What is massive pulmonary embolism?
Massive pulmonary embolism is when the blood clot ends up obstructing 50% or more of the pulmonary artery blood flow. When this condition occurs, medical care must be immediate as the risk of sudden death is greater.
Pulmonary embolism: when can it occur?
Some situations favor the appearance of pulmonary embolism, such as:
Postpartum pulmonary embolism
One of the changes in the female body during pregnancy is that the clotting system naturally becomes more active.
Thus, the risk of thromboembolism increases, especially in high-risk pregnancies.
According to data from the Maternal Mortality Committee, of the Ministry of Health, about 2.5% of the causes of death from pregnancy complications occur due to pulmonary embolism.
In addition, during complicated deliveries, amniotic fluid can be forced into the pelvic veins and can be carried through the bloodstream to the pulmonary artery and obstruct blood circulation.
Pulmonary embolism after surgery
After surgeries, especially those in which the patient must go through a long period of rest, the chances of pulmonary embolism increase.
In such cases, the patient must remain still for a long time, which increases the chances of the formation and spread of clots that can obstruct the pulmonary artery.
Chronic pulmonary embolism
When the patient presents with a single picture of pulmonary embolism and recovers normally, this situation is classified as acute pulmonary embolism .
However, about 4% of patients are unable to get rid of all clots, which again puts them at risk of having another picture of pulmonary embolism. When this happens, we have a picture of chronic pulmonary embolism .
What causes pulmonary embolism?
The reason that pulmonary embolism occurs is some material, usually blood clots, that builds up and gets stuck in an artery in the lungs.
Such clots usually come from deep veins in the legs, in a condition known as deep vein thrombosis (DVT).
One of the main reasons for the formation of clots is physical inactivity. If a person spends a lot of time sitting, gravity can cause blood to stagnate in the lower areas of the body, that is, in the legs.
Therefore, it is common for embolism to happen to people who travel a lot and spend a lot of time in the car, or patients who must be bedridden for a long time.
In the vast majority of cases of pulmonary embolism, several clots are involved in the development of the disease, but not necessarily all at once.
What happens is that the regions and that the blood can no longer flow, due to the obstruction caused by the clot, can die, which is known as pulmonary infarction .
In this way, it becomes more difficult for the lung to supply oxygen to the rest of the body.
Although the most common cause of pulmonary embolism is blood clots, often other substances can cause clogged arteries, such as:
After a fracture in a long bone, such as the tibia, fat fragmentation can occur. This fat can enter the bloodstream and obstruct the pulmonary artery.
During a complicated delivery, amniotic fluid can be forced into the pelvic veins, forming an embolus that can obstruct the pulmonary artery, causing embolism.
It can happen that gas bubbles form inside the bloodstream. This gas can end up clogging the pulmonary artery, causing embolism.
In many cases, it may happen that a piece of the tumor detaches from its original tissue and begins to travel through the bloodstream. Depending on its size, it can end up clogging the pulmonary artery.
Intravenous medications, heart valve infections and inflammation of veins with blood clots and infection can generate infected material that can obstruct the passage of blood in the pulmonary artery.
Deep vein thrombosis
The main risk factor for pulmonary embolism is the development of clots that obstruct the pulmonary arteries.
One of the main diseases that can cause these clots to appear is deep vein thrombosis .
The disease can be described as the appearance of a blood clot in some vein in the body, especially in the thigh or lower leg.
Other names that can describe the same condition are thromboembolism , post-thrombotic syndrome and post-paralytic syndrome .
What are the risk factors for pulmonary embolism?
There are several risk factors that can contribute to the onset of pulmonary embolism. Check out the main ones:
Surgical procedures, especially those involving the hip, pelvis or knee, increase the chance of developing blood clots.
Especially during the recovery period, prolonged inactivity can increase the chances of developing clots as well.
Cancer patients are at a higher risk of developing pulmonary embolism, as pieces of the tumor may come off their original site and obstruct the pulmonary arteries.
The family history of cardiovascular disease is a risk factor for both the development of blood clots and for other diseases, such as heart attack or stroke.
