Pulmonary embolism happens when one or more arteries of the lung are obstructed by a blood clot that prevents its passage, hinders its oxygenation and causes heart overload. The disease can occur in any cycle of life, both in men and women, and becomes more frequent with advancing age.
Most of the time, Pulmonary Embolism is caused by blood clots that form in the veins of the legs and, in some rarer cases, in the pelvic or abdominal cavity. Another form, even more rare, is fat or gas embolism, which occurs mainly in trauma, or in major surgeries in the pelvis or legs.
According to the vascular surgeon and president of the Brazilian Society of Angiology and Vascular Surgery of the Regional São Paulo (SBACV-SP), Dr. Fabio Rossi, the main factor that must be considered is that the disease has a high prevalence. “In Western countries, one to three cases per 1,000 inhabitants per year are affected by Deep Vein Thrombosis (DVT) of the lower limbs, which is responsible for Pulmonary Embolism. Today, venous thromboembolism is the third leading cause of cardiovascular death, second only to Acute Myocardial Infarction and Cerebral Vascular Accident. Furthermore, it is the number one preventable cause of death in hospitalized patients,” says Dr. Fabio.
Pulmonary embolism can be oligosymptomatic, that is, initially the symptoms may be milder, and do not attract so much attention, which represents a great danger, as they can be confused with other pathologies, such as flu and pneumonia, and the treatment ends up not being suitable. In the most serious cases, it is still confused with the Acute Myocardial Infarction, which is an even more serious problem, because the treatment of the Infarction is very different, and the delay in the correct diagnosis of the disease can lead the patient to death .
Anyone is at risk of developing blood clots, but there are some factors that make it more likely to happen:
Hereditary disorders that affect the blood, making it more prone to clotting, a family history of thrombosis or embolism.
Medical treatments: heart failure, cancer, chemotherapy, surgeries in general, especially large ones that require hospitalization, and prolonged rest. The risk increases when the patient is intubated in the ICU.
Staying in bed for a long time after surgery and a fracture in the leg area.
Long periods of immobility, such as traveling by plane, car, bus, trains, over four hours, and also in people who work a long time in a single position, standing or sitting.
During pregnancy, due to hormonal changes and also the weight of the baby that presses the veins in the pelvis and delays the return of blood and, in some cases, causes thrombosis.
Smoking, obesity and chronic use of contraceptives.
“The person with Pulmonary Embolism needs to be rescued as soon as they show the first symptoms. The faster the diagnosis is made, the better. The treatment is carried out through the use of anticoagulants, which prevents the thrombus from increasing in size and from detaching and moving through the bloodstream, lodging in the lung”, warns the doctor.
Main symptoms to look out for:
Shortness of breath that comes on suddenly and gets worse with physical exertion.
Chest pain mistaken for a heart attack. It is usually made worse by coughing, sneezing or straining.
Cough accompanied by bloody sputum.
Pain or swelling in the legs.
Fever and excessive sweating.
Rapid heartbeat or palpitations.
Dizziness and fainting.
In 25% of cases, which occurs in massive embolisms, the first manifestation is cardiac arrest and death. Therefore, immediate help is extremely important.
Still, according to the doctor, in hospitalized and high-risk patients, the use of low-dose anticoagulants, called prophylactics, is indicated, which prevent thrombus formation. This should always be done under strict medical supervision, as these drugs prevent thrombus and clot formation, but it is also possible to induce bleeding. In cases where the diagnosis is made, anticoagulants should be given at higher doses as soon as possible. In more severe situations, where there are hemodynamic repercussions, that is, hypotension and cardiogenic shock, it may be necessary to use thrombolytic drugs, which have the power to dissolve the clot, or even catheterization and the use of devices that have the ability to aspirate the clot.
In cases of thrombosis and chronic Pulmonary Embolism, or in those in which multiple episodes of relapse occur, Pulmonary Hypertension may arise, which greatly impairs cardiopulmonary capacity and brings limitations and irreversible worsening of quality of life.
“The best prevention involves educating all health professionals about the risk factors and raising awareness about the importance of early diagnosis. To the patient, we should recommend a healthy lifestyle, which includes a balanced diet, with a diet rich in vegetables and low in fat, avoiding the habit of smoking, practicing regular physical exercises and controlling weight. It is important that he is aware of all the signs of Pulmonary Embolism and that he seeks vascular medical attention immediately, so that the treatment begins as soon as possible”, advises Dr. Fabio Rossi.
