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Pulmonary Embolism

A pulmonary embolism is a clot that starts within the veins and moves up within the arteries into the lungs.

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Blood Clots:

Every 5-7 minutes, someone in Canada dies from a blood clot related health issue.

Pulmonary Embolism What is it?

Pulmonary embolisms, or PE for short can be very hard to detect. Only 50% of PE’s present symptoms at all. On the most part, PE’s start as a DVT or something similar within the femoral vein in the legs, then move up the femoral artery passing into the lungs.

As the blood clot passes within the artery of the lung and blocks blood flow, it can become very dangerous for the individual, or worse, fatal. This is called a pulmonary infarction.

Pulmonary Embolism Info Sheet:

Thrombosis Canada™ [ DOWNLOAD PDF ]

Statistics Statistics

At the moment, there isn’t a great deal of data collect on DVT+PE=VTE in Canada. We hope to one day to present more information as to the effects of pulmonary embolism.

"Although Canadian data are lacking, venous thromboembolism (VTE) is a common disease, affecting approximately 1-2 in 1,000 adults per year. Approximately one third of first VTE presentations are due to pulmonary embolism (PE) and the remainder are due to deep venous thrombosis (DVT)"

~ Source: ThrombosisCanada.ca

"Pulmonary Embolism – 3rd leading cause of cardiovascular death."

~ Source: ocfp.on.ca

"An estimated 45,000+ Canadians suffer from VTE related illnesses throughout Canada"

~ Source: Tagalakis V et al. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med 2013; 126: 13–21

Signs and Symptoms Signs & Symptoms

IF you experience ANY of these symptoms, call 911 immediately. Pulmonary Embolism is very serious since it can stop blood flow from entering your lungs.

Symptoms of Pulmonary Embolism:

• Shortness of breath
• Chest pain
• Rapid breathing
• Coughing up blood
• Fainting
• Rapid heart rate
• Sweating and anxiety
• Fainting

Symptoms of Deep Vein Thrombosis:

• Elastic sensation
• Finger imprinting
• Leg cramping
• Leg swelling
• Outer leg soreness
• Redness coloration
• Sharp pain in the calf
• Swollen foot
• Throbbing

Therapies Therapies

Certain measures need to be taken in order to investigate and diagnose a pulmonary embolism (PULL-mun-ary EM-bo-lizm). Talk to your doctor about your options.

PE Diagnosis:

Patient Assessment:

As all conditions, patients are first assessed by a medical professional. Factors are considered depending on the situation (ex. Patient history, trauma, surgery, risk assessment, etc.)

Blood Tests (D-Dimer):

Blood tests are done right away to measure the coagulation factor within a patient’s blood. This process includes a blood count and platelet count. The number of platelets in your blood determine the blood cell pieces that stick together, ultimately forming blood clots in the system.

Chest X-Ray:

A chest x-ray may be performed. They can give an image of the overall mapping of the lungs, but they cannot diagnose a pulmonary embolism, they can show doctors other factors which might be causing a patient’s symptoms.

Ultrasound:

An ultrasound is performed to have a visual understanding of the blockage in question. Measures are taken to ensure the DVT hasn’t moved into the arteries upwards towards the mid-section of the body. Ultrasounds can also look for signs that a blood clot has broken into smaller pieces.

Ultrasounds are also performed to test; compression, blood flow and possible pooling of blood. They can also measure the size and nature of the DVT in question.

MRI:

An MRI may be performed to create images of inside the body. MRI machines are powerful magnets that can see through the entire body and project the images on screen. This is a non-intrusive scan that can deliver quality results.

VQ-Scan - Lung Ventilation/Perfusion Scan:

This test measures the blood flow within the lungs. VQ-scans are divided between; ventilation and perfusion. The ventilation shows doctors the "air-flow" within the lungs, the perfusion scan shows the blood flow.

Both the ventilation and perfusion scan can give a clear and precise visual outlook for doctors to determine whether or not the lungs in question are not performing as required and measures need to be taken to determine further tests needed.

Multidetector CT pulmonary angiography (CTPA):

When all other tests fail, a pulmonary angiogram is performed. Due to their high-risk nature, these tests are a last resort. A catheter is inserted into your arterial system right up passed your heart into the lung arteries.

A die is then injected into the catheter in order to see abnormalities on an X-ray. As the die travels through the arteries, a blockage can be seen and detected.

PE Treatment:

Treatment for a pulmonary embolism depends on multiple factors. Doctors need to assess whether the patient requires more assistance in-house within the hospital, or whether can be discharged as an outpatient.

In-House Treatment:

Tachycardia (tak-ih-KAHR-dee-uh) Measured:

A patient’s heart rate is measured to ensure that all is well internally. That the body's functions are within normal parameters.

"Tachycardia carry a 15% risk of early mortality and should be admitted to an intensive care unit. Patients who are clinically-well and do not have evidence of myocardial injury or RV dysfunction are at low risk for early mortality (< 1%) and are appropriate for early discharge or home treatment."

~ Source: ThrombosisCanada.ca

Pulmonary Thromboendarterectomy (PTE Surgery):

In the case where a massive PE is detected, a small surgical procedure might be recommended which the clot is busted using the catheter inserted into the lung artery.

