Pulmonary embolism

Reviewed by Dr Patrick Davey, cardiologist

What is an embolus in the lung?

A lung embolus (pulmonary embolism) occurs when a blood vessel supplying the lung becomes clogged up by a clot - a lump of coagulated blood.

The clot may have travelled in the bloodstream from a vein in the pelvis, abdomen or in the leg; through the veins of the body, through the heart and into the lung. A damaged heart can also be the cause of these clots.

Who usually gets a lung embolus?

Most patients with this condition already suffer from some other kind of disease - sometimes a heart condition.

Apart from that, some other situations may also increase the risk of an embolus in the lung.

Elderly people, especially if they have to spend a lot of time in bed.

Cancer increases the risk even more. However, most people who have pulmonary emboli do not have cancer.

After an operation, especially in the abdomen.

Some people have a family tendency to develop pulmonary emboli.

Being overweight increases the risk even more.

After a long journey without moving around, the blood can clot in the legs where it will form a deep vein thrombosis which doctors call a DVT. This is also sometimes called 'Economy class syndrome', and if you have a medical history of circulation problems or blood clots, and are planning a long journey on a plane or coach then discuss possible preventive measures with your doctor beforehand.

Pelvic fractures and fractures of the lower limb.

Pregnancy and childbirth.

Due to the risk of getting an embolus in the lung, it is important that elderly people don't lie in bed more than is absolutely necessary. Those who have undergone an operation, should try to walk around gently as soon possible, in accordance with their doctor's instructions.

What are the symptoms of a lung embolus?

Signs of a small embolus:

the most important symptom is breathlessness, which often occurs suddenly and for which there is no other explanation such as an asthma attack.

you feel a sudden pain in your chest.

you may cough up blood in your phlegm.

you start feeling uncomfortable, nervous and anxious.

in the days that follow you may have a slight fever and feel exhausted but after a while you may feel better and the symptoms may disappear within a couple of weeks.

as there is a bigger risk of you getting a new embolus after the first, you should see a doctor immediately.

in virtually all cases you will need preventive medicine because of the chance of a re-occurrence. This means that most people who have had even a small pulmonary embolus need to go to hospital as an emergency to confirm the diagnosis and to start treatment.

Larger emboli in the lungs can be lethal. Unfortunately, attempts to resuscitate a person with a larger embolus rarely succeed.

Signs of larger emboli:

sudden appearance

you become pale and break out into a cold sweat

unconsciousness may follow quickly

without medical attention, death may occur.

What can I do if I suspect an embolus in my lung?

It is not easy to tell the difference between an embolus in your lung and a heart attack coronary thrombosis.

If you suspect that there is an embolus, you should call an ambulance immediately.

How can an embolus in the lung be treated?

Once diagnosed, you will be treated with medicine that 'thins' the blood (anticoagulants, such as heparin and warfarin). This treatment reduces the risk of getting a new embolus. This treatment can last for several months or even for the rest of your life, depending on the risk.

Today, it is sometimes possible to dissolve the embolus that is causing the blockage in the blood vessel with fibrinolytic or 'clot-busting' therapy. The treatment requires a rapid diagnosis and action in a hospital.

Following a pulmonary embolus, a search should be made for any conditions which increase the risk of further episodes, such as Hughes' syndrome.

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