Fractures in the leg
Fractures in long bones, such as those in the leg, can cause the fat present in the bone marrow of these bones to enter the bloodstream, causing blood vessel clogging.
History of heart attack or stroke
People who have had other cardiovascular problems are more likely to form clots, which increases the chances of pulmonary embolism.
The obesity increases the risk for the emergence of blood clots in the lower parts of the body, which increases the chances of developing pulmonary embolism.
Read more: Learn how to prevent adult and childhood obesity
One of the risk factors for the appearance of clots in the lower parts of the body is sitting for a long time and not moving. So much so that this condition is quite common in drivers, who spend a lot of time sitting.
So make sure you keep moving and do regular physical activity.
Smoking causes inflammation of blood vessels, which, in turn, can significantly increase the formation of clots in the bloodstream.
People over 60 are more likely to develop blood clots in the lower parts of the body, which increases the chances of pulmonary embolism.
Hormone replacement of estrogen or testosterone
A study at the University of Nottingham, England, showed that oral hormone replacement can increase the risk of developing venous thrombosis by up to 58%.
This increases the possibility of blood clots and, consequently, pulmonary embolism.
Read more: Menopause treatment: hormone therapy and alternative measures
If the patient has very large clots, that is, that cause a major obstruction in the passage of blood, the first symptoms may be the sensation of imminent fainting or loss of consciousness.
In cases where the patient ends up fainting, the body may begin to tremble, as in a seizure.
In such cases, blood pressure may drop to very low levels (shock) and the skin may turn bluish (cyanosis). These are the cases where the patient is most at risk of sudden death.
The obstruction caused by a clot in the pulmonary artery can cause inflammatory responses in the body, which can lead to symptoms such as decreased oxygen levels in the arterial blood. Understand the main symptoms:
Shortness of breathe
One of the most characteristic symptoms of pulmonary embolism is shortness of breath even at rest.
The patient goes through this experience, also called dyspnea , because the lung is unable to perform gas exchange correctly because of the clot.
Hypoxemia happens when there is a low concentration of oxygen in the arterial blood. This symptom can result in agitation, mental confusion, tachycardia, arrhythmias and hypotension .
The patient may present a condition in which hypoxemia leads to constriction (narrowing) of the blood vessels, which increases the pressure inside the organ.
A very common symptom is chest pain, a pain in the chest , similar to the pain of a heart attack. This is one of the clear signs that it is necessary to seek urgent medical help.
About 10% of clots can cause pulmonary infarction, which is when arterial blood (rich in oxygen) cannot reach the lungs. This condition usually occurs in patients or other pre-existing cardiopulmonary diseases.
Due to the lack of oxygenation, the heart can be affected and start to not work properly, causing the patient to experience a drop in blood pressure.
Due to the lack of oxygen in the blood, the patient may have cyanosis, which is when the skin presents a bluish tinge at its extremities.
Other common symptoms of pulmonary embolism are:
- Pallor in the skin;
- Accelerated pulse;
- Cough with or without blood;
- Wheezing when breathing.
How to diagnose pulmonary embolism?
Pulmonary embolism can be diagnosed by the general practitioner and pulmonologist, through procedures such as computed tomography, x-ray , pulmonary angiography, ultrasound and magnetic resonance. Understand more:
Computed tomography is an examination made by the emission of several x-ray beams through a tube that rotates around the patient continuously.
The machine then transforms the collected information into detailed images, on different planes, of the human body.
It is not an invasive test, nor does it cause pain and, in the case of pulmonary embolism, it can help diagnose lung health and check for the presence of blood clots.
The x-ray examination generates images of the interior of the human body through the use of ionizing radiation.
It is less accurate than computed tomography, but it can be used by medical staff to assess the health status of the lungs. In the case of pulmonary embolism, it is used to check for the presence of obstructions in the pulmonary arteries.
Pulmonary angiography can also be called pulmonary arteriography and is an exam that provides radiographic images of blood vessels, assessing the flow of blood to the lungs.
Thus, it is possible to check for the presence of clots or obstructions in the pulmonary arteries.
