Likewise, in women being treated for breast cancer, clotting risk is higher for those taking tamoxifen and raloxifene.

·       Surgery – In addition to extended bed rest, some types of surgeries increase clotting on their own. These include orthopedic procedures, particularly involving the hip, knee, or pelvis, major neurosurgery and cancer surgery.

·       Certain lifestyle factors – Excess weight increases risk and smoking may predispose some individuals to clot formation. Moreover, women of childbearing age have clotting risk during and after pregnancy and with oral contraceptives.

Once pulmonary embolism is diagnosed, you will be treated with two types of medications. Drugs given to treat this condition, while these may cause bleeding and heavy bruising, they prevent clots from forming, by decreasing your blood’s ability to clot. Blood thinners (anti-coagulants) such as heparin is a fast-acting anti-coagulant that may be given intravenously. Low-molecular weight heparin (another form of heparin) is used most often and given as an injection below the skin two or three times a day. Warfarin (Coumadin) may also be used, although it takes several days for it to start working.

The length of time you remain on blood thinners depends on the cause of pulmonary embolism and your overall health. While generally anti-coagulants are continued for about three months to six months or longer depending on whether it’s a first or second episode, a recognized risk factor contributed to the event, if blood clotting occurred for no apparent reason or if there’s an underlying clotting problem. Basically if you are at a high risk, blood thinners may be continued.

The second type of medication is clot dissolvers (thrombolytics). While clots usually dissolve on their own, in life-threatening situations, thrombolytics can quickly dissolve blood clots. Thrombolytics are reserved for emergencies because they can cause sudden, severe bleeding.

There are some self help measures you can practice to prevent clots and pulmonary embolism. If you travel by air, be an active traveler. Rather than sit for long periods of time, walk around the cabin as soon as it is permitted. If you are driving, stop every hour to get out of the vehicle and walk around. Stay hydrated. Dehydration may contribute to blood clot development.