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Pulmonary embolism

Pulmonary embolism
A lung illustration depicting a pulmonary embolism as a thrombus (blood clot) that has travelled from another region of the body, causes occlusion of the pulmonary bronchial artery, leading to arterial thrombosis of the superior and inferior lobes in the left lung
SpecialtyHematology, cardiology, pulmonology
SymptomsShortness of breath, chest pain, coughing up blood[1]
ComplicationsPassing out, abnormally low blood pressure, sudden death;[2] chronic thromboembolic pulmonary hypertension (long-term complication)
Usual onsetAdvanced age[3]
Risk factorsCancer, prolonged bed rest, blunt trauma, smoking, stroke, certain genetic conditions, estrogen-based medication, pregnancy, obesity, after surgery[3]
Diagnostic methodBased on symptoms, D-dimer, CT pulmonary angiography, lung ventilation/perfusion scan[4]
TreatmentAnticoagulants (heparin, warfarin, DOACs)[5]
Frequency~450,000 per year (USA), 430,000 (Europe)[6][7][8]
Deaths>10–12,000 per year (US),[9] >30–40,000 per year (Europe)[10]

Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism).[6] Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood.[1] Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg.[1] Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever.[11] Severe cases can lead to passing out, abnormally low blood pressure, obstructive shock, and sudden death.[2]

PE usually results from a blood clot in the leg that travels to the lung.[6] The risk of blood clots is increased by advanced age, cancer, prolonged bed rest and immobilization, smoking, stroke, long-haul travel over 4 hours, certain genetic conditions, estrogen-based medication, pregnancy, obesity, trauma or bone fracture, and after some types of surgery.[3][12] A small proportion of cases are due to the embolization of air, fat, or amniotic fluid.[13][14] Diagnosis is based on signs and symptoms in combination with test results.[4] If the risk is low, a blood test known as a D-dimer may rule out the condition.[4] Otherwise, a CT pulmonary angiography, lung ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis.[4] Together, deep vein thrombosis and PE are known as venous thromboembolism (VTE).[15]

Efforts to prevent PE include beginning to move as soon as possible after surgery, lower leg exercises during periods of sitting, and the use of blood thinners after some types of surgery.[16] Treatment is with anticoagulants such as heparin, warfarin or one of the direct-acting oral anticoagulants (DOACs).[5] These are recommended for at least three months.[5] However, treatment using anticoagulants is not recommended for those at high risk of bleeding, as well as those with renal failure.[17] Severe cases may require thrombolysis using medication such as tissue plasminogen activator (tPA) given intravenously or through a catheter, and some may require surgery (a pulmonary thrombectomy).[18] If blood thinners are not appropriate, a temporary vena cava filter may be used.[18]

Pulmonary emboli affect about 430,000 people each year in Europe.[8] In the United States, between 300,000 and 600,000 cases occur each year,[6][7] which contribute to at least 40,000 deaths.[9] Rates are similar in males and females.[3] They become more common as people get older.[3]

  1. ^ a b c "What Are the Signs and Symptoms of Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 9 March 2016. Retrieved 12 March 2016.
  2. ^ a b Goldhaber SZ (2005). "Pulmonary thromboembolism". In Kasper DL, Braunwald E, Fauci AS, et al. (eds.). Harrison's Principles of Internal Medicine (16th ed.). New York: McGraw-Hill. pp. 1561–65. ISBN 978-0-07-139140-5.
  3. ^ a b c d e "Who Is at Risk for Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 15 February 2016. Retrieved 12 March 2016.
  4. ^ a b c d "How Is Pulmonary Embolism Diagnosed?". NHLBI. July 1, 2011. Archived from the original on 7 April 2016. Retrieved 12 March 2016.
  5. ^ a b c Cite error: The named reference Chest2016 was invoked but never defined (see the help page).
  6. ^ a b c d "What Is Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 12 March 2016. Retrieved 12 March 2016.
  7. ^ a b Rahimtoola A, Bergin JD (February 2005). "Acute pulmonary embolism: an update on diagnosis and management". Current Problems in Cardiology. 30 (2): 61–114. doi:10.1016/j.cpcardiol.2004.06.001. PMID 15650680.
  8. ^ a b Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. (November 2014). "Thrombosis: a major contributor to global disease burden". Arteriosclerosis, Thrombosis, and Vascular Biology. 34 (11): 2363–71. doi:10.1161/atvbaha.114.304488. PMID 25304324.
  9. ^ a b Barco S, Valerio L, Ageno W, Cohen AT, Goldhaber SZ, Hunt BJ, et al. (October 2020). "Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000–18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database". The Lancet. Respiratory Medicine. 9 (1): 33–42. doi:10.1016/S2213-2600(20)30417-3. PMC 7550106. PMID 33058771.
  10. ^ Cite error: The named reference Barco_2020_EU was invoked but never defined (see the help page).
  11. ^ Tintinalli JE (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) (7 ed.). New York: McGraw-Hill Companies. p. 432. ISBN 978-0-07-148480-0.
  12. ^ Di Nisio, Marcello; Van Es, Nick; Büller, Harry R. (30 June 2016). "Deep vein thrombosis and pulmonary embolism". The Lancet. 388 (10063): 3060–3073. doi:10.1016/S0140-6736(16)30514-1. PMID 27375038. S2CID 25712161. Retrieved 18 November 2022.
  13. ^ "What Causes Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 7 April 2016. Retrieved 12 March 2016.
  14. ^ Pantaleo G, Luigi N, Federica T, Paola S, Margherita N, Tahir M (2014). "Amniotic fluid embolism: review". Current Pharmaceutical Biotechnology. 14 (14): 1163–67. doi:10.2174/1389201015666140430161404. PMID 24804726.
  15. ^ "Other Names for Pulmonary Embolism". July 1, 2011. Archived from the original on 16 March 2016. Retrieved 12 March 2016.
  16. ^ "How Can Pulmonary Embolism Be Prevented?". NHLBI. July 1, 2011. Archived from the original on 7 April 2016. Retrieved 12 March 2016.
  17. ^ Tarbox, Abigail K; Swaroop, Mamta (2013). "Pulmonary Embolism". International Journal of Critical Illness and Injury Science. 3 (1). nternational Journal of Critical Illness and Injury Science: 69–72. doi:10.4103/2229-5151.109427. PMC 3665123. PMID 23724389.
  18. ^ a b "How Is Pulmonary Embolism Treated?". NHLBI. July 1, 2011. Archived from the original on 9 March 2016. Retrieved 12 March 2016.

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