The dangerous condition of a blood clot lodging in the lungs.

 

Causes of Pulmonary embolism

Pulmonary embolism poses a risk after major surgery and in individuals who are bed-bound with illnesses such as a heart attack, stroke or pneumonia, II is an important cause of postoperative illness and much research has gone into trying to reduce the risks after surgery.

The problem begins when blood clots within the veins in the calves and thighs. This is the condition of a deep vein thrombosis. Fortunately, most of the clots remain within the leg. However, there is a risk that a portion of the blood clot, called an embolus, might become detached and be carried off in the bloodstream to the lungs. The clot then becomes stuck in the blood vessels, causing the symptoms below.

For unknown reasons, the risk of pulmonary embolism is higher with certain general illness, especially cancer. This is probably due to some effect that makes blood clot abnormally easily. There is also a very small increased risk of pulmonary embolism in women taking oestrogen in the contraceptive pill or hormone replacement therapy (HRT). The risk depends on the type of pill; those containing hormones called gestodene or desogestrel pose a higher risk. Recent research suggests the period of highest risk from HRT is in the first year of treatment.

Symptoms of Pulmonary embolism

There may be the symptoms of a deep vein thrombosis, for example a painful swollen calf, but often there is no warning and the legs appear normal. A small embolus may cause pleurisy or slight breathlessness. Doctors will consider a pulmonary embolus if these symptoms occur after a high-risk procedure such as hip replacement or in someone who has just had a heart attack or been bed-bound for some reason.

A large pulmonary embolus blocks off a major portion of one lung, with resulting sudden severe breathlessness, faintness, chest pain and often coughing of blood.

An embolus can also be detected by the absence of sounds over part of the lung and changes on the ECG (an electrical recording of the heart). Ordinary chest X-rays tire not especially helpful in making the diagnosis. It is better to have a lung scan, here a radioactive injection is given, which should spread evenly through the lungs. Failure to spread suggests a large embolus.

If the embolus is big enough it will completely block blood (low through the lungs, resulting in sudden death.

Treatment of Pulmonary embolism

Treatment aims to reduce the risk of abnormal blood clotting after surgery and to prevent a deep vein thrombosis. One way to reduce the chances of thrombosis is for the patient to wear compression stockings during surgery. Drugs, for example heparin, are given to make the blood less likely to clot. If there has been a small embolus, therapy is started with heparin by injection or warfarin by mouth.

Treatment of a large clot can be successful if immediate skilled chest surgery is available to remove the blood clot from the blood vessels of the lungs. This is only possible in a lew centres, which emphasizes how important it is to reduce the risks in the first place.

Commonly Asked Questions

How can I reduce my risks of pulmonary embolism?

If yon need surgery, see what steps the hospital takes to reduce risk. This might include wearing compression stockings and being given heparin during surgery. Start walking as soon as possible after surgery, a heart attack or stroke. Stop smoking and stop taking the contraceptive pill before major surgery.

What risk of pulmonary embolus does the contraceptive pill carry?

About double the natural risk – less than a one in a hundred thousand chance per annum. This is still less than the health risks from pregnancy.

Can a pulmonary embolism recur?

There is an increased risk in anyone who has had one before. Frequent emboli may result from unusual auto-immune disorders, a source of blood clots within the heart or a hidden cancer.

Complementary Treatment of Pulmonary embolism

This is a medical emergency and needs urgent treatment in hospital. Postoperatively, a number of complementary therapies can help the body to heal, for example chakra balancing. Yoga and tai chi/chi kung arc gentle forms of exercise which could help after recovery. Diet – to prevent recurrence, a nutritional therapist would probably recommend you switch to a diet rich in fish oils and take supplements of vitamin E and garlic.