Pulmonary Embolism

What is a Pulmonary Embolism?

Pulmonary embolism is the blockage of one or more pulmonary arteries in the lungs by a blood clot. Pulmonary embolism is among the diseases with a very high risk of being life-threatening.

What Causes Pulmonary Embolism?

There are three main causes of pulmonary embolism. The first is damage to the endothelium, the inner lining of the blood vessels. The second is stasis, a slowing or stagnation of blood flow within the vessels. The third is an increased tendency for blood clotting.

A clot formed in the deep veins of the lower extremities (legs and feet) and, less commonly, in the veins of the abdomen due to these three factors travels to the right ventricle of the heart. From there, it reaches the lungs through the pulmonary arteries, causing an embolism.

The clot that reaches the lungs blocks one or more large or small vessels on either the right or left side of the lungs, depending on its size, disrupting circulation in that part of the lung. The larger the vessels blocked in the lungs, the more severe the consequences.

What Are the Risk Factors for Pulmonary Embolism?

In healthy individuals, there is a balance between the cellular components that contribute to blood clotting and the factors that prevent clotting. Certain conditions and diseases can disrupt this balance, leading to clotting within the vessels without injury. Factors that can contribute to this include:

Trauma: There is a risk of embolism, especially with fractures of long bones.

Surgical procedures: Damage to any vessel during surgery can result in embolism. Abdominal surgeries, leg surgeries, or surgeries involving general anesthesia and lasting for extended periods can lead to embolism in the days following surgery.

Prolonged immobility: Extended bed rest due to surgery, heart attack, leg fracture, trauma, or any serious illness can facilitate blood clot formation.

Long journeys: Prolonged immobility during long flights or car journeys slows blood flow in the legs and leads to clot formation.

Medications: Oral contraceptives (birth control pills) can lead to an increased tendency to clot, causing embolism.

Genetic predisposition: Some individuals have a higher risk of developing embolism due to a genetic tendency toward clotting within the vessels (e.g., Protein C and S deficiency, Factor V Leiden mutation, Homozygous prothrombin gene mutation, antithrombin III deficiency).

Cancer: Cancers of the pancreas, ovaries, and lungs, as well as various cancers that have spread to distant parts of the body, increase the risk of pulmonary embolism by causing an increase in certain substances responsible for blood clotting. Additionally, chemotherapy treatment is another risk factor that increases the risk of clot formation.

Smoking: Smoking, especially when combined with other risk factors, makes some people more prone to clot formation.

Being overweight: Obesity increases the risk of blood clotting, particularly in women who smoke or have high blood pressure.

Symptoms of Pulmonary Embolism

The symptoms of pulmonary embolism include sudden onset shortness of breath, sharp chest pain that worsens with breathing, palpitations, and bloody sputum. One or more of these symptoms may occur together. Sudden fainting due to blockage of the main vessel by a large clot or sudden death due to blockage of both vessels can also occur.

The symptoms of pulmonary embolism can vary greatly depending on how much of the lungs are affected by the clot, the size of the clots, and whether there is an underlying lung or heart condition.

How is Pulmonary Embolism Diagnosed?

The definitive diagnosis of pulmonary embolism is made through a contrast-enhanced lung CT scan taken under the embolism protocol.

One of the most important aspects of diagnosis is taking a good patient history and considering the possibility of embolism. Symptoms such as shortness of breath, bloody sputum, and side pain, which are signs of embolism, can also appear in many other chest diseases. If the patient’s history, sudden onset, and the presence of risk factors suggest pulmonary embolism, the first step should be a simple blood test.

In pulmonary embolism, the value of a test called D-dimer increases, but it is not sufficient for a definitive diagnosis. In patients suspected of embolism with elevated D-dimer levels, a definitive diagnosis is made through a lung CT scan performed under the embolism protocol using contrast material. The result of this scan identifies which vessel in the lung contains a clot. Doppler ultrasound should also be performed on the deep veins of the legs to determine where the clot originated.

