Pulmonary Embolism: What it is, Causes, Symptoms, Treatment & Types

What is Pulmonary Embolism?

A pulmonary embolism (PE) is a condition in which one or more pulmonary arteries in the lungs become blocked, usually by a blood clot that travels from another part of the body, most commonly the legs. The illness lowers blood oxygen levels and decreases blood flow to the lungs. This condition can put extreme stress on the heart and harm lung tissue. While big clots can be lethal, little clots may only produce minor symptoms. In order to avoid complications, prompt medical intervention is crucial.

What are the Types of Pulmonary Embolism?

Pulmonary embolism can be classified into 3 main categories, which involve the following:

• Acute: This condition is quite common but hard to diagnose. In fact, symptoms can vary from person to person. Common symptoms include chest pain, dyspnoea, cough, and pleuritic chest pain.

• Subacute: The condition develops slowly and is tough to diagnose. Delays in diagnosis lead to further delays in treatment and poorer treatment outcomes. Individuals with subacute PE are known to have a higher mortality rate than those with acute PE. The symptoms of the condition can develop over 2–12 weeks.

• Chronic: This condition is characterised by residual blood clots that remain attached to the walls of the pulmonary arteries after treatment. It causes chronic thromboembolic pulmonary hypertension (CTEPH).

How Common is Pulmonary Embolism in India?

A pulmonary embolism is a serious health condition and one of the major causes of preventable hospital deaths worldwide. According to the World Health Organisation, this condition affects nearly 10 million people globally every year.

In India, pulmonary embolism is increasingly reported due to factors such as obesity, smoking, prolonged immobility, surgeries, and heart disease. According to a study, smoking was present in 18% of pulmonary embolism patients, while immobilisation affected 16% of cases. The hospital mortality rate in the study was approximately 6 to 7%, highlighting the importance of early diagnosis and timely treatment.

What are the Symptoms of Pulmonary Embolism?

Symptoms of pulmonary embolism can differ depending on the size and number of clots.

Although there are various types of symptoms, some of the most common ones include the following:

• Rapid Heartbeat: A lower oxygen supply may cause the heart to beat faster than usual.

• Sudden Shortness of Breath: Breathing difficulties that might happen quickly, even when you are at rest.

• Coughing Up Blood: A persistent cough may occur, and blood may sometimes be present in the mucus.

• Dizziness or Fainting: Low oxygen levels can make a person feel lightheaded or cause fainting.

• Excessive Sweating: Unusual sweating may happen due to breathing difficulty and stress.

• Chest Pain: Severe or acute chest pain that gets worse as you breathe deeply.

What Causes Pulmonary Embolism?

Pulmonary embolism commonly develops due to blood clots that travel from various parts of the body. Some causes for it are as follows:

• Deep Vein Thrombosis: Most pulmonary embolisms occur when blood clots formed in the deep veins of the legs break loose and travel to the lungs.

• Air Bubbles: Sometimes air or gas bubbles can enter the bloodstream during medical procedures, injuries, or trauma. These bubbles can block blood flow in the lungs.

• Prolonged Immobility: Staying inactive for extended periods, such as during bed rest, hospital stays, or long trips, can increase the risk of blood clots forming.

• Tumour: Fragments of cancerous tumours can sometimes break off and enter the bloodstream. These fragments may block arteries in the lungs.

• Amniotic Fluid: Rarely, amniotic fluid can get into the mother's bloodstream during labour or delivery. This can lead to life-threatening pulmonary embolism.

• Multiple Clots: In some cases, multiple blood clots may block different arteries in the lungs simultaneously.

What are the Complications of Pulmonary Embolism?

Pulmonary embolism can become life-threatening without timely treatment. Possible complications include the following:

• Cardiac Arrest
  A severe pulmonary embolism can suddenly stop the heart from beating properly, leading to a life-threatening medical emergency.

• Reduced Oxygen Supply
  Blocked blood flow can cause lung tissue damage (pulmonary infarction) and reduce oxygen supply to the body.

• Lung Tissue Damage (Pulmonary Infarction)
  Blocked blood flow to the lungs may cause lung tissue damage or death, a condition known as pulmonary infarction.

• Sudden Drop in Blood Flow (Obstructive Shock)
  A large blood clot can severely block normal blood circulation, leading to a dangerous drop in blood flow and oxygen supply throughout the body.

When Should I See My Healthcare Provider?

