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
- 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
- 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
- Pregnant and lactating women
What are the symptoms of pulmonary embolism?
- 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.
- 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?
- 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.
- 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.