What is a Pulmonary Embolism?

A pulmonary embolism is a sudden blockage in one of the pulmonary arteries in the lungs. It’s typically caused by a blood clot in one of the legs, known as deep vein thrombosis, that breaks loose and travels through the bloodstream to the lung. A pulmonary embolism can cause permanent damage to the affected lung, low oxygen levels in the blood, organ damage due to low oxygen and even death – especially if the clots are large or numerous – without rapid treatment.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of pulmonary embolism. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Many people with pulmonary embolism have no symptoms. If symptoms appear, they may include: 

• Chest pain which worsens with deep breathing or coughing
• Cough, which may produce blood
• Fever
• Lightheadedness or dizziness
• Rapid or irregular heartbeat
• Shortness of breath, especially upon exertion
• Sweaty or blue-toned skin 

As mentioned above, pulmonary embolism is usually caused by a blood clot that starts in the leg. Symptoms of a clot in the leg – deep vein thrombosis (DVT) – include: 

• Pain (typically in the calf; may feel like cramping or soreness)
• Redness of the skin on the lower leg
• Swelling
• Tenderness to the touch
• Warmth to the touch 

Diagnosis

To diagnose a pulmonary embolism, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common diagnostic procedures can include:

Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.

Chest X-ray: A common imaging test of the lungs, heart and aorta. 

Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Pulmonary angiogram: A thin tube (catheter) is inserted into a blood vessel (usually in the groin) and threaded into the heart and pulmonary arteries. Dye is injected to make the blood vessel visible during an X-ray. This can show any blood clots or other blood vessel issues.

Spiral CT scan: In a spiral CT scan, the scanner rotates around the body in a spiral to create 3-D images. This scan can detect abnormalities within the arteries of the lungs with greater precision than conventional CT scans

Ultrasound: An ultrasound device can measure blood pressure on various points of your arm or leg, which will help the physician determine if you have any blockages and how quickly blood flows through your arteries.

Causes

Pulmonary embolism is typically caused by DVT. Certain behaviors and lifestyle factors can increase your chance of developing a blood clot in the leg, including: 

• Being overweight, especially if you smoke and/or have high blood pressure
• Smoking, especially combined with other risk factors
• Supplementing estrogen (birth control pills, hormone replacement), especially if you smoke or are overweight

Risk Factors

Risk factors that could contribute to DVT – and, consequently, pulmonary embolism include: 

Cancer: Some cancers – like pancreatic, ovarian and lung cancer – can increase levels of substances that cause blood clots to form. Chemotherapy can compound that risk. Women taking tamoxifen or raloxifene for breast cancer are also at a higher risk of clots. 

Heart disease: Cardiovascular disease, particularly heart failure, makes blood clots more likely.

Pregnancy: The baby pressing on veins in the pelvis can slow blood return from the legs, increasing a woman’s risk of clots. 

Prolonged immobility: Clots are more likely to form during long periods of inactivity, like being confined to bed after injury or surgery and/or long plane or car trips. 

Surgery: This is a major cause of clots, so medication to prevent clots may be given before and after major surgery. 

Prevention

While all cases of DVT and pulmonary embolism cannot be prevented, there are ways to reduce your risk, including: 

Get out of bed, and exercise your legs and feet while on bedrest or traveling: It’s very important to get moving as soon as possible after surgery, injury or illness. If you cannot get out of bed – or if you’re confined to a car, plane, train or bus while traveling – make sure to exercise your legs and feet. Point your toes up to stretch your calves, then relax. Repeat several times.

Practice good heart health: Watch what you eat, exercise (as advised by your physician) and avoid smoking. Smoking and being overweight are two major, preventable causes of DVT. 

Take anticoagulants before/after surgery: Before and after certain types of major surgery, your physician may prescribe blood thinners. Take them as directed. 

Use compression stockings: If you have a known clot risk, wearing these specially fitted stockings can help blood circulate effectively in your legs. 

Prognosis

Prognosis for pulmonary embolism depends on the clot’s type, size and whether there are any other medical problems. If treated promptly, the outlook is good and most people can recover fully. The riskiest time for complications or death is in the first few hours after the embolism occurs, and there is a high risk of another embolism occurring within six weeks of the first one, necessitating immediate and continuing treatment.

Treatment and Recovery

Prompt treatment of a pulmonary embolism is essential and may include: 

Blood Thinning Medication

These medications prevent new clots from forming. They may be prescribed before or after surgery or for a diagnosed clotting disorder.

Clot-Dissolving Medication

These medications – also called clot-busting drugs – are administered through the vein and can dissolve clots quickly. Because they can cause sudden and severe bleeding, they are only used in life-threatening situations, like during a massive pulmonary embolism or stroke.

Clot Removal

A surgeon may remove a large or life-threatening clot via a thin, flexible catheter threaded through the blood vessels.

Vein Filter

A surgeon can use a catheter to position a filter in the inferior vena cava, which leads from the legs to the right side of the heart. The filter can help keep clots from being carried from the legs to the lungs.

