Pulmonary Embolism (Lung Embolism) Treatment in Delhi, India

A pulmonary embolism occurs when one of the pulmonary arteries in the lungs gets blocked. Often, pulmonary embolisms are caused by blood clots that enter the lungs via deep leg veins or, in some cases, from veins in other areas of the body.

It can be fatal because the blood clots prevent blood circulation to the lungs. However, early diagnosis and treatment reduce the risk. The risk of developing pulmonary embolism can be reduced by taking steps to avoid blood clots in the legs.

Symptoms of Pulmonary Embolism

The symptoms of pulmonary embolism differ depending on the size of a blood clot and if a person has underlying heart or lung disease. Common symptoms of pulmonary embolism include:

• Cough 
• Chest pain
• Shortness of breath and uneasiness
• Irregular heartbeat
• Excessive sweating
• Fever
• Dizziness and lightheadedness
• Swelling or pain in the legs 
• Hemoptysis (coughing out blood)

Causes of Pulmonary Embolism

Pulmonary embolism is commonly caused when a blood clot blocks an artery in the lung. In most cases, these blood clots form in the deep veins of a person’s leg and move to the arteries. This condition is called deep vein thrombosis. 

Pulmonary embolism frequently involves many clots. Each clogged artery drains blood from the regions of the lung it supplies, which might be life-threatening. This is referred to as a pulmonary infarction. This makes it harder for the lungs to supply oxygen to the rest of the body. Apart from blood clots, other substances can also obstruct blood arteries, including:

• Air bubbles
• Fat from a shattered long bone’s marrow
• Tumor fragment

Diagnosis of Pulmonary Embolism

Diagnosis of pulmonary embolism can be difficult, especially for those with underlying heart or lung illness. Because of this, the doctor will probably inquire about a patient’s health history, conduct a physical examination, and request one or more of the following tests:

• Blood test: A blood test for the clot-dissolving chemical D dimer substance may be recommended. While many other factors can also cause high D dimer levels, high levels may signify an increased risk of blood clots. Blood testing may also be used to identify any hereditary clotting disorders a person may have. Levels of oxygen and carbon dioxide can also be determined by blood tests. The amount of oxygen in the bloodstream may decrease if there is a clot in a blood artery in the lungs.
• Ultrasound: Duplex ultrasonography, also known as duplex scan or compression ultrasonography, is a non-invasive procedure that uses sound waves to scan the veins in the thigh, knee, calf, and sometimes the arms to check for deep vein blood clots. The transducer, a wand-like tool that directs sound waves to the veins being tested, is moved over the skin. To generate a moving image on a computer, these waves are then reflected back to the transducer. The risk of deep vein thrombosis is lower when there are no clots. If clots are found, treatment will most likely begin right away.
• CT Pulmonary Angiography (CT - PA) with deep venous thrombosis (DVT) Protocol: The most common and most reliable test done in susceptible cases of pulmonary embolism & lower limbs.
• Pulmonary angiography: This procedure gives a precise image of the blood flow in the lungs’ arteries. It is the most accurate diagnostic procedure, but it has significant risks and is only used when other tests are unsatisfactory. In pulmonary angiography, a flexible tube (catheter) is inserted into a major vein, often in the groin, through the heart and into the pulmonary arteries. The catheter is then filled with a particular dye, and X-rays are obtained while the dye travels down the arteries in the lungs.
• Chest X-ray: This non-invasive scan is recommended to rule out illnesses that mirror the disease even though they cannot detect pulmonary embolism.

Pulmonary Embolism Treatment

The aim of pulmonary embolism treatment is to stop the blood clot from becoming larger and from re-forming. Immediate treatment is necessary to avoid major consequences or complications.

