Pulmonary Embolism PE: Overview and Treatment
Running is a popular and highly effective exercise. One of the reasons it is so popular is because it is one of the best ways to improve cardiovascular health. Improving cardiovascular health comes with a whole host of health benefits, and in general improves your overall quality of life. Something to keep in mind while engaging in cardiovascular exercise, however, is that it comes with a great deal of resistance. Improving cardiovascular health is a long process, requiring commitment and a resilience to discomfort. When running, the times when you are making the most progress towards becoming healthier is when you are out of breath, sweaty and sore.
When your body is in this state of hyperactivity, your heart and cardiovascular system are engaged in resistance training, similar to how you can effectively strengthen any other muscle in your body. For this reason, effective running involves bringing your body to this threshold and maintaining it for as long as possible. While shortness of breath and cardiovascular resistance are often signs of positive progress, there are times where this can be a negative. If shortness of breath and heaviness in your chest are persistent, even when you aren’t running, it could be the sign of a serious condition known as a pulmonary embolism. A fragment of a clot can break away from the interior of a vessel at any time; whether you are running, walking, talking, or sleeping. It is important to be aware of the signs and symptoms of a PE.
What Are Pulmonary Embolisms (PE)?
A pulmonary embolism (PE) is a very serious injury that can come about as a consequence of tissue breaking away. It involves a blood clot traveling into the lungs from another part of the body. The clot originally formed in another part of the body, most commonly the lower leg. Once the clot has formed, it is referred to as deep vein thrombosis. There are times when this clot can dislodge from the veins in your lower leg and begin to travel up your veins. At this stage, it turns into an embolus, moving through the body towards the heart and lungs. Once the embolus reaches the lungs, the veins become more constricted, causing the clot to lodge itself again in your vein. Here, it begins to cut off oxygen to other parts of the body. This is often debilitating to the body, as it can cause organ failure due to oxygen deprivation. In severe cases, PE can even lead to death, so it is important to identify it quickly and begin treatment.
Symptoms vary for pulmonary embolisms (PE), depending on the embolus’ point of origin, the size of the clot, and how much it affects the lung. However, there are some common symptoms to look out for, such as chest pain and shortness of breath. If the embolus originated in a particular limb, you may experience swelling in that limb, or deep vein thrombosis. Additionally, the skin around the affected area may be discolored or clammy. Indicators of severe PE include dizziness, a bloody cough, or an irregular heartbeat.
Common Symptoms of a Pulmonary Embolism (PE):
- Swelling in one limb
- Clammy skin
- Chest pain
- Shortness of breath
- Excessive coughing with blood
- Heart palpitations or irregularities
- Dizziness or lightheaded feeling
- Fever and sweating
If you have been immobile for a long period of time, the risk of developing PE is greater, as one scientific study has shown. This inactivity can come about as a result of extended rest when recovering from a major injury, such as a stroke or broken bone. Additionally, extended activity from a sedentary lifestyle can contribute towards cases of PE, especially in the elderly and obese. Sometimes, the trauma that comes from a major injury can also be the cause, often from spine related injuries. In a situation where deep vein thrombosis develops as a result of an injury, the likelihood of developing PE increases drastically. Obesity, high blood pressure, and previous heart problems are also common causes for pulmonary embolisms.
Potential Causes of Pulmonary Embolisms:
- Spinal injury
- Extended immobility
- Deep vein thrombosis
- Previous heart conditions
- High blood pressure
The risk factors for developing PE are directly related to the potential causes. For example, obesity and a sedentary lifestyle increases the risk, as it can contribute to developing heart conditions, blood clots, and high blood pressure. Age is another risk factor, with older runners being at higher risk of spinal injury, which is often a harbinger of embolus development. Additionally, the elderly are at a greater risk of developing heart problems or experiencing a stroke, especially if they frequently engage in high intensity exercise such as frequent long distance running. Women experiencing menopause are also at risk of PE, although only during the onset; post-menopause, the risk factor decreases as your body adjusts to the changes. Most distressing is that the elderly may have a weaker heart and lungs that are already under greater stress, meaning cases of PE in older runners are much more severe and potentially life-threatening. Previous injury is also a risk factor, especially if the injury occurred in the spinal region or required extended rest. This risk factor is independent of age, so younger runners that experience spine injury are still at risk of PE.
