Prognosis

The prognosis of pulmonary embolism depends mainly on the size of the embolism and the duration of its existence and on recurrent embolism events. With consistent therapy, the probability of a new pulmonary embolism can be greatly reduced. The aim here is to prevent the formation of a thrombosis.

Without further therapy, there is a high risk that the event will recur (probability 30% !!!). The duration of the hospital stay depends very much on the patient’s condition. If the pulmonary embolism is small and is treated quickly, patients can usually be discharged home after a few days on the normal ward.

Patients who are put into a life-threatening condition by a severe pulmonary embolism sometimes have to spend several weeks in intensive care until they are out of danger. Patients are often left on the ward for a few days for monitoring despite a marked improvement in their condition. The reason for this is that complications such as renewed pulmonary embolism or pneumonia occur especially in the first days after pulmonary embolism.

The duration of recovery after pulmonary embolism varies greatly from patient to patient. After small pulmonary embolisms and rapid initiation of therapy, patients often recover within a few days, whereas large pulmonary embolisms with late treatment can cause symptoms such as listlessness, rapid fatigue and shortness of breath for weeks after hospitalization or even permanently. Young patients usually recover faster than older patients.

Pre-existing heart or lung diseases can delay recovery. If complications such as pneumonia or permanent heart damage occur, recovery can also take considerably longer. How long an incapacity to work lasts depends very much on the severity of the symptoms, the course of recovery and the type of job.

The duration is usually decided by the family doctor on the basis of the patient’s well-being. In the best case, work can be resumed after only a few days. Especially physically less strenuous activities do not require a longer sick leave if the patient no longer shows any symptoms.

In the case of severe pulmonary embolisms, the inability to work can last for months. Many sufferers show rapid fatigue after only slight exertion for weeks after hospitalization, in the worst case permanently. This can mean weeks of incapacity to work in physically demanding activities.

Some patients even become permanently unable to work after severe pulmonary embolisms, especially if complications occur. The chances of survival after a pulmonary embolism depend to a large extent on what part of the pulmonary vascular system is affected and what complications occur. Basically, pulmonary embolism is divided into four degrees of severity.

Severity I has the best survival chances. Usually only small branches are affected and the embolism has no effect on heart function. Severity II is characterized by incipient right heart failure.

In this case, somewhat larger arteries are blocked, resulting in increased pressure in the vessels. In contrast, the right ventricle has to pump, which results in a changed function. Here the survival rate is more than 75%.

In severity level III, the affected persons suffer a shock, their blood pressure drops and at the same time their pulse rate rises. Since one of the main arteries of the lung is affected by the embolism, the body cannot absorb enough oxygen.Less than 75% of those affected survive this pulmonary embolism. The most dangerous degree of severity is the fourth.

Affected persons have to be resuscitated (resuscitated) because the heart stops beating due to the lack of oxygen. Less than half of those affected survive this event. Pulmonary embolism is an extremely serious disease that must be taken seriously.

Depending on its severity, up to 50% of those affected die. The mortality rate is particularly high when large branches of the pulmonary vascular system are affected. If an embolism has established itself only in smaller branches, survival depends on the heart function.

If the heart can compensate for the changes in the vessels, the embolism is fatal in less than 25% of cases. If the heart is also affected, the figure is 25 to 50%. Very small embolisms can also cause a chronic course that is usually not noticed for years.

Here, the survival times are significantly longer than with acute pulmonary embolism. The most dangerous consequences of pulmonary embolism occur when the heart is also affected. A large thrombus (blood clot) often blocks a pulmonary artery.

This not only causes the body to take up too little oxygen. It also leads to higher pressure in the pulmonary vessels, against which the right half of the heart in particular has to pump. The combination of increased workload and less oxygen can seriously damage the heart muscles and lead to heart muscle weakness, which in the worst case can be fatal.

Another complication occurs when the lung tissue is not sufficiently supplied with blood (and thus nutrients) over a long period of time. This undersupply is also called a lung infarction. The affected areas can become inflamed, resulting in a so-called infarct pneumonia (pneumonia caused by a lung infarction). Especially if the lungs and heart are already weakened by the embolism, additional pneumonia can have fatal consequences.