What is an acute pulmonary embolism (PE)?
An acute pulmonary embolism is a sudden blockage of a pulmonary artery in the lungs, usually caused by a blood clot that has traveled from another part of the body, typically from the deep veins of the legs (deep vein thrombosis, or DVT). This blockage can reduce or cut off blood flow to parts of the lung, leading to potentially life-threatening complications.
What causes an acute pulmonary embolism?
The most common cause of acute pulmonary embolism is deep vein thrombosis (DVT). Other causes and risk factors include:
- Blood Clots: Formed in the deep veins of the legs, pelvis, or other areas, which then travel to the lungs.
- Surgery: Particularly orthopedic or pelvic surgery, which can increase the risk of clot formation.
- Immobility: Prolonged periods of immobility, such as during long flights or bed rest, can increase the risk of clots.
- Cancer: Certain cancers and cancer treatments can increase clotting risk.
- Pregnancy and Postpartum Period: Increased risk due to hormonal changes and pressure on veins.
- Hormone Therapy: Use of birth control pills or hormone replacement therapy.
- Genetic Factors: Inherited conditions that affect blood clotting (e.g., factor V Leiden mutation).
What are the symptoms of acute pulmonary embolism?
Symptoms can vary depending on the size of the clot and the extent of lung involvement but may include:
- Sudden Shortness of Breath: Difficulty breathing that comes on quickly.
- Chest Pain: Often sharp or stabbing, and it may worsen with deep breathing or coughing.
- Cough: Sometimes with blood-tinged sputum.
- Rapid Heart Rate: Increased heart rate (tachycardia).
- Lightheadedness or Fainting: Feeling dizzy or faint, which can be associated with a decrease in blood pressure.
- Swelling or Pain in the Legs: Particularly in one leg, which could indicate DVT.
How is acute pulmonary embolism diagnosed?
Diagnosis typically involves:
- Medical History and Physical Examination: Assessing risk factors, symptoms, and performing a physical exam.
- Imaging Tests:
- CT Pulmonary Angiography (CTPA): The primary imaging test to visualize blood clots in the pulmonary arteries.
- Ventilation-Perfusion (V/Q) Scan: An alternative imaging test that assesses airflow and blood flow in the lungs.
- Ultrasound: To detect DVT in the legs.
- Blood Tests:
- D-dimer Test: Elevated levels of D-dimer can suggest clotting, though this test alone is not diagnostic.
- Electrocardiogram (ECG): To assess heart function and rule out other conditions.