Pulmonary Embolism

A pulmonary embolism (PE) occurs when a blood clot breaks free from its site of origin and travels to the lungs, forming a blockage in an artery.

Symptoms of PE include chest pain, shortness of breath, severe cough, coughing up of blood and even sudden death.

Pulmonary embolism is the major concern for patients experiencing deep vein thrombosis (DVT).

Symptoms of Pulmonary Embolism

The following are the most common symptoms of a pulmonary embolism. However, each individual may experience symptoms differently:

  • Sudden shortness of breath (most common)
  • Chest pain, usually worse with breathing
  • A feeling of anxiety
  • A feeling of dizziness, lightheadedness, or fainting
  • Palpitations and heart rarcing
  • Coughing up blood
  • Sweating
  • Low blood pressure

You may or may not have these symptoms should a pulmonary embolism occur. Usually, if PE is suspected, the physician will check your legs for evidence of a deep vein thrombosis. The type and extent of symptoms of a pulmonary embolism will depend on the size of the embolism and whether the person already has existing heart and/or lung problems. The symptoms of a pulmonary embolism may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Treatments for Pulmonary Embolism

Anticoagulants are often referred to as "blood thinners," although they don't actually thin the blood. While these drugs do not dissolve a clot, they can stabilize it by allowing the clot to stick to the vein wall, thereby avoiding pulmonary embolism and allowing the body to eliminate or partially dissolve the clot over time. Examples of anticoagulants include warfarin (Coumadin) and heparin.

Also called clot busters, these medications are given intravenously to break down the clot.

Filters are mechanical devices that "catch" deep vein thrombosis (DVT) clots that are released from the leg or pelvis and are traveling toward the lungs where they would cause pulmonary embolism. Filters are used in situations where a patient may need additional protection from clots that can result in pulmonary embolism. They may also be used when "blood thinners" are not effective or when a patient cannot receive anticoagulation. They are placed in the large vein of the abdomen (the inferior vena cava, commonly called the IVC) that receives the blood from both legs returning to the heart and lungs. This filter is placed by an endovascular specialist. The endovascular specialist advances a small tube containing the filter into a vein in the groin, neck or arm to the intended site in the IVC where the filter is released allowing it to open fully and attach to the walls of the IVC.  From its position in the IVC, clots escaping from either leg or from the pelvis veins can be trapped. Some types of IVC filters are permanent, while others can be removed when the risk of pulmonary embolism has passed.

During a percutaneous thrombectomy a catheter is inserted into the site of the embolism, using X-ray guidance. Once the catheter is in place, it is used to break up or extract the embolism or dissolve it by injecting thrombolytic medication.

An important aspect of treatment of pulmonary embolism is prophylactic treatment to prevent formation of additional embolisms.

Pulmonary embolectomy (PE) is the surgical removal of a pulmonary embolism. This procedure is generally performed in severe situations in which: 

  • The PE is very large. 
  • The patient cannot receive anticoagulation or thrombolytic therapy due to other medical considerations. 
  • That patient has not responded adequately to anticoagulation or thrombolytic therapy and is not in stable condition.

Medications that rapidly dissolve blood clots, called thrombolytics, are used selectively in patients with severe deep vein thrombosis or pulmonary embolism (PE) - when extensive blood clots in the lung result in acute heart failure or acute lung failure.

Endovascular specialists administer thrombolytics in the hospital to closely monitor patients for an infrequent but potentially serious risk of bleeding.

A vena cava filter is a small metal device placed in the large blood vessel that returns blood from the body to the heart to prevent clots from traveling to the lung. These filters are generally used in patients who cannot receive anticoagulation treatment for medical reasons, develop additional clots even with anticoagulation treatment, or develop bleeding complications from anticoagulation.

Dr. Jay Varma

Ask An Inova Expert

 What You Need to Know About Pulmonary Embolism
 Jay Varma, MD

Q: Are there tests to diagnose a pulmonary embolism?

A: The diagnosis of a pulmonary embolism (PE) can usually be made on a clinical basis, especially in the setting of deep vein thrombosis (DVT). Timely diagnosis is important so that treatment to remove or disperse the clot occurs as quickly as possible. A well-equipped facility such as Inova Schar Heart and Vascular has the latest imaging equipment available to confirm the presence of a pulmonary embolism.

The current study of choice to confirm PE is known as a computed tomography angiogram (CTA), in which X-ray dye is injected into the patient's arm so that the image is as clear and sharp as possible.

Patients who cannot tolerate the contrast dye can benefit from a special nuclear medicine imaging study known as a VQ scan (ventilation-perfusion lung scan). Either of these studies is helpful in the diagnosis and subsequent treatment of a pulmonary embolism.