“The purpose of PTE surgery is to remove the tough fibrous material that is blocking the pulmonary arteries in order to allow the right side of the heart to work properly. With this material out of the way, blood can get to all parts of the lungs and oxygen pick up is improved. When these clots are removed from the pulmonary arteries, the heart and the lungs begin to work together better.”

~ Source: >OttawaHeart.ca

Outpatient Care:

VTE Treatment:

Anticoagulation Treatment:

A 7-day dose of Low-Molecular Weight Heparin is administered. Heparin injections react quickly to ensure anticoagulation prior to the oral medication(s) taking effect.

Oral Anticoagulation:

While the heparin takes effect, the patient is administered an oral anticoagulant (i.e. Coumadin, Xarelto, etc.). This treatment usually lasts up to 3 months depending on the severity of the VTE.

Outpatient Care:

Many VTE patients undergo “outpatient care” while treated their DVT and PE. Some patients may be required to have blood tests regularly performed depending on the nature of the medications.

For ex. Coumadin has to be regularly monitored, and INR test is performed to ensure the patient is taking the appropriate dose to stay at a therapeutic rate. Doses may be increased or decreased as needed.

Diet Changes:

Certain foods may need to be avoided. Leafy greens and certain fruits contain high concentrations of Vitamin K, which is a reversal agent (natural coagulant). Please talk to your doctor about options needed while taking your anticoagulants.

Physiotherapy:

Your doctor may recommend you undergo some form of non-intrusive physiotherapy to help rebuild the muscles in the affected area. DVT’s cause some damage internally, regular exercise when possible is recommended to help build healthy muscles to ensure blood flow is properly distributed throughout the body.

Lung Tests:

Certain air-quality tests may be done afterwards to ensure the airways are clear and gaining strength. Patients should report any problems breathing to their doctor(s) right away.

Prevention and Risks Prevention & Risks:

Preventing VTE’s should be everyone’s ultimate goal. Fact is, not all blood clots can be prevented unfortunately, but below are some common goals a person should want to achieve while living out their daily lives.

Risks of VTE Reoccurrence:

The risks of developing another pulmonary embolism after the initial PE is drastically increased. Patients should be conscious about their lifestyle choices to ensure their chances of VTE reoccurrence is diminished.

Prevention is the Key-2-DVT-Free:

Blood Pressure:

Ensuring your lifestyle includes regular blood pressure checks is very important. Blood clots are affected by blood pressure, or lack thereof.

Obesity:

Being overweight poses a great deal of risks to your health. One of those risks is developing a DVT. Being overweight puts a great deal of strain on your heart and also puts pressure on your veins and arteries. Your risks are higher.

Exercise:

Individuals who exercise regularly are less likely to develop DVT’s. Laziness doesn’t pay. Regular walks, stretching, yoga, and non-intrusive exercises strengthens muscles around the walls of your veins. Healthy muscles increase blood flow throughout the body.

NOTE: Excessive weight lifting can have the opposite effect causing blood vessels to burst, expand and retract.

Smoking:

As if we as humans need another reason to quit smoking, but as many already know, smoking causes arteries and veins to retract, thus causing blood flow problems. Smoking drastically affect blood pressure increasing the risks of developing blood clots.

Gaming:

Some “gamer’s” have been known to develop DVT clots simply by sitting for far too long at one time. Lack of movement causes blockages in the veins. The longer a person plays videos games without stretching, the longer they’re at risk of developing these silent killers.

Long Flights:

More and more we hear of the long-flight horror story. It’s a proven fact that long flights now pose serious risks to individuals because of the lack of movement while sitting for hours on end. Simple exercises to help open up the veins and to increase blood flow is now practiced by a great deal of airlines.

Flights that are 12 hours or longer increases the risks dramatically. Make sure to venture to the washroom at least once an hour. Practice safe sitting habits, while stretching out your pelvic area as much as possible.

Pregnancy:

Pregnancies are common factors for deep vein thrombosis. Pregnant mothers should take all precautions during their pregnancy. A great deal of studies has been done on the subject. More and more doctors are familiar with the risks involved. Make sure to speak to your doctor about your personal risks and what therapies and/or treatment options are available.

Trauma:

Trauma to the body is very unpredictable. A traumatic fall, car crash, sports injury, etc. can cause a lot of internal damage not seen by the naked eye. Any trauma should be treated seriously; measures should be taken to be checked by a local hospital for internal injuries that might affect blood flow in any way.

Surgeries:

Patients should be well informed about the risks of having surgeries performed. Even in the best circumstance, whenever a body is worked on, there are risks of bleeding, bruising and damaged arterial systems. Patients should make sure to discuss anticoagulant options, and make sure they keep their appointments.

Work Environment:

These days an average person works long hours, many of those hours are stuck behind a desk positioned within a chair not moving around much. This daily commitment to our work can cause complications since we tend not to think about the damage forming within our lower extremities. Getting up and stretching is very important to maintain healthy blood flow.

Medical Note:

Any and all information provided here is not designed to give medical advice and/or replace recommendations from doctors.
Information therein comes from personal experiences of thrombosis patients.

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