A pulmonary embolism occurs when a blood clot lodges in the lung’s blood vessels, reducing blood flow, impairing lung function and causing severe chest pain.
A pulmonary embolism is one of the more serious causes of chest pain, capable of causing permanent lung damage or death. Fortunately, prompt pulmonary embolism treatment greatly increases the chance of survival.
Pulmonary Embolism: How it Happens
Pulmonary embolisms rarely originate in the lungs. More often, the blood clot was formed in a distant part of the body.
A blood clot can form in any blood vessel. Most blood clots involved in pulmonary embolism, however, form in the deep veins of the legs. When a blood clot develops in the leg veins it is known as a DVT, or deep vein thrombosis.
A blood clot is referred to as a thrombus while it is attached to its point of origin. If the clot breaks loose from its point of origin, it can travel through the veins and the right side of the heart, ultimately lodging in the lung’s blood vessels and causing a pulmonary embolism.
Pulmonary Embolism Causes and Risk Factors
Pulmonary embolism can affect anyone at any age. Certain factors, however, increase the risk of pulmonary embolism.
Causes of pulmonary embolism are often identical to causes of abnormal blood clotting. In fact, 50 percent of patients requiring pulmonary embolism treatment have hereditary blood-clotting conditions.
After inherited blood conditions, surgery is one of the more common causes of pulmonary embolism. Surgical replacement of major joints (the hips and the knees) is responsible for many surgery-related pulmonary embolisms.
Estrogen-based birth control pills and hormone therapy alter a woman’s blood clotting factor levels, increasing her risk for pulmonary embolism. Estrogen levels also change radically during pregnancy. This is why pulmonary embolism is the leading cause of death for pregnant women.
Being inactive for long periods of time can reduce blood flow through the veins and can increase a person’s risk for developing blood clots. Thus, people who are bedridden for a long time and people who are sitting on an airplane for an extended period of time are at an elevated risk for pulmonary embolism due to DVT.
Other risk factors for pulmonary embolism include:
- cardiovascular disease
- family history
- high blood pressure
- inflammatory bowel disease
- some cancers.
Pulmonary Embolism Symptoms and Chest Pain
Chest pain and other pulmonary embolism symptoms vary in intensity from case to case. The size of the embolism, the number of emboli lodged in the lungs and the amount of lung tissue affected all influence pulmonary embolism symptoms. General health and the presence of lung or heart disease also affect symptom occurrence and severity.
Chest pain due to pulmonary embolism feels similar to chest pain that is often felt during a so-called classic heart attack. Pulmonary embolism chest pain is described as “stabbing,” “sharp” or “dull.” As with heart attack chest pain, pulmonary embolism chest pain can radiate to the shoulders, neck, jaw or arms.
Differentiating pulmonary embolism symptoms from other causes of chest pain requires a thorough medical exam. Some aspects of pulmonary embolism chest pain, however, do differ from other causes of chest pain. For instance, pulmonary embolism chest pain worsens with activity but does not dissipate with rest. Pulmonary embolism chest pain may also worsen during deep breathing, coughing and eating.
Other Pulmonary Embolism Symptoms
The presence of additional symptoms help differentiate pulmonary embolism from other causes of chest pain. Pulmonary embolism chest pain is often accompanied by shortness of breath and tachycardia (rapid heart rate). Coughing may yield bloody sputum or sputum streaked with blood.
Other possible pulmonary embolism symptoms include:
- clammy skin
- cyanosis (blue-tinged skin)
- swollen legs
- weak pulse
It is important to note that, while severe chest pain is often a symptom of pulmonary embolism, half of all pulmonary embolism cases have no symptoms.
Pulmonary Embolism Treatment
Immediate pulmonary embolism treatment is essential: One in 10 pulmonary embolism fatalities occur within one hour of symptom onset. As with heart attacks, the sooner pulmonary embolism treatment begins, the less likely permanent tissue damage will occur.
Pulmonary embolism treatment begins with the administration of heparin, a fast-acting anticoagulant that prevents new blood clot formation while halting the growth of existing emboli. Heparin is administered intravenously or by injection.
Heparin does not dissolve existing blood clots. In life-threatening circumstances, pulmonary embolism treatment may include antithrombolytic drugs. Known as clotbusters, antithrombolytic drugs actively dissolve blood clots. Clotbusters can cause severe and even fatal, bleeding, so their use in pulmonary embolism treatment is reserved for extremely serious cases.
After initial pulmonary embolism treatment with heparin, doctors generally prescribe the oral anticoagulant warfarin. Warfarin therapy typically lasts for three to six months for an initial embolism. If a genetic cause is determined for clot formation or if there is a personal history of abnormal clotting, pulmonary embolism treatment may be continued indefinitely.
Mayo Foundation for Medical Education and Research. (September 28, 2007). Pulmonary Embolism. Retrieved November 7, 2007, from the Mayo Web site: www.mayoclinic.com/health/pulmonary-embolism/DS00429/DSECTION=1.
Merck Manuals Online Medical Library. (updated February 2003). Pulmonary Embolism (PE). Retrieved November 7, 2007, from the Merck Web site: www.merck.com/mmhe/sec04/ch046/ch046a.html.
National Library of Medicine. (updated November 1, 2007). Pulmonary Embolism. Retrieved November 7, 2007, from the MedlinePlus Web site: www.nlm.nih.gov/medlineplus/pulmonaryembolism.html.