Pulmonary embolism happens when one or more arteries of the lung are obstructed by a blood clot that prevents its passage, hinders its oxygenation and causes heart overload. The disease can occur in any cycle of life, both in men and women, and becomes more frequent with advancing age.
Most of the time, Pulmonary Embolism is caused by blood clots that form in the veins of the legs and, in some rarer cases, in the pelvic or abdominal cavity. Another form, even more rare, is fat or gas embolism, which occurs mainly in trauma, or in major surgeries in the pelvis or legs.
According to the vascular surgeon and president of the Brazilian Society of Angiology and Vascular Surgery of the Regional São Paulo (SBACV-SP), Dr. Fabio Rossi, the main factor that must be considered is that the disease has a high prevalence. “In Western countries, one to three cases per 1,000 inhabitants per year are affected by Deep Vein Thrombosis (DVT) of the lower limbs, which is responsible for Pulmonary Embolism. Today, venous thromboembolism is the third leading cause of cardiovascular death, second only to Acute Myocardial Infarction and Cerebral Vascular Accident. Furthermore, it is the number one preventable cause of death in hospitalized patients,” says Dr. Fabio.
Pulmonary embolism can be oligosymptomatic, that is, initially the symptoms may be milder, and do not attract so much attention, which represents a great danger, as they can be confused with other pathologies, such as flu and pneumonia, and the treatment ends up not being suitable. In the most serious cases, it is still confused with the Acute Myocardial Infarction, which is an even more serious problem, because the treatment of the Infarction is very different, and the delay in the correct diagnosis of the disease can lead the patient to death .
Anyone is at risk of developing blood clots, but there are some factors that make it more likely to happen:
Hereditary disorders that affect the blood, making it more prone to clotting, a family history of thrombosis or embolism.
Medical treatments: heart failure, cancer, chemotherapy, surgeries in general, especially large ones that require hospitalization, and prolonged rest. The risk increases when the patient is intubated in the ICU.
Staying in bed for a long time after surgery and a fracture in the leg area.
Long periods of immobility, such as traveling by plane, car, bus, trains, over four hours, and also in people who work a long time in a single position, standing or sitting.
During pregnancy, due to hormonal changes and also the weight of the baby that presses the veins in the pelvis and delays the return of blood and, in some cases, causes thrombosis.
Smoking, obesity and chronic use of contraceptives.
“The person with Pulmonary Embolism needs to be rescued as soon as they show the first symptoms. The faster the diagnosis is made, the better. The treatment is carried out through the use of anticoagulants, which prevents the thrombus from increasing in size and from detaching and moving through the bloodstream, lodging in the lung”, warns the doctor.
Main symptoms to look out for:
Shortness of breath that comes on suddenly and gets worse with physical exertion.
Chest pain mistaken for a heart attack. It is usually made worse by coughing, sneezing or straining.
Cough accompanied by bloody sputum.
Pain or swelling in the legs.
Fever and excessive sweating.
Rapid heartbeat or palpitations.
Dizziness and fainting.
In 25% of cases, which occurs in massive embolisms, the first manifestation is cardiac arrest and death. Therefore, immediate help is extremely important.
Still, according to the doctor, in hospitalized and high-risk patients, the use of low-dose anticoagulants, called prophylactics, is indicated, which prevent thrombus formation. This should always be done under strict medical supervision, as these drugs prevent thrombus and clot formation, but it is also possible to induce bleeding. In cases where the diagnosis is made, anticoagulants should be given at higher doses as soon as possible. In more severe situations, where there are hemodynamic repercussions, that is, hypotension and cardiogenic shock, it may be necessary to use thrombolytic drugs, which have the power to dissolve the clot, or even catheterization and the use of devices that have the ability to aspirate the clot.
In cases of thrombosis and chronic Pulmonary Embolism, or in those in which multiple episodes of relapse occur, Pulmonary Hypertension may arise, which greatly impairs cardiopulmonary capacity and brings limitations and irreversible worsening of quality of life.
“The best prevention involves educating all health professionals about the risk factors and raising awareness about the importance of early diagnosis. To the patient, we should recommend a healthy lifestyle, which includes a balanced diet, with a diet rich in vegetables and low in fat, avoiding the habit of smoking, practicing regular physical exercises and controlling weight. It is important that he is aware of all the signs of Pulmonary Embolism and that he seeks vascular medical attention immediately, so that the treatment begins as soon as possible”, advises Dr. Fabio Rossi.
