My Handi-Capable Reporter       Volume  8  Issue 3

March 2003

CHANGING PESSMISM TO OPTIMISM

 

DOCTORS CORNER

What is Pulmonary Embolus?

Pulmonary embolus is a blockage of an artery in the lungs by fat, air, tumor tissue, or blood clot.

What causes Pulmonary Embolus?

Pulmonary emboli are caused by clots from the venous circulation, from the right side of the heart, from tumors that have invaded the circulatory system, or from other sources such as amniotic fluid, air, fat, bone marrow, and foreign substances. Most are caused from clots originating in the lower extremities called deep vein thrombosis(DVT), and many resolve on their own. A pulmonary embolism affects as many as 5 out of 10,000 people in the U.S. each year, and sudden death can occur as a result of pulmonary embolism. The risk factors include prolonged bed rest or inactivity, oral contraceptive use, surgery, child birth, cancer, stroke, heart attack, heart surgery, and fractures of the hips or femur.

How can you prevent Pulmonary Embolus?

Early detection and treatment of DVT(clots of the legs) of patients who are at risk by early walking and activity after surgery can reduce the risk of pulmonary embolus. Other clot-preventive measures include leg exercises and elastic support stockings as appropriate. Subcutaneous heparin therapy (low doses of heparin injected under the skin) may be used for those on prolonged bedrest.

What are the symptoms of Pulmonary Embolus?

A cough:
     a. begins suddenly
     b. may produce bloody sputum (significant amounts of visible blood or lightly blood streaked sputum)
     c. sudden onset of shortness of breath at rest or with exertion
     d. splinting of ribs with breathing (e.g., bending over or holding the chest)
     e. lightheadedness
     f. fainting
     g. dizziness
     h. chest pain:
          1) under the breastbone or on one side
          2) sharp, stabbing, burning, aching or dull, heavy sensation
          3) may be worse at night
          4) may radiate to the shoulder, arm, neck, jaw, or other area
          5) may be worsened by breathing deeply, coughing, eating, bending, or stooping
          6) sweating
          7) anxiety
          8) breathing, rapid
          9) rapid heart rate (tachycardia)

Additional symptoms that may be associated with this disease:

     a. wheezing
     b. skin, clammy
     c. skin discoloration, bluish
     d. pulse, weak or absent
     e. nasal flaring
     f. joint pain
     g. pelvis pain
     h. leg pain in one or both legs
     i. breathing, absent temporarily
     j. blood pressure, low
     k. abdominal indigestion
     l. swelling in the legs (lower extremeties)
     m. lump associated with a vein near the surface of the body (superficial vein), may be painful

Signs & Tests:

Tests to evaluate the function of the lungs:
     a. arterial blood gases
     b. pulmonary function tests

Tests to detect the location and extent of embolism:
     a. chest X-ray
     b. lung scan
     c. pulmonary angiogram

Tests to detect DVT (a common cause):
     a. venography of the legs
     b. extremity arteriography
     c. blood flow studies
     d. Doppler ultrasound exam of an extremity
     e. plethysmography of the legs

An ECG may show abnormalities caused by strain on the heart

This disease may also alter the results of the following tests:
     a. pulmonary ventilation/perfusion scan
     b. febrile/cold agglutinins
     c. antithrombin III
     d. ACE levels

Treatment: Emergency treatment and hospitalization are necessary. Definitive treatment consists of dissolving the clot by thrombolytic therapy. Anticoagulant therapy is preventive by inhibiting further clot formation. Thrombolytic therapy (clot-dissolving medication) includes streptokinase, urokinase, or TPA. Anticoagulation therapy (clot-preventing medication) consists of heparin by intravenous infusion initially, then oral warfarin (Coumadin), or subcutaneous heparin may be started concurrently. Oxygen therapy is required to maintain normal oxygen concentrations until the acute injury to the lungs has resolved. The death rate is 30% with undiagnosed pulmonary embolism. After diagnosis and treatment, the death rate drops to 3%.