Individuals at Risk for Pulmonary Embolisms:
- Obese individuals
- The elderly
- Women experiencing menopause
- Previously injured individuals
- Runners with heart conditions
- Individuals with a sedentary lifestyle
It is surprisingly common for patients to be inaccurately diagnosed with PE. This is usually caused by errors in imaging technology, but it can also be due to an alternate condition developing with similar symptoms to a pulmonary embolism. This is why it’s important to get an accurate diagnosis, even going so far as to seek out a second opinion, since pulmonary embolisms are very serious and potentially life-threatening.
- Cancer: There is a link between cancer and PE, as numerous studies have shown. Tumors such as angiosarcoma can cause clotting similar to embolus, but treatment is much different. It is important to rule out cancer when diagnosing your condition, as improper treatment can potentially be fatal.
- Arteritis: Temporal arteritis shares many symptoms with PE, such as headaches, swelling, fever, coughing, and a lightheaded feeling. It can cause a stroke, which is a risk factor in developing PE, but it is not the same thing as a pulmonary embolism. The main differentiating factor is whether you can still breathe normally.
- Improper Imaging: Sometimes, human error can be the cause of a false diagnosis. If the patient has experienced heart surgery in the past, if other body parts are obstructing the view of the scan, or if there are technical issues with the imaging machine, PE can be falsely diagnosed. For these reasons, it is recommended to obtain a second opinion when diagnosing your injury.
Without proper and immediate treatment for PE, further injury is likely to occur. In many cases, the fatal nature of pulmonary embolisms are due to these complications arising. This is why if you suspect a pulmonary embolism, you should move as quickly as possible to get your condition diagnosed so you can begin treatment. Otherwise, you may experience these conditions on top of PE:
- Heart Failure: If the presence of an embolus is persistent, your heart may stop functioning at its full capacity. Heart failure is a scary term: however, it doesn’t refer to a complete shutdown of the heart, just that its functionality is limited. It will still supply the rest of your body with oxygen, but not as much as it is usually capable, and under much more severe strain.
- Pulmonary Hypertension: This condition rarely crops up as a result of PE, but the possibility is still present. In pulmonary hypertension, your blood pressure is higher, but only in the veins connecting your heart to your lungs. Your heart then has to work harder to gather oxygen, resulting in chest pain and shortness of breath.
- Pulmonary Infarction: Another rare occurrence when faced with pulmonary embolisms, pulmonary infarction is a possible complication for severe cases left untreated for too long. In pulmonary infarction, the lung tissue affected begins to die, and you may cough up blood in addition to feeling chest pain and shortness of breath.
- Cardiac Arrest: Unlike heart failure, cardiac arrest is a condition where the heart literally fails to function, causing a loss of consciousness and a complete stop to breathing and blood flow. This condition has a high mortality rate, and is usually fatal unless heart functionality can be restored quickly. Cardiac arrest doesn’t occur in every case of PE, but the likelihood is high enough that it is a concern.
How Do You Treat Pulmonary Embolisms?
If you have identified some of the symptoms of PE in your own body, and if you fit some of the risk factors, it is a very good idea to check for a pulmonary embolism. The first step in treating any running injury is to rule out any other potential ailments, in order to save time, money, and potentially your life. In this case, the best way to know without a doubt that you are experiencing PE is to obtain a diagnosis from a doctor.