Pulmonary embolism can become life-threatening if not treated promptly. You should seek immediate medical attention if you experience any of the following symptoms:

• Sudden shortness of breath that develops without an obvious cause.

• Chest pain that worsens with deep breathing, coughing, or movement.

• A rapid, pounding, or irregular heartbeat, especially when accompanied by other symptoms.

• Coughing up blood or blood-stained mucus.

• Sudden dizziness, lightheadedness, or fainting.

• Severe pain, swelling, redness, or warmth in one leg may be signs of deep vein thrombosis (DVT), a common cause of pulmonary embolism.

How is Pulmonary Embolism Diagnosed?

Doctors diagnose pulmonary embolism by conducting various tests, such as the following:

How is Pulmonary Embolism Managed?

Management of pulmonary embolism consists of preventing clot growth and avoiding future clots. Some common ways of management include:

• Embolectomy: To remove a blood clot from the lungs, an embolectomy is performed. When other therapies are ineffective, it is typically considered in severe circumstances.

• Anticoagulants (Blood Thinners): Anticoagulants are the most commonly used treatment for pulmonary embolism. These medications help prevent blood clots from growing larger and reduce the risk of new clots forming.

• Inferior Vena Cava (IVC) Filter: A device called an inferior vena cava (IVC) filter is inserted into a big vein to prevent blood clots from entering the lungs. For those unable to take blood thinners, an inferior vena cava filter may be considered.

• Thrombolysis: A catheter or IV is used to deliver clot-dissolving drugs. In cases of severe pulmonary embolism or when blood thinners are ineffective, thrombolysis is typically advised.

Pulmonary Embolism During Pregnancy

Women are 10 times more likely to develop pulmonary embolism due to certain risk factors and hormonal changes. Some preventive measures a pregnant woman should take are:

• Staying hydrated and physically active may help improve blood circulation and reduce the risk of blood clots.

• Performing leg exercises and wearing compression stockings during prolonged sitting can help prevent blood clots.

• Being aware of a family history of blood clots and discussing pregnancy-related risks with a doctor can help in early prevention.

• Controlling obesity, diabetes, and heart or lung conditions may help lower the risk of this illness.

• Regular movement and exercise can help improve blood circulation and reduce the risk of clot formation.

What is the Prognosis for Pulmonary Embolism?

Treatment does not stop when an individual is discharged from the hospital. Many individuals need to continue taking blood thinners for at least three months. The duration of treatment depends on individual risk factors and overall health. Your healthcare provider will tell you what’s best based on your risk factors and overall health. A pulmonary embolism is a major life event, so recovery can take a while.

Can Pulmonary Embolism Be Reversed?

Yes, pulmonary embolism can often be treated successfully. Recovery from blood clots in the lungs can differ significantly from person to person. Many people may tend to recover in several months, whereas some might recover in a month or two. During this time, people may need to keep taking medication to prevent additional blood clots in future.

How Can I Prevent Pulmonary Embolism?

You can reduce the risk of this condition by following certain prevention tips, such as:

• Take prescribed medications, including blood thinners, regularly to help prevent pulmonary embolism.

• After surgery, follow your healthcare provider’s advice and start moving safely as soon as possible.

• Avoid sitting still for long periods and try to move, stretch, or flex your legs every 30 minutes.

• Wearing loose clothing and compression stockings can help reduce the risk of blood clot formation.

• Staying hydrated, elevating your legs, and doing foot exercises may help improve blood circulation.

Does Health Insurance Cover Pulmonary Embolism?

Yes, most health insurance plans in India generally cover pulmonary embolism treatment, including hospitalisation expenses, ICU charges, diagnostic tests, medicines and injections, surgery or clot-removal procedures, and post-hospitalisation care.

The coverage for this condition comes with a waiting period, and the extent of coverage may vary from plan to plan. Policyholders and prospective buyers are advised to carefully review the policy documents to understand what is and is not covered under their specific plan.

How Much Health Insurance Coverage is Needed for Pulmonary Embolism Treatment?

Pulmonary embolism treatment may involve emergency care, ICU admission, advanced imaging tests, blood thinners, and long-term follow-up. So, individuals may consider a health insurance coverage policy of ₹5 lakh to ₹10 lakh. For elderly people with other severe complications, coverage of ₹10 lakh to ₹25 lakh is suggested due to rising healthcare costs.