The ultrasound Doppler can also get the names ultrasound Doppler or Doppler color .
Through it, it is possible to evaluate the circulation of blood vessels and the flow of blood in a certain organ or region.
Thus, the examination allows to check the presence of blood clots that can cause pulmonary embolism.
Magnetic resonance imaging uses a magnetic field that causes agitation in the body’s molecules to generate high resolution images from inside the human body, which can show the internal structures of the organs.
In this way, it can assess the health of the lungs and detect the presence of clots in the pulmonary arteries.
Is pulmonary embolism severe?
Pulmonary embolism can be considered a serious condition due to the risk of leading the patient to sudden death.
Estimates show that approximately 15% of cases of sudden death may be due to unidentified pulmonary embolism. However, this condition is treatable most of the time.
Approximately 85% of patients who go through this are able to heal through drug and surgical treatment.
Is there a cure?
Yes , pulmonary embolism is curable ! It occurs through treatment with anticoagulant drugs, which can clear the pulmonary arteries.
What is the treatment?
Once the doctor has suspected pulmonary embolism, he will probably recommend hospitalization of the patient for further examinations and for the treatment itself.
The conventional procedure uses a certain type of medication, but in rare cases surgery may be necessary.
The main type of treatment is the use of anticoagulant drugs, which can be administered orally or by injection. They are intended to prevent the growth of blood clots present in the body and the formation of new ones.
If the complementary exams confirm the suspicion of pulmonary embolism, the patient must take injections of anticoagulant medication for at least 5 days, in addition to starting treatment with oral anticoagulants for at least 3 months.
Thus, the recovery from the disease will be complete, especially in those cases where the disease is diagnosed early.
Some patients may use thrombolytic drugs, which are more effective in dissolving clots and, consequently, treating embolism.
However, the use of these drugs can induce bleeding, making their indication limited to some patients with greater clinical severity.
In rare cases, it may be necessary for the patient to undergo an embolectomy , a type of emergency surgery that aims to remove the clot that is blocking the pulmonary artery.
This surgery is done by inserting a catheter with a suction device at the tip in the artery. The catheter then pulls out the clot, allowing blood to circulate normally.
Filter in the inferior vena cava
For patients who have some kind of contraindication to the use of anticoagulants, or whose treatment with anticoagulants has no effect, it may be necessary to insert a vena cava filter.
The procedure is nothing more than a metal device that facilitates blood circulation in the place where the clot is located.
This device is placed through a catheter inserted through a vein in the neck or groin.
The drugs used to treat pulmonary embolism are anticoagulants and aim to prevent the growth of blood clots that are already present and the formation of new ones.
Among the main drugs, we can highlight:
- Rivaroxabana ( Xarelto , Rixantil , Vynaxa );
- Dabigatran Etexylate ( Pradaxa );
- Apixabana ( Eliquis );
- Edoxabana ( Lixiana )
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Once you have had a pulmonary embolism, your chances of developing another are greater, so some lifestyle changes are necessary.
Due to the use of anticoagulant drugs, for example, a change in diet may be necessary.
The intake of foods rich in vitamin K , which helps the body to carry out the blood clotting process correctly, for example, should be avoided during treatment, as they can prevent the drugs from working properly.
Thus, it is necessary to eat less dark green vegetables, limit the consumption of fish, liver and some types of vegetable oil.
Stopping drinking during treatment is also an important measure.
Some medications that can interfere with the functioning of anticoagulants, so, before taking any medication, talk to a doctor. In general, you should avoid:
- Flu medications;
- Pain medications;
- Sleeping medications;
Another life change to be adopted is physical activity. This will not only be good for your health as a whole, but it will also help blood circulation, preventing the formation of very large clots that can pose risks.
Especially if diagnosed early, the prognosis of pulmonary embolism is good. Through treatment with anticoagulants, it is possible to heal and return to normal activities.
However, it cannot always be diagnosed in time. In such cases, especially in cases of massive pulmonary embolism, the patient may suffer sudden death, usually within hours of the embolism occurring.
