A pulmonary embolism (PE) occurs when a blood clot enters the pulmonary circulation – impacting your heart and lung function. In the United States, it is estimated that over 100,000 people die from a PE or related blood clot each year. Here, Miles Jackson, M.D., a vascular surgeon at Henry Ford Health, answers some questions about common causes of a PE and what your treatment options might look like.
Q: How do pulmonary embolisms develop?
Dr. Jackson: The most common way that a PE develops is when a blood clot that is somewhere else in the body moves and suddenly blocks the arteries that supply the lungs with blood. We often see cases of PE in patients with deep vein thrombosis (DVT), or blood clots formed in other parts of the body – especially in the lower extremities. One of the most serious risks of DVT is that these blood clots can make their way to your lungs, which can be life threatening.
Q: Besides having deep vein thrombosis, are there other risk factors that might put someone at a greater risk for a pulmonary embolism?
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Dr. Jackson: Because a PE is closely related to DVT, there is a lot of overlap in the risk factors for both. These risk factors are often related to your body’s inflammatory response or impact how well your body is able to circulate blood. This includes:
- A sedentary lifestyle
- Smoking
- Use of certain medications
- Obesity
- Trauma or injury
- Pregnancy
- Recent surgery
- Recent infection
- Having cancer or undergoing chemotherapy
Q: How do you know if you have a pulmonary embolism?
Dr. Jackson: Symptoms of PE may vary quite a bit from person to person. Patients usually report symptoms such as chest pain, shortness of breath that gets worse with movement, as well as symptoms associated with DVT including leg swelling or pain in your extremities. In some cases, patients will faint as a result of the lack of blood flow to the lungs.
Q: What should you do if you are experiencing symptoms of a pulmonary embolism?
Dr. Jackson: Obviously if you are experiencing new symptoms of chest pains and shortness of breath, your best plan of action is to call 911 or seek medical attention immediately. Most PE cases that we see come into the hospital from the emergency room. For other symptoms, like swelling or changes in your physical activity tolerance, talk to your doctor on how to proceed. Since these symptoms are often minor in comparison to others, we sometimes get patients that are diagnosed with a PE when they come in for routine doctor’s appointments.
Q: How are pulmonary embolisms treated?
Dr. Jackson: It really depends on the severity of your case, which doctors can assess once a PE has been diagnosed. Our goal in treating PE is to resolve the symptoms you are experiencing and protect heart and lung function. We want to make sure you aren’t in any pain and that your heart is functioning well without any additional stress.
Most cases are mild and can be treated quickly without intervention. For mild cases, patients are given a blood thinner as a first line of defense to help break down the blood clot – allowing your blood to begin circulating as normal. We will continue to monitor your symptoms, CT scans and ultrasounds of your heart and your bloodwork to decide if further treatment in needed. About 25% of PE cases are considered more severe and do require further treatment.
Experts from pulmonology, cardiology, vascular surgery, and interventional radiology review your case together to determine how to proceed. If we decide that more treatment is needed, we have options. The first is procedure where we can go in to remove the blood clot to restore blood flow to the lungs. The second option is to administer intravenous medications to help the blood clot break down more. Both methods are effective, but if you are a good candidate for surgery, it is likely we will push for that option since it puts less stress on the heart and reduces your risk of causing other bleeds throughout the body.
Q: What are your chances of surviving a pulmonary embolism?
Dr. Jackson: In very severe cases of PE, there is a possibility that your heart becomes overworked in effort to overcome the blood clot in the lungs. When this happens, there is about a 30% chance of mortality within a month, so seeking treatment at the first signs of symptoms is essential.
The good news is, after PE treatment, returning to your normal level of function is very possible, but it may take time. Be sure to pay attention to any changes in your health (good or bad) and report back to your care team. While some shortness of breath may still occur, if you notice any new swelling or chest pains, contact your doctor or seek medical attention immediately.
Reviewed by Dr. Miles Jackson, a vascular surgeon who sees patients at Henry Ford Allegiance Vascular Health in Jackson.
