Pulmonary Embolisms: The Best Treatment Is Prevention
Lung health A pulmonary embolism (PE) occurs when a blood clot travels into the lungs, blocking one or more pulmonary arteries. PE is usually caused by blood clots that originate in the legs, known as deep vein thrombosis (DVT).
Pulmonary embolism almost always occurs in conjunction with deep vein thrombosis, so medical professionals often group the conditions together as thromboembolism (VTE).
Dangers and complications
PE can occur suddenly and can potentially cause short and long-term breathing problems and sometimes death. In fact, PE is the most common preventable cause of death among hospitalized patients and VTE is the third-most common cardiovascular disease, after coronary disease and stroke.
In some cases, PE can also lead to pulmonary hypertension, a condition in which the blood pressure in the right side of the heart and lungs is too high. When the arteries inside your lungs have obstructions, your heart has to work harder to push blood through those vessels. This increased blood pressure can begin to wear out a section of the heart.
Having the ability to recognize early symptoms of PE is integral for patients to receive prompt diagnosis and treatment. “Early detection is very important because it allows the institution of treatments that are effective to reduce the size of existing clots and, most importantly, to prevent additional life-threatening clots from going to the lungs,” explains Dr. Jim Douketis, Thrombosis Specialist at St. Joseph’s Healthcare Hamilton, Professor of Medicine at McMaster University, and President of Thrombosis Canada.
Cari MacLean will always be grateful to the staff of Oakville-Trafalgar Memorial Hospital for saving her life. Video credit: Oakville-Trafalgar Memorial Hospital
Common symptoms include abrupt onset of shortness of breath, chest pain when breathing and, in severe cases, light-headedness and low blood pressure. “Symptoms can also be subtle and can be confused with other conditions, like pneumonia or muscle strain, so it is important for patients to seek medical attention, especially if they are at increased risk,” says Dr. Douketis.
PE can be caused by prolonged immobilization, typically after surgery or due to a medical illness. In such circumstances, preventive use of blood thinners for short periods can greatly reduce the risk for PE. There are other risk factors for PE. Women who are pregnant or take supplemental estrogen are at higher risk of having a PE.
“Early detection is very important because it allows the institution of treatments that are effective to reduce the size of existing clots and, most importantly, to prevent additional life-threatening clots from going to the lungs.”
If you’re on a plane or car ride for more than six hours, it’s a good idea to get up and walk around once every hour or two. “If you’re not able to do that, do some calf exercises as you’re sitting,” says Dr. Mangesh Inamdar, an Emergency Physician at Oakville-Trafalgar Memorial Hospital. “If you have a medical condition that puts you at high risk, a doctor can prescribe a compression stocking: the best treatment is prevention.”
Effective treatments offer full recovery
The treatment of PE consists of a blood-thinner, called an anticoagulant. In severe cases of PE, ‘clot busting’ drugs known as thrombolytics are used and can be life-saving. In recent years, newer blood thinners have become available that provide effective, safer and easier treatment options than were previously available. Blood thinning treatment usually lasts for three to six months, although some patients will require longer treatment. “Most patients will experience a good recovery and can lead normal lives even while they continue to take blood thinners,” says Dr. Douketis.
Cari MacLean knows firsthand how serious a PE can be. On Oct. 9, 2012, the Oakville resident was minutes from death. MacLean was home alone when she fell gravely ill, but, somehow, she was able to make it to the phone and dial 911. MacLean spent two weeks in hospital, where she received blood-thinning injections and, on her release, was put on a six-month regime of oral medication.
“Today, I am completely recovered: my health is very good,” says MacLean, now age 52. “I feel great and am back to my former levels of activity.”
MacLean traces her health problems back to six months before that fateful night, when she experienced cramping in her left calf shortly after a long haul flight to Vietnam. This cramping was the initial signs of deep vein thrombosis, but Maclean was unaware of this at the time. Upon her return from Vietnam, she saw an athletic therapist who successfully treated the cramping.
Six months later, the day before she experienced her PE, Maclean was reading in bed when her left calf began to cramp. It was the same feeling she’d had in Vietnam. “The day of my PE, I woke up and went downstairs to make some coffee,” says MacLean. “I recall having to stop after a few steps of stairs to catch my breath.”
Later that night, while in the bath, MacLean started to feel very unwell. She vomited and was sweating profusely. “I was too weak to get to my bed. It was while I was curled up in fetal position by the toilet that a booming voice in my head said ‘no, it doesn’t end like this, get up off the floor, call 911’,” says MacLean.
MacLean advises anybody experiencing possible PE symptoms to listen to their body. “I ignored the signs because I was a healthy, active ‘young’ person,” she says. “But any kind of leg cramp, swelling, discoloration, hot to the touch combined with shortness of breath warrants a visit to the nearest Emergency Department right away. There they have the means to do all the necessary tests to rule in or out a PE.”