The first step the doctor will usually take when diagnosing your injury is an interview. This involves asking questions about your medical history, with the goal being to determine if any past injuries or preexisting conditions may have led to PE. Afterwards, they may perform a brief examination of your body, touching certain parts to gauge your pain levels. From this point, more in-depth body scans may be necessary, especially if they suspect deep vein thrombosis. The most commonly used method is an electrocardiogram, which is able to measure electric wave activity in the heart. From there, the next course of action is to perform a scan with imaging technology, that will provide a much clearer picture of what’s happening inside your body.
Imaging Technology for Diagnosing Pulmonary Embolisms:
- Duplex Ultrasound: Also known as a Duplex Doppler, this form of ultrasound imaging is designed to target the arteries and veins. It can be used on your chest to look for an embolus, or on your limbs to check for the presence of deep vein thrombosis.
- X-Rays: Using standard X-ray scans, doctors can get a clear picture of your general chest area. While this won’t provide as much detail on your arteries or lungs, using an X-ray can rule out other respiratory conditions such as pneumonia.
- CTPA: This is an acronym for CT Pulmonary Angiography. It involves exposing the body to a small amount of radiation in order to capture a detailed image of the chest. CTPA is often used to examine patients’ lungs for the presence of PE.
- VQ Scan: Short for ventilation and perfusion scan, a VQ scan involves radiotopic imaging in a milder form than CTPA. It isn’t used as often as other scans, but may be recommended for people allergic or resistant to stronger forms of imaging. It involves breathing in air mixed with small amounts of radiation, in order to capture data on the flow of air in your lungs.
Once an accurate diagnosis has been obtained, treatment can begin. An effective first course of action a doctor will usually pursue is a prescription for medication. The type of medicine used is called an anticoagulant, or blood thinner, and it prevents the body from forming clots. There are a few different possible anticoagulants patients may be prescribed for treating PE, and they can come in the form of an injection, tablet, or drinkable syrup. The common procedure for treatment is using injections first, as they take effect quickest, and then prescribing tablets or syrup over the next few months.
Anticoagulants for Treating Pulmonary Embolisms:
- Heparin is an injected blood thinner, used most commonly on hospital inpatients. Another form of this anticoagulant is called low molecular weight heparin, or LMWH. Common brands of heparin are Fragmin and Clexane.
- Warfarin is a form of ingested blood thinner, meaning it is taken orally either in tablet or syrup form. These are used commonly for a few months after treatment, in order to prevent clots from re-forming.
- Fondaparinux Sodium, also known as Arixtra, is another form of intravenous blood thinner used commonly during surgery. It is often used to prevent deep vein thrombosis or pulmonary embolism during surgical treatment for other conditions, but can be used for standard PE treatment if other medicines can’t be used.
- Thrombin Inhibitors are a recent development in anticoagulant medicine for treating PE. It is used as an alternative for LMWH for patients that are at risk of developing complications, such as internal bleeding. Common forms of thrombin inhibitors are lepirudin, desirudin, bivalirudin and argatroban.
This is a more extreme and immediate form of embolism treatment. Using much stronger medicine than standard anti-coagulants, it is injected directly into the affected part of the body, either through an IV or with the aid of a catheter. This procedure can be risky for some patients, potentially resulting in internal bleeding. For this reason, it is reserved for emergency treatment, with standard blood thinner treatment being more commonly prescribed. However, patients who are resistant to blood thinners or who are in need of immediate life saving treatment can benefit from this procedure.
Oxygen therapy is sometimes used in conjunction with other treatment methods: not necessarily in order to treat the condition, but in order to mitigate the symptoms, such as shortness of breath and feeling lightheaded. It involves supplying pure oxygen to the body, either through the use of a face mask or with a tube inserted into the patient’s windpipe. Oxygen therapy can provide relief during initial stages of PE treatment, until the anticoagulant medicine begins to take effect, clearing out the lungs and making normal breathing effective once more. While providing fresh oxygen won’t improve the overall functionality of the heart and lungs, having a fresh source ensures that your body gets the most out of each breath, even if it is strained.
