Symptoms
Possible symptoms of pulmonary embolism include:
- Shortness of breath (dyspnea), rapid breathing, cyanosis.
- Chest pain
- Cough with blood or sputum
- Rapid heartbeat
- Fever, sweating
- Loss of consciousness (syncope)
- Low blood pressure, shock
- Symptoms of deep vein thrombosis, such as a swollen, warm leg
The severity varies and depends, among other things, on how large the embolus is and whether it completely occludes the vessel. It is also possible to have a symptomless course. A pulmonary embolism is a medical emergency that can have a fatal outcome if it is severe. Those affected should therefore seek medical treatment immediately. The condition can damage the lungs (pulmonary infarction) and leads to an undersupply of oxygen to the body. Pulmonary embolism is a risk factor for developing pulmonary hypertension.
Causes
Pulmonary embolism is most often caused by a blood clot in an arterial blood vessel in the lungs. About 90% of these clots originate in the deep veins of the legs (deep venous thrombosis) or in the veins of the pelvis. The thrombus detaches and travels to the pulmonary arteries via the right heart as a so-called embolus. Risk factors include (selection):
- Surgical procedures, e.g., after joint replacement (osteoarthritis surgery).
- Fractures, injuries
- Cardiovascular diseases
- Cancer, chemotherapy
- Bedriddenness, hospitalization, immobility.
- Heredity
- Blood clotting disorders
- Pregnancy
- Age, previous pulmonary embolism
- Estrogen therapy
- Obesity
Diagnosis
Diagnosis is made based on patient history, symptoms, physical examination, laboratory methods (e.g., D-dimers), an ECG, and imaging (e.g., CT).
Nonpharmacologic treatment
- Surgical removal of the blood clot (embolectomy).
- Vena cava filter
Drug treatment
Antithrombotics are administered for both prevention and treatment:
- Heparins: e.g., dalteparin, enoxaparin, nadroparin.
- Fondaparinux
- Vitamin K antagonists: phenprocoumon, warfarin.
- Factor Xa inhibitors, e.g., rivaroxaban
- Thrombin inhibitors, e.g., dabigatran.
Fibrinolytics (thrombolytics) such as alteplase are used to dissolve the blood clot in a severe course. This is referred to as lysis therapy.
Prevention
- Antithrombotics (see above)
- Compression stockings
- Physical exercise
- Avoid risk factors
- Take enough liquid