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Pulmonary-Embolism Hows and Whys PDF
Pulmonary-Embolism Hows and Whys PDF
Pulmonary Embolism
If blood flowing within the blood vessels of the body stops, the tissue it sup-
plies could die from lack of oxygen. If, after a serious wound, blood flowing
outside the body does not stop, a person could die from hemorrhage. Yet, the
blood within the blood vessels flows almost perfectly throughout life, and bleed-
ing usually stops within minutes after a cut. Occasionally, blood can clot within
the blood vessels, which is called a thrombus. Abnormal material floating in the
blood is called an embolus. A thrombus that breaks free and floats in the mov-
ing bloodstream is called a thromboembolism. The blood in the veins, with its
slow flow and low pressure, is more likely to clot (venous thrombus) than blood in
the arteries; it may go to the lungs (pulmonary embolism or venous thromboembo-
lism), where it can become lodged in the small blood vessels. An embolism can also
be caused by other material floating free in the bloodstream, as in, for example,
tumor embolism or foreign-body embolism, but these conditions are rare compared
to thromboemboli and are not considered further in this chapter.
Blood coagulation is highly regulated; a moving stream works to prevent
clotting, and stagnant blood promotes clotting. Tissue injury triggers blood
clotting, and any defect in the many factors controlling clotting may increase or
decrease the chance of blood coagulation.
Pulmonary emboli are common, difficult to diagnose, and often deadly.
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CASE STUDY
Comment
This patient’s risk factors for pulmonary thromboembolism included
immobility, the high levels of estrogens associated with pregnancy, and the
tissue injury associated with surgery. Her first symptom was subtle and did
not immediately suggest venous thrombosis. Once pulmonary embolism
was suspected, prompt lifesaving treatment was begun even before the
CT scan confirmed the diagnosis. This patient was fortunate not to suffer
from complications of the anticoagulant, and the blood clot in her leg was
successfully treated. Complications such as bleeding can occur from
anticoagulants. Unresolved blood clots can cause chronic pain and
swelling in the extremity where the thrombosis occurred. In the lungs,
unresolved blood clots can cause increased blood pressure (pulmonary
hypertension) and be associated with serious chronic disease. Happily,
this patient fully recovered.
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clotting risk by decreasing the breakdown of this factor. Mutations in factor V are
common (present in 5 percent of the population). Abnormalities in thrombolysis,
such as deficiencies in antithrombin III, can also promote clot formation.
Anything that reduces blood flow, such as heart failure, narrowing of blood ves-
sels, or immobility, increases the risk for clotting. And almost anything that causes
injury, such as cancer, surgery, or trauma, also increases the risk of clot formation.
D ischarge diagnosis n
Pneumonia 1,145,469
Cancer 1,039,359
Stroke 507,106
Trauma 419,831
Sepsis 417,875
Arthropathy/spondylopathy 279,261
Paralysis/coma 20,287
Total 7,742,419
The risk of pulmonary embolism depends on the amount of tissue injured and lack of mobility. Brain or
nerve tissue injury may be more likely to cause clotting than injuries in other tissue (4).
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The greatest risk of pulmonary embolism occurs when a clot has formed in the
thighs or pelvis. The blood flow from these areas leads directly to the lungs, where
a detached clot can lodge in the pulmonary arteries. Clots in the veins of the calves
or arms, however, may also be associated with pulmonary embolism.
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Agents that rapidly break down clots are available. This thrombolytic therapy
is usually reserved for severely ill patients because it can cause bleeding.
Although infrequent, bleeding into the brain could have dire consequences. In
some situations, a filter is placed in the main vein (inferior vena cava) leading
from the legs to the lungs to stop any thrombi from traveling to the lungs.
The prognosis depends on the size of the pulmonary embolism. The effect
can be so mild as to go unnoticed or it can result in sudden death. If a patient is
promptly treated and has no recurrence, it is likely that full function will be
restored. Undetected or inadequately treated pulmonary embolism can result in
pulmonary hypertension and long-term respiratory disability.
Although the main conditions associated with blood clotting (stasis or slowing of
blood flow), hypercoaguability (abnormal clotting factors), and tissue injury were
described by the German pathologist Dr. Rudolf Virchow more than 150 years
ago, considerable more knowledge on how these affect pulmonary embolism
[R] [L]
Dean E. Schraufnagel
This computed tomography (CT) image shows a blood clot (arrow) lodged in the
main pulmonary artery obstructing the flow of the contrast material in white.
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Dean E. Schraufnagel
The small pulmonary artery was plugged by a pulmonary embolus. The body organizes and
dissolves, or tries to dissolve, the clot to reestablish blood flow (arrow).
has been gained in recent years. Genetic factors associated with blood
coagulation problems are being discovered, and more detailed information on
the process of blood clotting continues to be learned. It is possible to screen
persons for several genetic coagulation abnormalities, although it is uncertain
which patients should have these tests performed. Population screening has not
been shown to save enough lives or reduce illness sufficiently to justify the
expense in most cases.
Research has continued to improve the diagnostic tools, giving better
images of the obstructed blood vessels. D-dimer levels appear to be the best of
the many diagnostic blood tests studied, although their high sensitivity, which
can lead to false positives, is a drawback. D-dimer levels can be elevated in
other high-risk situations, such as surgery and certain diseases that cause these
products to be found in the blood.
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Pulmonary Embolus
www.nlm.nih.gov/medlineplus/ency/article/000132.htm
Mayo Clinic
Pulmonary Embolism
www.mayoclinic.com/health/pulmonary-embolism/DS00429
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