Surgical treatment for pulmonary embolisms vary in severity, and usually require little to no anesthetic. Many of them involve inserting apparatus into the patient’s body in order to stop PE. Depending on the severity of the embolism, some patients will need to stay in the hospital for a few days after surgery in order to have more tests performed, and some will be able to return home the day of the surgery.
- Filter insertion involves placing a small filter in the vena cava, a large vein in the body that connects your limbs to the right atrium of your heart. With an inferior vena cava filter, or IVC filter, clots are captured before they can reach the heart, while still allowing blood to flow past it. Eventually, your body will break up the clot with natural anticoagulant properties, or with the aid of medication.
- Embolectomy is a surgical procedure used in severe cases of PE. It is performed in the chest, very close to the heart, and involves directly removing the clot. It carries a high risk of death, so this treatment is normally reserved for patients at a high risk of death from the embolism. Another form of embolectomy that is less dangerous involves inserting a catheter to break up the clot, known as a catheter embolectomy. However, this form of embolectomy is specialized, meaning only certain hospitals are able to perform it.
How Do You Prevent Pulmonary Embolisms?
The most effective way to prevent PE is to prevent deep vein thrombosis, since it is the most common cause of embolus development. For this reason, many of the treatment methods listed below are also useful for treating DVT. For more information about deep vein thrombosis, you can read our separate article about it here.
Providing some form of compression to your legs is very helpful in preventing the forming of clots in your legs. This is especially important when recovering from another serious injury that may require extended periods of inactivity. With properly applied compression, swelling is reduced in the legs, and it becomes much harder for clots to develop in them as well. If clots are beginning to form, proper compression will help break up these clots with the assistance of anti-coagulants. One popular method of applying compression to your legs is compression stockings. These can be worn by men or women, and they provide even compression from your ankles to your upper thigh. The compression eases off the further up your leg, ensuring comfort for daily wearing. Another method is intermittent pneumatic compression, or IPC. These are special cuffs worn on the legs that slowly inflate and deflate. This provides steady compression without causing excessive discomfort or cutting off circulation, and are most commonly used on patients recovering from leg injuries as a deep vein thrombosis preventative measure.
Another important step to take for those at risk of PE, whether you exercise regularly or are required to take a long resting period, is elevating your legs. This can be done simply by propping up your legs with pillows while laying down. There are also specially designed chairs and beds that can be obtained that are designed to elevate your legs while using them. The role elevation plays in reducing clots is assisting your legs with circulation. Combined with compression and the use of blood thinners when needed, keeping your legs elevated will go a long way toward preventing the forming of clots, as well as preventing clots from dislodging and moving toward your heart and lungs.
The most effective preventative measure you can perform for DVT and PE is to move your legs regularly. This can understandable be difficult for those recovering from an injury, but an effort should be made to exercise your legs in order to prevent the formation of clots. If you are able, take short walks intermittently throughout the day. Not only will this help prevent clots, but it can also rehabilitate your lower body faster, allowing you to resume running regularly in a shorter period of time. If you are unable to stand up or take walks, either due to an injury or due to travel, flex your leg muscles occasionally. Whether you are able to stand and walk around, are unable to stand, or are confined to a limited space for extended periods of time, there are exercises you can perform in order to encourage circulation and prevent the forming of an embolus.
Seated Exercises for Preventing Pulmonary Embolisms:
These are exercises that can be performed while seated in a chair. They are recommended for individuals at risk of PE who have limited mobility, or who are traveling for long periods of time. These exercises require you to be sitting upright, and you must be able to bend your knees.
- Foot Lifts: With both your feet flat on the ground, slowly lift your toes up as high as you can with your heels still touching the ground. Hold for a few seconds, then slowly lower them back to the ground. Then, lift your heels up with your toes still on the ground and hold for a few seconds before returning to the starting position. Repeat five to ten times.
- Ankle Rotations: Lift both your feet off the ground so they have a full range of motion. Begin rotating your ankles by moving your toes in a circle, one foot moving clockwise and the other moving counterclockwise. Perform this movement for twenty to thirty seconds, then switch directions for each foot and repeat.
