Understanding the Causes and Risks of Pulmonary Embolism

Written by Medicover Team and Medically Reviewed by Dr Alla Bhagyaraj , Pulmonologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Pulmonary embolism (PE) is a serious and potentially life-threatening condition that occurs when one or more pulmonary arteries in the lungs become blocked, most commonly by a blood clot. In most cases, these clots originate in the deep veins of the legs or pelvis-a condition known as deep vein thrombosis (DVT)-and travel through the bloodstream to the lungs.

The blockage can reduce or completely stop blood flow to parts of the lungs, impair oxygen exchange, and place significant strain on the heart. Without prompt diagnosis and treatment, pulmonary embolism can lead to severe complications or even death. Recognizing the causes, risk factors, symptoms, diagnosis, and treatment options is essential for early intervention, improving outcomes, and preventing recurrence.

What Are the Symptoms of Pulmonary Embolism?

Symptoms of pulmonary embolism can vary greatly depending on the size of the clot and the part of the lung affected. Common symptoms include:

Shortness of Breath: Sudden and unexplained difficulty breathing, which worsens with exertion.
Chest Pain: Sharp, stabbing pain that may become worse with deep breathing, coughing, or eating.
Cough: A persistent cough that may produce bloody or blood-streaked sputum.
Leg Pain or Swelling: Particularly in the calf, which can indicate DVT.
Rapid or Irregular Heartbeat: Known as arrhythmia.
Dizziness or Fainting: Due to decreased oxygen levels in the blood.

What Causes Pulmonary Embolism?

The primary cause of pulmonary embolism is the formation of blood clots, known as thromboembolisms. These clots often originate in the deep veins of the legs, a condition known as deep vein thrombosis (DVT). When part of a clot breaks off, it can travel through the bloodstream to the lungs, causing a blockage.

Other less common causes of pulmonary embolism include:

Fat Embolism: Fat particles enter the bloodstream, often due to fractures of long bones.
Air Embolism: Air bubbles entering the bloodstream, which can occur during certain medical or surgical procedures.
Amniotic Fluid Embolism: Amniotic fluid enters the mother's bloodstream during childbirth.
Tumour Embolism: Cancer cells break off from a tumour and travel to the lungs.

When Should You See a Doctor for Pulmonary Embolism?

If you have symptoms that could indicate pulmonary embolism, consult a pulmonologist or cardiologist immediately. Prompt medical evaluation is essential because a pulmonary embolism can rapidly reduce oxygen supply, damage the lungs and heart, and become life-threatening without urgent treatment.

You should see a doctor if you have:

Sudden shortness of breath or unexplained chest pain.
Persistent cough with blood-streaked sputum.
Leg swelling or pain, especially in one calf.

Get medical help immediately if:

Severe breathing difficulty or loss of consciousness.
Chest pain with rapid heartbeat or bluish lips.
Coughing up significant amounts of blood.

These could be signs of a serious complication of Pulmonary Embolism and require urgent medical care.

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How is Pulmonary Embolism Diagnosed?

Diagnosing pulmonary embolism involves a combination of clinical evaluation, imaging tests, and laboratory tests. Common diagnostic methods include:

Imaging Tests

CT Pulmonary Angiography: The most common test, which provides detailed images of blood flow in the lung arteries.
Ventilation-Perfusion (V/Q) Scan: Measures air and blood flow in the lungs, used when CT is contraindicated.
Ultrasound: Primarily used to detect DVT in the legs.
Chest X-ray: Helps rule out other conditions with similar symptoms.

Laboratory Tests

D-dimer Test: Measures a substance that is released when a blood clot breaks up. Elevated levels suggest the presence of abnormal blood clotting.
Arterial Blood Gas Analysis: Measures oxygen and carbon dioxide levels in the blood.
Troponin and BNP Levels: Cardiac markers that can indicate strain on the heart due to PE.

What Are the Treatment Options for Pulmonary Embolism?

The treatment of pulmonary embolism aims to prevent the clot from growing, stop new clots from forming, and dissolve or remove the existing clot. The treatment approach depends on the size of the clot, the severity of symptoms, and the patient's overall health.

Anticoagulant Medications

Heparin: Often given intravenously or by injection to prevent new clots from forming.
Warfarin: An oral anticoagulant used for long-term treatment.
Direct Oral Anticoagulants (DOACs): Such as rivaroxaban and apixaban, which are easier to manage and do not require regular blood tests.

Thrombolytic Therapy

Also known as "clot busters," these medications are used to dissolve large clots in emergency situations. They are typically reserved for severe cases due to the risk of severe bleeding.

Surgical Interventions

Catheter-directed Thrombolysis: A procedure where medication is delivered directly to the clot through a catheter.
Embolectomy: Surgical removal of the clot, used in life-threatening cases where other treatments are not effective.
Inferior Vena Cava (IVC) Filter: A device implanted in the large vein (vena cava) to prevent clots from travelling to the lungs. This is usually reserved for patients who cannot take anticoagulants.

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What Are the Risk Factors for Pulmonary Embolism?

Certain factors can increase the likelihood of developing blood clots and, consequently, pulmonary embolism. Recognizing these risk factors can help reduce the chances of developing this potentially life-threatening condition.

Medical Conditions

Deep Vein Thrombosis (DVT): The primary precursor to pulmonary embolism.
Inherited Clotting Disorders: Genetic conditions that increase the tendency to clot.
Cancer: Particularly cancers of the pancreas, ovary, lung, and gastrointestinal tract.
Heart Disease: Particularly heart failure, which increases the risk of clot formation.

Lifestyle Factors

Prolonged Immobility: Extended periods of inactivity, such as bed rest or long flights.
Obesity: Excess weight increases pressure in the veins of the legs and pelvis.
Smoking: Damages blood vessels and increases the risk of clot formation.

Hormonal Factors

Hormone Replacement Therapy: Especially estrogen therapy, which increases clotting risk.
Birth Control Pills: Certain contraceptives that contain estrogen can increase clotting risk.
Pregnancy: Increases pressure in the pelvis and veins, and hormonal changes increase clotting risk.

Surgical and Medical Interventions

Surgery: Orthopaedic surgery, especially, can increase the risk of clot formation.
Catheters: Long-term use of intravenous catheters can increase clot risk.

How Can Pulmonary Embolism Be Prevented?

Preventive measures are crucial, especially for individuals at high risk. Taking steps to improve blood circulation and reduce clot formation can significantly lower the risk of pulmonary embolism.

Anticoagulation Therapy: For individuals with a history of DVT or PE.
Compression Stockings: To improve blood flow in the legs.
Lifestyle Modifications: Maintaining a healthy weight, quitting smoking, and staying active.
Prophylactic Anticoagulation: For patients undergoing surgery or those on long-term bed rest.