• Blood thinners: These medications help the body break up clots while preventing new clots from developing and existing clots from growing. Heparin is a common anticoagulant that may be administered through a vein or injected beneath the skin. It activates immediately and is frequently used for a number of days with an oral anticoagulant.
• Clot dissolvers or thrombolytics: Although clots often dissolve on their own, thrombolytics is administered to dissolve clots fast. These clot-busting medications are often only used in life-threatening situations due to the risk of abrupt and severe bleeding. Modern oral anticoagulants act more rapidly and cause fewer drug side effects. However, bleeding is the most frequent adverse effect of anticoagulants.
• Noval oral anticoagulants (NoAC) and other drugs
• Clot removal surgery: The doctor can advise clot removal surgery to remove a big, potentially fatal clot from the lung. The treatment uses a narrow, flexible tube (catheter) inserted through the blood vessels to remove clot.

Complications of Pulmonary Embolism

An embolism in the lungs may be fatal. Undiagnosed and untreated pulmonary embolisms can cause about one-third of patients to die. But when the problem is identified and properly treated, that number reduces.

In addition to pulmonary embolism, pulmonary hypertension, characterised by excessively high blood pressure in the right side of the heart and the lungs, can result from pulmonary embolism. 

When the arteries in the lungs are blocked, the heart is forced to work harder to pump the blood through it, raising blood pressure and eventually weakening the heart.

In a few cases, small emboli commonly occur and grow over time, leading to chronic pulmonary hypertension (also known as chronic thromboembolic pulmonary hypertension).

Risk factors of Pulmonary Embolism

• Heart condition: Clot development is more common in patients with cardiovascular illness, especially heart failure.
• Cancer: Chemotherapy can significantly raise the risk of blood clots in patients with certain malignancies, especially those that have spread to the brain, ovary, pancreas, colon, stomach, lung, and kidney. Women who have a personal or family history of breast cancer and take tamoxifen or raloxifene are also more likely to develop blood clots.
• Clotting-related disorders:  Some genetic blood abnormalities cause it to clot more easily. The risk of blood clots may also be increased by other medical conditions, such as renal illness.
• Smoking: Most people are prone to develop blood clots for unknown reasons, especially when tobacco use is combined with other risk factors.
• Overweight: Excess weight increases the risk of blood clots, especially in those with additional risk factors.
• Pregnancy:  Blood flow from the legs may be slowed by the weight of the baby pressing against pelvic veins. Blood that slows or accumulates is more prone to clotting.
• COVID-19: Those who have COVID-19 with significant symptoms are more likely to get pulmonary embolism.
• Surgery: One of the main causes of blood clots is surgery. For this reason, clot-preventing medicine may be used both before and after major surgery, such as joint replacement.

Prevention of Pulmonary Embolism

Pulmonary embolism can be avoided by preventing deep vein thrombosis (DVT) in the legs. To  avoid blood clots, doctors generally take proactive measures, such as:

• Blood thinners or anticoagulants: These drugs are frequently administered to patients at risk for blood clots before and after surgery, as well as to patients with diseases including heart attack, stroke, or cancer-related problems.
• Compression stockings: The veins and leg muscles are able to transport blood more effectively due to the constant compression provided by compression stockings. They provide a secure, easy, and affordable means of preventing blood stagnation during and after general surgery.
• Leg elevation: Elevate the legs with books or blocks during sleep, if possible. It could be really helpful. Raise the bed’s foot by 4 to 6 inches (10 to 15 cm).
• Exercise: Getting moving around as soon as possible after surgery will help prevent pulmonary emboli and speed up recovery. This is one of the main reasons why a patient is advised to get up and walk around the day of the procedure, even though patients might be in pain where the incision is.
• Pneumatic compression: This method uses thigh-high or calf-high bands that are frequently compressed and massaged with air that is regularly pumped in and out of the bands to improve blood flow.
• Avoid long sitting/sitting in one posture; for example, avoid long driving, travelling in aircraft, long office hours, etc.

Review

Reviewed by Dr. Inder Mohan Chugh - Senior Director, Pulmonology.