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Pulmonary Embolism

Pulmonary Embolism

What is Pulmonary Embolism?

Pulmonary embolism (PE) is the term used to describe the clot (thrombus) that has formed in the deep veins of the leg, breaks off from the site where it formed, and occludes the pulmonary artery. Depending on the size of the piece or pieces that have broken off from the clot in the leg, PE can cause an occlusion in the main body of the artery or in one or more of its branches. When one of the main arteries is blocked, it is called a “massive pulmonary embolism” and the situation is very serious.

Who are the candidates for PE?

The source of PE in almost all cases is deep vein thrombosis (DVT). A thrombus (blood clot) that has formed in the deep veins of the leg detaches there, occluding the pulmonary artery and causing PE. People who are at risk for DVT are therefore also at risk for PE.

Apart from these, fatty substances in the marrow of the broken bone, amniotic fluid during pregnancy or birth, and drug abuse are also rare causes that can lead to PE.

What are the symptoms of PE?

Depending on the prevalence and severity of the development of PE, one or more of the following symptoms may occur:

• Breathing difficulties
• Achy chest pain
• Coughing
• Coughing up blood (hemoptysis)
• Palpitations
• Low blood pressure
• Sudden cardiac arrest

How is PE diagnosed?

Doppler ultrasound is initially performed to diagnose DVT in a patient who has possible symptoms and who is suspected of having PE. However, Doppler ultrasound does not reveal PE, it only reveals the presence/absence of DVT, which can cause PE.
Although the D-dimer test rises in PD, it can also rise in many other conditions. Therefore, by itself, it is not conclusive for the diagnosis of PE. However, it may play a role in the clinical course of the patient diagnosed with PE.

Echocardiogram is a very useful, simple, painless, and inexpensive method for diagnosing pulmonary artery embolism. However, the definitive diagnosis of PE is made by a pulmonary angiogram, which is performed using computed tomography.

Pulmonary Embolism

What are the treatment options of PE?

1. Medication Therapy
Anticoagulant (blood thinning) medications: The diagnosed patient should begin taking these medications immediately. They are available in tablet form (Coumadin or new generation anticoagulants) or as injections (heparin or low molecular weight heparin). The effect of the injection forms starts immediately after administration, while the effect of the pill forms starts 12-48 hours after ingestion. The effect of anticoagulant medications used in long-term treatment should be monitored closely because of the risk of re-clotting and bleeding.
Systemic Thrombolytic Therapy: this involves the intravenous administration of various clot-dissolving medications. Its effect is more pronounced than that of anticoagulants, but because the risk of major hemorrhage is higher than with anticoagulants, this is a treatment method that is almost no longer used.

2. Surgical Treatment
In some cases, it is possible to surgically remove the piece of clot that has lodged in the pulmonary artery. However, this operation, which is quite risky, is used only as a last option.

3. Percutaneous Interventions
These are the most widely accepted methods today. In these procedures performed in the angiography room, the patient is placed on the face and an incision is made in the popliteal vein. Depending on the condition/severity of the patient and the disease, one or more of the following procedures may be planned.
• Applications for DVT
• Pulmonary thrombolytic therapy: injection of clot-dissolving drugs into the pulmonary artery.
• Thrombolytic therapy with ultrasound accelerated catheter: This is a method that uses high-frequency ultrasound waves while simultaneously delivering clot-dissolving medication into the pulmonary artery.
• Percutaneous aspiration thrombectomy: It is possible to completely aspirate the clot with a device guided to the pulmonary artery.

Tags: pulmonary embolism, vein, coagulation, pulmonary thrombosis, filter, shortness of breath, chest pain