What is the best treatment for pulmonary embolism?

WHAT IS PULMONARY EMBOLISM?

Pulmonary embolism can be defined as a blockage caused by blood clotting in one of the pulmonary arteries in the lungs.  These blood clots (usually small) may travel to the lungs from deep veins in the leg or any other part of the body. When the clot is large, blood flow to the lungs can be drastically affected and this could result in serious complications.

According to research, more than 300,000 persons develop pulmonary embolism yearly and its mortality rate is about 24% on an annual basis.

Pulmonary embolism can be quite dangerous and life-threatening since it affects the lungs but with early diagnoses and proper treatment, its risk can be reduced and properly managed.

CAUSES 

Pulmonary embolism is mostly caused by an obstruction in the pulmonary artery which is responsible for the blood supply of the lungs. These obstructions could include blood clotting, tumors, air bubbles, amniotic fluid. and rarely fat that is entered into the blood vessel when bones are broken.

However, the primary cause of pulmonary embolism is blood clotting in the deep veins of the legs that travel into the lungs. The part of the lungs affected will be deprived of nutrients and blood supply for its cells, leading to pulmonary infarction (death of the lungs or the affected part).

RISK FACTORS

Certain factors increase the tendencies for one to develop a pulmonary embolism. Such factors include

• Disorder in your blood which makes it clot too easily and quickly
• Sitting, standing, or staying in a spot for a long time, due to illness, inactivity due to surgery, etc
• Surgery involving the legs, hips, belly.
• Pregnancy
• Childbirth through cesarean section
• Smoking
• Disease involving certain cancer in the brain, ovary, pancreas, lungs, etc.
• Heart failure, stroke, and serious respiratory infections
• Birth control pills
• Increase in age
• Overweight or obesity
• People with conditions such as deep vein thrombosis
• People with the coronavirus are at risk of developing pulmonary embolism
• Long trips

HOW IS PULMONARY EMBOLISM DIAGNOSED?

It might be a bit difficult to effectively diagnose this condition due to similarities in its symptoms that it shares with other conditions such as heart attack, panic attack, pneumonia. However, when diagnosing for this condition, you will be

• Examined for the symptoms
• Personal medical history and family medical history will be checked
• Perform some blood tests  to rule out other conditions and to check for the level of oxygen and carbon dioxide in the blood, as a clot may reduce the oxygen level in the blood, and also to check if you have an inherited clotting disorder
• You will undergo some scans such as X-rays, computed tomography, angiogram, and a ventilation-perfusion lung scan.
• An electrocardiogram is also performed.

SYMPTOMS

Its symptoms are dependent on certain factors such as:

• Area of the lungs affected 
• Size of the blockage
• Respiratory infections
• Underlying disease

The symptoms of pulmonary embolism include:

• Sudden shortness of breath which gets worse with exertion
• Sharp pains at the chest especially when coughing or breathing deep or bending
• Coughing out pink or foamy mucus.
• Sweating a lot
• Dizziness
• Increase heart rate
• Anxiety
• Irregular heartbeat
• Fever
• Pains in the leg especially at the calf
• Discolored skin

TREATMENT 

The treatment of pulmonary embolism is dependent on how severe the condition is and can be treated. with 

• Medications 

Drugs such as anticoagulants help prevent the blood from clotting and if there are existing clots, they prevent them from getting bigger. The body, over time, will dissolve the clot on its own. They could be administered through the vein (intravenous) or taken as a pill (oral). This anticoagulant includes warfarin, heparin, etc. However, internal bleeding may be experienced as the side effect of this medication which occurs when the medication thins your blood too much. Your doctor will monitor your progress through a blood test

• Embolectomy

This is an emergency treatment that involves the use of a thin flexible tube that is inserted into your vein at your thigh or arm. They push it till it gets to the lungs and they remove the clot.

• Inferior Vena Cava Filter

The inferior vena cava which is a large vein that carries blood from the lower region of our body to the heart is inserted with a filter through surgery to prevent clots from entering into the lungs. This is done when anticoagulants can not be used due to surgery, stroke caused by bleeding, etc.

COMPLICATIONS 

When this condition is left untreated, it could lead to serious health complications and sometimes death. It could cause pulmonary hypertension, which involves the increase in the pressure of blood in the lungs and subsequently, the right side of your heart due to the increase in workload the heart must overcome in other to supply blood effectively to the body. Over time, this weakens the heart also.

Any complication which may arise when pulmonary embolism isn’t treated over some time is chronic thromboembolic pulmonary hypertension.

PREVENTION 

The prevention of clotting in the leg (deep veins of the leg) can be done through:

• The use of anticoagulant medications helps reduce the risk of blood coagulation especially in people that tend to their blood clotting easily.  It is administered to people about to undergo surgery, medical conditions such as heart attack, stroke, or some complicated cancer. They are also called blood thinners.
• After surgery, a kind of compression stockings may be given which help squeeze the legs to enhance the flow of blood. this is to avoid stagnating blood which might lead to clotting especially after surgery.
• Elevation of the leg; try as much as possible to make sure the leg is properly elevated, mostly during the night, especially for pregnant women. This can be quite effective. 
• Physical activity; try increasing your physical activity and avoid staying in one place for long to avoid stagnant blood and prevent pulmonary embolism, especially after surgery. It also helps in promoting healing and recovery. You might be a push to walk around the hospital a little despite the pain you may feel at the surgery site. This is to help prevent blood clotting
• Pneumatic compression involves the treatment of the use of thigh-high or calf-high cuffs that inflate and deflate air every minute to massage the vein in your legs and improve blood flow.
• Drink lots of water; you are advised to drink lots of water especially while on a very long trip. This will help keep you hydrated and prevent dehydration, which promotes the development of blood clotting.
• Try flexing your muscles every 15 to 30 minutes while sitting. Take a break while driving or sitting at least after every one hour. 

RECOVERY

The recovery of pulmonary embolism may take weeks or months depending on how severe the situation is and how soon it was diagnosed. To help promote recovery, you will have to

• Adjust your diet and reduce your intake of food rich in vitamin K as it helps promote blood clotting and increase your consumption of vegetables, fish, etc.
• Avoid medications such as aspirin, cold medications, pain, and sleeping pills, antibiotics, etc except it was recommended by the doctor.
• Exercise regularly.
• Since pulmonary embolism primarily starts in the leg, try using compression stockings. These compression socks are designed in such a way that they get tighter as they go down towards the ankle. This helps the blood circulation there.
• If you feel depressed about it, talk to someone. 

FAQs

• How long is the treatment for pulmonary embolism?

Pulmonary embolism treatment usually takes about 3months for treatment. After that, some reevaluation will be done to determine the risks and the benefit of continuing therapy.

• What is the best treatment for pulmonary embolism?

The best treatment of pulmonary embolism is anticoagulation therapy and the use of thrombolytics as it is less expensive compared to other treatment options involving surgery

• What causes recurrent pulmonary embolism?

Recurrent pulmonary embolism can be caused by proximal venous thrombosis. Recent studies have shown 17% of people with recurrent episodes of pulmonary embolism e proximal deep venous thrombosis.

• How often does deep venous thrombosis causes pulmonary embolism?

More than 50% of the recorded cases of pulmonary embolism has been caused by deep vein thrombosis. It is mostly checked for during diagnoses in other to rule out similar disease conditions with the same symptoms.

• What happens to the lungs after pulmonary embolism?

About 4% of people with pulmonary embolism suffer from chronic damage to the lungs. This condition is called chronic thromboembolic pulmonary hypertension. If left untreated, it could result in heart failure.