Why aren’t your lungs working?
You’ve just come back from an awesome vacation, you’re at the grocery store getting what you need to restock your kitchen when you bend over to pick something up off the bottom shelf and you suddenly feel short of breath and have chest pain. It doesn’t get any better when you stand up. Are you having a heart attack? Why can’t you breathe?
A pulmonary embolism (PE) is when blood supply is cut off from your lungs due to a blockage. This blockage can be from a number of things, such as fat from the marrow of a broken long bone, collagen or other tissue, part of a tumor or air bubbles. The most common reason is because of blood clot that comes from somewhere else in your body and travels to your lungs through your bloodstream. This type of clot typically forms in larger, deeper veins and small portions can break off and enter the bloodstream. Typically, these types of clots are usually found in your lower legs and are called Deep Vein Thrombosis (DVT). Once the clot reaches the arteries of the lungs and causes the lack of blood flow to the lung tissue, the tissue begins to die (pulmonary infarction). This makes it difficult for your lungs to get oxygen to the other parts your body. This is why having a pulmonary embolism is considered a life-threatening emergency and needs immediate medical treatment.
Symptoms depend on the amount of lung tissue involved, the size of the clots and if you have any underlying health concerns. The most common symptom is shortness of breath that appears suddenly and gets worse the more you move. You can have chest pain that gets worse when you take a deep breath, cough, eat, bend or stoop. It also increases with exertion and doesn’t improve with rest. Coughing is the third common symptom and it can yield bloody or blood-streaked sputum (mucus). Other symptoms can include pain and/or swelling in one or both legs (usually in your calf), clammy/discolored skin (cyanosis), fever, excessive sweating, rapid/irregular heartbeat and being lightheaded/dizzy. Any one can develop blood clots that lead to pulmonary embolism but somethings put you at an increased risk, such as personal history of previous blood clot, family history of blood clots, heart disease, cancer, surgery, prolonged immobility (bed rest or long trips), smoking, being overweight, being pregnant and taking supplemental estrogen.
The goal of treatment for a pulmonary embolism is to prevent the current blood clot from increasing in size (hopefully get rid of it) and a future blood clot from occurring. The primary method to accomplish this is by using anticoagulants (blood thinners) to decrease your blood’s ability to clot. They usually come in the form of pills or injections that are given just beneath your skin. The main side of effect is an increased risk of bleeding. They do not break up existing clots. Thrombolytics (clot busters) are able to do this but come with a very high risk of bleeding and only done if the clots do not dissolve on their own. The clot could be removed via surgery if the clot is very large and life-threatening. For people who are unable to take anticoagulants and are not candidates for thrombolytics, a filter can be placed into the large vein (vena cava) in your abdomen. This prevents blood clots from reaching your lungs by catching them as they travel in your bloodstream past the filter.
The main focus of prevention for pulmonary embolism is prevention of a DVT in order to avoid any chance of a clot breaking off and reaching the lungs. This is mainly done through taking anticoagulants, wearing compression stockings, elevate your legs whenever possible and increasing your physical activity. When traveling, it is important to remember to drink plenty of fluids, take a break from sitting, flex your ankles frequently and wear support stockings. If you will be on bedrest for an extended period of time, your doctor may order pneumatic compression devices to be applied to your calves that intermittently, gently squeeze them in order to mimic the natural movement of your muscles and help to keep your blood from clotting.
Pulmonary embolisms are a serious medical condition that needs immediate medical treatment, but they are treatable. If you have any questions about pulmonary embolism, please speak with your doctor. If you would like more information, please visit the Society for Vascular Surgery’s pulmonary embolism page at https://vascular.org/patient-resources/vascular-conditions/pulmonary-embolism