- Seated Curl: With both feet flat on the ground, bend your upper body toward your knees. Grab your upper shins with your hands and slowly move them down your leg in a walking motion, stopping at your ankles, holding for ten to twenty seconds. Return to starting position and repeat three to five times.
- Knee Extensions: Start with your feet flat on the ground and your knees bent. Slowly lift one foot off the ground until your knee is extended and your leg is straight. Hold for five seconds, then slowly lower your leg back to the ground. Repeat the movement with your other leg. Perform this exercise ten times with each leg.
- Knee Lifts: Start with your knees bent and both feet flat on the ground. Slowly lift the foot of one leg off the ground, using your thigh and keeping your leg bent. Hold for a few seconds, then slowly lower it back to the ground and repeat the movement with the other leg. Perform this exercise ten to twenty times for each leg.
If you aren’t confined to a chair and are able to move around freely, the best way to prevent DVT and PE is to walk regularly. As a general guideline, the best practice is to take a short walk every two hours, starting at 15 minutes a day and working your way up to 45 minute long walks every day.
In addition to regular exercise, proper nutrition is another highly effective preventative measure to avoid clots. Avoiding specific unhealthy foods and replacing them with healthier options will help reduce clots in your bloodstream, as well as providing general health benefits that will improve your running ability over time. These health benefits apply to all age groups, but the elderly in particular should emphasize these dietary changes as they are at the highest risk of nutrition deficiencies.
Substances to Avoid When Preventing Pulmonary Embolisms:
- Saturated Fats: These are commonly found in dairy products, such as cheese and whole milk. They can also be found in beef and chocolate. Consuming excessive amounts of saturated fats can increase the likelihood of heart problems by up to 25%, as scientific studies have shown.
- Cholesterol: Commonly found in saturated fats, cholesterol is found in the majority of foods derived from animals, such as dairy and meat. Some cholesterol is needed in the body for the production of hormones and Vitamin D, but too much cholesterol can cause blood clots, which can potentially turn into an embolus.
- Cranberries: These should be avoided if you are on blood thinner medication, since they contain high amounts of warfarin. Too much warfarin can cause the opposite effect of clotting in your bloodstream, and thin your blood too much to the point where you can suffer from internal bleeding.
Substances to Add When Preventing Pulmonary Embolisms:
- Lean Proteins: Protein is an essential nutrient for the body, responsible for promoting strong muscles and bones. Protein can be found in foods rich in saturated fats such as beef and dairy, but you should seek out leaner sources of protein instead. Some common sources of lean protein include grilled chicken, turkey, and leafy green vegetables.
- Omega-3: Omega-3 fatty acids are necessary for many functions in the body, and are commonly recommended to reduce heart disease. However, it is not naturally produced in the body, and can only be obtained through food. For this reason, it is very important to include foots rich in Omega-3 into your diet. Foods rich in Omega-3 fatty acids include fish such as mackerel, herrings, sardines, and salmon. If you are unable or unwilling to add fresh fish to your diet, you can also take Omega-3 supplements such as fish oil tablets to provide your body with the same effect.
- Green Tea: Green Tea, also known as matcha, is a commonly recommended dietary supplement with many dietary benefits, such as improving metabolism and suppressing appetite. However, it has also been shown to reduce levels of cholesterol in the body, preventing heart disease. Switching out coffee for green tea as a morning caffeine source can be very effective in preventing blood clots, as well as assisting with weight loss.
Heart disease is no laughing matter. Whether it comes on quickly or gradually, it is important to treat blood clots and pulmonary embolisms fast and effectively. Understanding the risks of PE is important, but it is still important to remain calm. With proper treatment and methods of prevention, DVT and PE can be mitigated and you can resume running after a short period of recovery. This article was thoroughly researched with scientific studies and information provided by medical professionals, but you still should not treat it as medical advice. Always go to a doctor if you believe you are experiencing health problems.
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