Complications

Potential complications of a pulmonary embolism include: 

• Abnormal heart rhythms, known as arrhythmias
• Cardiac arrest (the abrupt loss of heart function) and sudden death
• Paradoxical embolism, a blood clot that does not travel with normal blood flow
• Pleural effusion, a buildup of fluid between the outer lining of the lungs and the inner lining of the chest cavity
• Pulmonary hypertension, a type of high blood pressure that affects the arteries in the lungs and the right side of the heart
• Pulmonary infarction, death of lung tissue
• Shock, insufficient circulation of oxygen in the body which causes vital organs and tissues to shut down

Diagnosis

To diagnose a pulmonary embolism, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common diagnostic procedures can include:

Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.

Chest X-ray: A common imaging test of the lungs, heart and aorta. 

Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Pulmonary angiogram: A thin tube (catheter) is inserted into a blood vessel (usually in the groin) and threaded into the heart and pulmonary arteries. Dye is injected to make the blood vessel visible during an X-ray. This can show any blood clots or other blood vessel issues.

Spiral CT scan: In a spiral CT scan, the scanner rotates around the body in a spiral to create 3-D images. This scan can detect abnormalities within the arteries of the lungs with greater precision than conventional CT scans

Ultrasound: An ultrasound device can measure blood pressure on various points of your arm or leg, which will help the physician determine if you have any blockages and how quickly blood flows through your arteries.

Causes

Pulmonary embolism is typically caused by DVT. Certain behaviors and lifestyle factors can increase your chance of developing a blood clot in the leg, including: 

• Being overweight, especially if you smoke and/or have high blood pressure
• Smoking, especially combined with other risk factors
• Supplementing estrogen (birth control pills, hormone replacement), especially if you smoke or are overweight

Risk Factors

Risk factors that could contribute to DVT – and, consequently, pulmonary embolism include: 

Cancer: Some cancers – like pancreatic, ovarian and lung cancer – can increase levels of substances that cause blood clots to form. Chemotherapy can compound that risk. Women taking tamoxifen or raloxifene for breast cancer are also at a higher risk of clots. 

Heart disease: Cardiovascular disease, particularly heart failure, makes blood clots more likely.

Pregnancy: The baby pressing on veins in the pelvis can slow blood return from the legs, increasing a woman’s risk of clots. 

Prolonged immobility: Clots are more likely to form during long periods of inactivity, like being confined to bed after injury or surgery and/or long plane or car trips. 

Surgery: This is a major cause of clots, so medication to prevent clots may be given before and after major surgery. 

Prevention

While all cases of DVT and pulmonary embolism cannot be prevented, there are ways to reduce your risk, including: 

Get out of bed, and exercise your legs and feet while on bedrest or traveling: It’s very important to get moving as soon as possible after surgery, injury or illness. If you cannot get out of bed – or if you’re confined to a car, plane, train or bus while traveling – make sure to exercise your legs and feet. Point your toes up to stretch your calves, then relax. Repeat several times.

Practice good heart health: Watch what you eat, exercise (as advised by your physician) and avoid smoking. Smoking and being overweight are two major, preventable causes of DVT. 

Take anticoagulants before/after surgery: Before and after certain types of major surgery, your physician may prescribe blood thinners. Take them as directed. 

Use compression stockings: If you have a known clot risk, wearing these specially fitted stockings can help blood circulate effectively in your legs. 

Prognosis

Prognosis for pulmonary embolism depends on the clot’s type, size and whether there are any other medical problems. If treated promptly, the outlook is good and most people can recover fully. The riskiest time for complications or death is in the first few hours after the embolism occurs, and there is a high risk of another embolism occurring within six weeks of the first one, necessitating immediate and continuing treatment.

Treatment and Recovery

Prompt treatment of a pulmonary embolism is essential and may include: 

Blood Thinning Medication

These medications prevent new clots from forming. They may be prescribed before or after surgery or for a diagnosed clotting disorder.

Clot-Dissolving Medication

These medications – also called clot-busting drugs – are administered through the vein and can dissolve clots quickly. Because they can cause sudden and severe bleeding, they are only used in life-threatening situations, like during a massive pulmonary embolism or stroke.

Clot Removal

A surgeon may remove a large or life-threatening clot via a thin, flexible catheter threaded through the blood vessels.

Vein Filter

A surgeon can use a catheter to position a filter in the inferior vena cava, which leads from the legs to the right side of the heart. The filter can help keep clots from being carried from the legs to the lungs.

Complications

Potential complications of a pulmonary embolism include: 

• Abnormal heart rhythms, known as arrhythmias
• Cardiac arrest (the abrupt loss of heart function) and sudden death
• Paradoxical embolism, a blood clot that does not travel with normal blood flow
• Pleural effusion, a buildup of fluid between the outer lining of the lungs and the inner lining of the chest cavity
• Pulmonary hypertension, a type of high blood pressure that affects the arteries in the lungs and the right side of the heart
• Pulmonary infarction, death of lung tissue
• Shock, insufficient circulation of oxygen in the body which causes vital organs and tissues to shut down