Pulmonary Embolism

What is Pulmonary Embolism?

• Pulmonary embolism (PE) is a blockage of blood vessels supplying the lungs (pulmonary artery) due to blood clot.
• These blood clots arise from deep veins of lower leg or thigh or arm (Deep vein thrombosis aka DVT).
• This leads to decreased blood flow to the lungs, decreased oxygen levels that can potentially be dangerous and life-threatening.

What are the Consequences of Pulmonary Embolism?

• Most PE cases are not diagnosed, hence not treated.
• DVT precedes PE which itself may not be diagnosed. Symptomatic DVT presents with the swollen limb.
• DVT can lead to PE and consequent death in up to 70% of cases.

What are the causes of pulmonary embolism?

• Deep vein thrombosis
• Cancer
• Air bubbles in the lungs
• Fat from the bone injuries or fracture

What increases the risk of developing Pulmonary Embolism?

• Recent surgeries of the spinal cord, hip or knee
• DVT
• Carcinoma treated with chemotherapy
• Chronic lung or cardiac disease(Heart failure)
• Blood clotting disorder
• Brain stroke
• History of venous catheterization
• Prolonged immobility due to patient who is older age, bedridden, recent major surgery or intensive care unit.
• Medications containing estrogen-like Oral contraceptive pills and hormone replacement therapy
• Obesity
• Pregnant and lactating women
• Smoking

What are the symptoms of pulmonary embolism?

• Breathlessness
• Palpitations
• Chest pain or discomfort
• Giddiness and sudden loss of consciousness
• Coughing up blood

What are the complications of pulmonary embolism?

• Despite modern therapies for 8-10% affected by pulmonary embolism die.
• Pulmonary hypertension: Increased blood pressure in the lungs and right side of the heart.
• In rare conditions, fragmented blood clots get deeply deposited in medium to small-sized blood vessels leading to chronic thromboembolic pulmonary hypertension (CTEPH).

How is pulmonary embolism diagnosed?

• CT pulmonary angiogram: Definitive test that identifies blood clots in pulmonary arteries as well as the severity of the problem.
• Electrocardiogram
• Echocardiogram
• Venous duplex ultrasound: the test is to identify blood clots in the deep vein
• Blood tests: D-Dimer test
• Chest X-ray
• Medical history
• Physical examination

How is pulmonary embolism prevented?

Non-pharmacological treatment:

• Drink plenty of water
• Avoid standing/sitting for a long duration
• Maintain a healthy weight
• Use compression stockings to prevent DVT (Deep vein thrombosis)
• Quit smoking
• Regular exercise
• Do not take over the counter drugs without suggestion from your doctor. 

Pharmacological treatment:

• Anticoagulation therapy (Heparin, warfarin, enoxaparin or fondaparinux) is the first-line treatment for acute PE to dissolve the clot.
• Although anticoagulants are the first-line therapy for PE, some patients may get benefit from added therapy like clot-buster drugs (thrombolysis or fibrinolysis) if they fulfil the following criteria

1) Evidence of moderate to severe right ventricle injury

2) Evidence of respiratory or circulatory insufficiency in PE patients

• Thrombolytic agents (streptokinase, urokinase, tissue plasminogen activator) prescribed for breaking the clots through a catheter (Catheter-directed thrombolysis).
• Thrombus aspiration using Penumbra technology.
• Embolectomy: This surgery used a flexible tube to remove embolus in the artery or vein.

What is the uniqueness of treatment of pulmonary embolism by Dr C Raghu?

Dr Raghu and team use new technology, Penumbra, for thrombus aspiration after identifying the location and size of the thrombus and remove the clot with higher success rate and symptoms improve.