Can Pulmonary Embolism Be Fatal?

Pulmonary embolism is a disease with a high mortality rate. A blood clot that nearly completely blocks both pulmonary arteries can result in the patient’s death.

How is Pulmonary Embolism Treated?

Treatment for pulmonary embolism varies depending on whether it is mild, moderate, or severe.

In cases of mild to moderate pulmonary embolism, treatment with blood-thinning medications, known as anticoagulants, is usually sufficient. Heparin is an anticoagulant, and treatment typically begins with heparin. It can be administered intravenously or subcutaneously.

If the patient’s kidney function is adequate, the subcutaneous form of heparin is easier to use. For intravenous heparin, regular blood tests are needed to ensure its effectiveness. After five days of heparin treatment, anticoagulant tablets are continued orally for 3-6 months.

In severe pulmonary embolism, both main pulmonary arteries are blocked. The patient develops sudden shock and must be treated in an intensive care setting. In such cases, fibrinolytic therapy, which involves drugs that dissolve the clots blocking the vessels, is administered intravenously.

The choice of treatment for pulmonary embolism is determined by evaluating the patient’s risk factors.

Anticoagulant medications prevent clotting in the blood and the formation of new clots, but they do not dissolve the existing clot blocking the vessel. The clot in the vessel dissolves through the body’s natural clot-dissolving mechanisms, and this occurs over time. The body begins the process of dissolving the existing clot within the first 24 hours.

Can Pulmonary Embolism Be Cured?

If pulmonary embolism does not occur with a severe, large blockage, the chances of recovery are very high. Following a pulmonary embolism, treatment should be applied correctly, and regular check-ups are essential.

How Long Does Pulmonary Embolism Treatment Last?

Treatment for pulmonary embolism lasts at least three months. However, this period can be extended depending on the severity of the disease and the patient’s risk factors. In cases where the patient has a genetic predisposition (e.g., Protein C and S deficiency, Factor V Leiden disease, Homozygous prothrombin gene mutation, antithrombin III deficiency),they may need to take blood-thinning medications for life.

What Should Pulmonary Embolism Survivors Be Careful About?

Pulmonary embolism is a life-threatening disease with a risk of recurrence. Survivors of pulmonary embolism should take the following precautions:

• Use prescribed blood-thinning medications regularly.
• Regular doctor check-ups are essential.
• Weight loss is necessary, as excess weight increases the risk of clots.
• Quit smoking.
• Avoid birth control pills, or use them cautiously if necessary.
• Regular exercise and a healthy diet help maintain vascular health.
• People who work or travel for long periods without movement should drink plenty of water, stand up and walk around every hour, and move their legs.
• Wearing compression stockings, known as special stockings, to prevent clot formation in the legs can be helpful. These stockings become tighter towards the ankle, helping blood move upwards from the leg muscles.
• Avoid foods rich in vitamin K, which aids blood clotting. For this purpose, after consulting with a doctor, it may be necessary to limit the consumption of vitamin K-rich green leafy vegetables, fish, liver, and certain types of vegetable oils.

How Can Pulmonary Embolism Be Prevented?

Preventive measures against clot formation within the vessels can reduce the risk of pulmonary embolism.

Achieving an ideal body weight is very helpful in preventing a tendency toward clotting and reducing the burden on the legs. For this reason, adopting a habit of adequate and balanced nutrition is essential, and if necessary, appropriate diet programs should be applied under the supervision of a dietitian.

Regular exercise appropriate to body characteristics and age should be practiced. A sedentary lifestyle should be avoided. People traveling for long periods should take intermittent breaks and move their legs.

Drinking plenty of fluids reduces the tendency for blood clotting. Since the use of tobacco products greatly increases the risk of clotting within the vessels, smoking should be stopped.

Consult a doctor before using medications containing estrogen and testosterone. High-risk patients should wear protective compression stockings on their legs.