In pulmonary embolism (LE) (synonyms: Arterial pulmonary embolism; Embolic pneumonia; Embolic pulmonary infarction; Fulminant pulmonary embolism; Hemorrhagic pulmonary infarction; Infarction of the lung; Pulmonary artery embolism (LAE); Pulmonary embolism; Pulmonary infarction; Pulmonary thromboembolism; Pulmonary thrombosis; Massive pulmonary embolism; Nonmassive pulmonary embolism; Postoperative pulmonary embolism; Pulmonary artery embolism; Pulmonary artery thromboembolism; Pulmonary artery thromboembolism; Pulmonary embolism; Pulmonary infarction; Pulmonary thromboembolism; Pulmonary venous thromboembolism; Pulmonary embolism; Pulmonary artery thrombosis; Thrombotic pulmonary infarction; Venous thromboembolism (VTE); ICD-10-GM I26. -: Pulmonary embolism) is a mechanical obstruction (“blockage or narrowing”) of one or more pulmonary artery branches (branches of the pulmonary artery) caused primarily by pelvic-leg thrombosis (about 90% of cases) more rarely by a thrombus (blood clot) from the upper extremities. In connection with deep vein thrombosis of the leg and pelvis (deep vein thrombosis, (TVT); “deep vein thrombosis“, DVT), the term venous thromboembolism (VTE) is also used. Furthermore, an embolism can also result from tissue fragments, air, fat or foreign bodies. Four degrees of severity of pulmonary embolism can be distinguished:
- Hemodynamically stable without right heart dysfunction.
- Hemodynamically stable with right heart dysfunction
- With symptoms of shock
- Duty to resuscitate
Acute pulmonary embolism with hemodynamic instability (condition in which the circulation is impaired to a clinically relevant degree) and its clinical manifestations:
- Cardiac arrest
- Obstructive shock – systolic blood pressure < 90 mmHg or when vasopressors (drugs that raise or support blood pressure) are required to keep it above 90 mmHg. Occurrence of the same although there is no volume deficiency and at the same time signs of hypoperfusion (reduced blood flow) to the organs are evident. This is accompanied by decreased vigilance (attention), cold damp skin, increased lactate concentration and oliguria (decreased urine volume with a daily maximum of 500 m)/anuria (lack of urine output; maximum 100 ml/24 h).
- Persistent hypotension – systolic blood pressure < 90 mmHg or decrease in systolic blood pressure by ≥ 40 mmHg, duration > 15 min and not due to arrhythmia (cardiac arrhythmia), hypovolemia (decrease in the amount of blood circulating in the circulation), or sepsis (blood poisoning).
Pulmonary embolism is the third leading cause of cardiovascular death, with a high incidence of unreported cases. It often occurs in immobilized persons.Furthermore, in women of childbearing age, the proportion of fatal pulmonary embolism in all deaths is relatively high. Peak incidence: the maximum incidence of pulmonary embolism is between the ages of 60 and 70. For vascular surgery patients, the incidence peak of perioperative (describing the period before, during, and after surgery) pulmonary embolism is on postoperative (post-op) day 3 and in general surgery on postoperative day 9. The prevalence (disease incidence) of pulmonary embolism for all hospitalized patients is 1-2% (in Germany). Deep vein thrombosis (TBVT) is approximately three times more common than thromboembolism. The incidence (frequency of new cases) of pulmonary embolism is approximately 60-70 cases per 100,000 population per year (in Germany). The incidence of community-acquired pulmonary embolism in adults is about 28 per 100,000 population and in children up to 4.9 per 100,000 population. In hospitalized patients, the incidence is thought to be up to 57 per 100,000.The incidence of fulminant (severe course) pulmonary embolism is 1 per 100,000 population per year. Pulmonary embolism can be detected autopsy in 10-15% of decedents. Course and prognosis: The further course depends, among other things, on the severity of the pulmonary embolism, the age of the patient, previous illnesses and whether the thrombus dissolves again (restitutio ad integrum) or the vessel remains closed (pulmonary infarction). Pulmonary embolism frequently recurs and is then associated with a higher mortality rate (number of deaths in a given period, relative to the number in the population concerned). The recurrence rate is 30%. Men have a higher risk of recurrence than women.As a result of the disease, exercise limitations and psychological effects may occur, including the development of chronic thromboembolic pulmonary hypertension (CTEPH). The latter can lead to obstruction of part of the pulmonary circulation, resulting in an increase in pulmonary vascular resistance. Postoperative lethality (mortality relative to the total number of people with the disease) is 0.2-0.5% despite prophylaxis.
