Pulmonary Embolism

The type and extent of symptoms of a pulmonary embolism will depend on the size of the embolism and whether the person already has existing heart and/or lung problems. The following are the most common symptoms, but you may experience symptoms differently – and these symptoms may resemble other conditions or medical problems, so it’s always best to talk with your doctor. Pulmonary embolism symptoms include:

• Sudden shortness of breath (most common)
• Chest pain (usually worse with breathing)
• A feeling of anxiety
• A feeling of dizziness, lightheadedness, or fainting
• Palpitations (heart racing)
• Coughing up blood (hemoptysis)
• Sweating
• Low blood pressure

Symptoms of Deep Vein Thrombosis:

• Pain in the affected leg (may occur only when standing or walking)
• Swelling in the leg
• Soreness, tenderness, redness, and/or warmth in the leg(s)
• Redness and/or discolored skin

Pulmonary embolism is often difficult to diagnose because the signs and symptoms of PE mimic those of many other conditions and diseases. In addition to a complete medical history and physical examination, diagnostic procedures for a pulmonary embolism may include any, or a combination, of the following:

• Chest X-Ray: A type of diagnostic radiology procedure used to assess the lungs as well as the heart. Chest X-rays may provide important information regarding the size, shape, contour, and anatomic location of the heart, lungs, bronchi, great vessels (aorta and pulmonary arteries), and mediastinum (area in the middle of the chest separating the lungs).
• Ventilation-Perfusion Scan (V/Q Scan): A type of nuclear radiology procedure in which a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the lungs. A ventilation scan evaluates ventilation, or the movement of air into and out of the bronchi and bronchioles. A perfusion scan evaluates blood flow within the lungs.
• Pulmonary Angiogram: An X-ray image of the blood vessels used to evaluate various conditions. A dye (contrast) will be injected through a thin flexible tube placed in an artery. This dye makes the blood vessels visible on X-ray.
• Spiral Computed Tomography (Also Called CT or CAT Scan): A diagnostic procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. Contrast is a substance injected into an intravenous (IV) line that causes the particular organ or tissue under study to be seen more clearly. CT with contrast enhances the image of the blood vessels in the lungs.
• Magnetic Resonance Imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Duplex Ultrasound (US): A type of vascular ultrasound procedure done to assess blood flow and the structure of the blood vessels in the legs. Blood clots from the legs often dislodge into the lung. Since the treatment of DVT or deep venous thrombosis and PE are the same, US is a portable, less risky and cheaper alternative that gives your doctor the same information.
• Laboratory Tests: Blood tests to check the blood's clotting status, including a test called D-dimer level. Other blood work may include testing for genetic (inherited) disorders that may contribute to abnormal clotting of the blood. In addition, arterial blood gases may be checked to determine the amount of oxygen in the blood.
• Electrocardiogram (ECG or EKG): One of the simplest and fastest procedures used to evaluate the heart. Electrodes (small, plastic patches) are placed at certain locations on the chest, arms, and legs. When the electrodes are connected to an ECG machine by lead wires, the electrical activity of the heart is measured, interpreted, and printed out for the doctor's information and further interpretation.
  
  

Specific treatment for pulmonary embolisms will be determined by your doctor based on your age, overall health, medical history, the extent of the disease and your tolerance for specific medications, procedures, or therapies. Of course, your personal opinions and preferences will also be taken into consideration. Treatments may include:

Medications

• Anticoagulants: Also described as blood thinners, these medications decrease the ability of the blood to clot. Examples of anticoagulants include warfarin (Coumadin) and heparin.
• Fibrinolytic Therapy: Also called clot busters, these medications are given intravenously (IV) to break down the clot.

Surgery

• Vena Cava Filter: A small metal device may be used to prevent clots from traveling to the lung. These filters are generally used in patients who cannot receive anticoagulation treatment (for medical reasons), who develop additional clots even with anticoagulation treatment, or who develop bleeding complications from anticoagulation.
• Pulmonary Embolectomy: Surgical removal of a pulmonary embolism. This procedure is generally performed only in severe situations in which the PE is very large, the patient either cannot receive anticoagulation and/or thrombolytic therapy due to other medical considerations or has not responded adequately to those treatments, and the patient's condition is unstable.
• Percutaneous Thrombectomy: Insertion of a catheter (long, thin, hollow tube) to the site of the embolism, using X-ray guidance. Once the catheter is in place, the catheter is used to break up the embolism, extract it (pull it out), or dissolve it by injecting thrombolytic medication.

Our pulmonary rehabilitation programs at INTEGRIS help you by creating individualized plans and education, so you can do more things you enjoy. Support services include:

• Stress management, relaxation exercises and emotional support
• Medication management
• Exercises for physical conditioning programs
• Assistance with obtaining respiratory equipment and portable oxygen
• Lung medication
• Infection control
• Oxygen and equipment