For this to happen, however, there are some factors that must be taken into account, such as the size of the clot, the size of the clogged arteries, the number of clogged arteries, the effect of the clog on the heart’s ability to pump blood and the general state of health person’s.
After treatment begins, it can take up to 12 months for the body to fully recover. Still, about 50% of patients have partial recovery.
However, if not treated properly, it can be fatal. Lethality in these cases is approximately 30%.
Complications: does pulmonary embolism leave sequelae?
There are some complications that can occur if the pulmonary embolism is not treated correctly or takes too long to be diagnosed. Understand:
Pulmonary hypertension occurs when the blood pressure in the lungs and the right side of the heart is higher than normal.
This is because, due to the presence of obstructions in the pulmonary arteries, the heart is forced to work harder to push blood into the vessels.
As a consequence, there is an increase in blood pressure within these vessels and the heart. This can lead to wear of these organs and increase the risk for other cardiovascular diseases, such as hypertension, heart attack and stroke.
During the process of dissolving blood clots, it is possible that the body is left with sequelae inside the veins, with the functioning of the valves compromised.
Because of these valve changes, the blood return is impaired and can lead to the appearance of swelling, varicose veins, darkening and hardening of the skin and even wounds.
If the disease is not diagnosed in time or is not treated correctly, the patient’s symptomatic condition can worsen drastically.
Difficulty in breathing can impair oxygenation of various organs, including the heart, which can lead to fatal cardiac arrest.
How to prevent pulmonary embolism?
There are several ways to prevent pulmonary embolism. Check out the main tips:
Cigarettes have more than 400 carcinogens and cancer is a risk factor for pulmonary embolism.
Some cases of this disease are caused by pieces of tumor that move from the place of origin and obstruct the pulmonary arteries.
In addition, one of the effects of nicotine in the blood is the narrowing of blood vessels, which increases the chances of clots forming.
Practice physical activity
Regular physical activity is one of the best ways to prevent disease. Through it, it is possible to improve the general state of health, as well as immunity, which helps to prevent infections.
In the case of pulmonary embolism, physical activity will help maintain the health of your blood vessels, preventing the appearance of clots and preventing the disease itself.
Avoid standing too many hours
Sitting and standing for long periods of time can hinder circulation, especially in the veins of the lower limbs, the legs. It is there that most clots form and then end up in the lungs.
If you have to spend a lot of time sitting, because of your work, for example, you can still prevent the formation of clots through these measures:
- Make sure there is a comfortable space for your legs;
- Bend and stretch your legs every 30 minutes while sitting;
- Take breaks to stand and stretch your legs after long periods of sitting;
- Press your feet against the floor from time to time.
These measures help to maintain circulation in the legs and prevent the formation of clots.
Excessive alcohol consumption can bring some problems to the heart, such as high blood pressure and increased risk of heart attack and stroke.
That’s because, when in excess, alcohol can cause irregular beats ( cardiac arrhythmia ), which can weaken the heart muscle as a whole over time.
In addition, alcohol can cause vasodilation, which allows clots previously trapped somewhere in the body to travel through the bloodstream, and can reach, for example, the pulmonary arteries.
There are other simple steps you can take on a daily basis that can decrease the chances of developing pulmonary embolism. Among them, the following stand out:
- Wear compression stockings during very long plane trips;
- Decrease the intake of coffee and other caffeinated beverages;
- Avoid taking sleeping pills;
- Drink water regularly;
- Wear comfortable clothes that do not tighten too much.
What is the difference between embolism and thrombosis?
Thrombosis is nothing more than blocking a blood vessel by clots, preventing blood from being transported. Embolism, on the other hand, is when a clot that is obstructing a vein travels to a pulmonary artery, preventing arterial blood (rich in oxygen) from bathing a certain area.
What causes pulmonary embolism?
Pulmonary embolism is caused when there is an obstruction in the pulmonary arteries, compromising the supply of oxygen to that organ. This obstruction is most commonly caused by a blood clot, but it can also be the result of air bubbles, pieces of tumor or fat from a broken bone.