A quick overview:
What is a pulmonary embolism?
Pulmonary embolism causes closure of one or more pulmonary arteries. Untreated, this can lead to death. The blockage is caused by a blood clot that is flushed into the lungs. This closes the arteries, which are important for lung circulation. The affected lung section is then cut off from the blood, oxygen and nutrient supply. At the same time, the blood backs up to the heart. This can lead to shortness of breath and heart failure. Quick help is therefore essential.
Pulmonary embolism is relatively common, the mortality rate is high: In Germany, around 50,000 people develop pulmonary embolism every year. More than 40,000 people die as a result. A comparison: Pulmonary embolism causes more deaths each year than road traffic accidents, breast and prostate cancer and HIV.1
Causes: How does a pulmonary embolism develop?
The most common cause of pulmonary embolism is deep vein thrombosis (DVT). Then a slowed blood flow, changes to the vessel wall and increased blood clotting (Virchow's triad) are the three essential factors for the formation of a blood clot.
In this case, the risk factors for pulmonary embolism are the same as those leading to the disease of deep vein thrombosis of the leg. Risk factors for pulmonary embolism are, for example: older age, surgery, lack of exercise, smoking, blood clotting disorders, pregnancy or taking hormone preparations (for example birth control pills). Some painkillers can also slow the flow of blood. In addition, pulmonary embolism can be caused by amniotic fluid, fat, air or bone cement in the context of joint replacement.
Symptoms and signs of pulmonary embolism
The symptoms of pulmonary embolism are often unclear. They are often confused with a heart attack. From a symptom-free course to death by heart failure, anything is possible. If diffuse symptoms occur in people who also suffer from unilateral leg swelling (possibly thrombosis) and/or fall into the above-mentioned risk groups, pulmonary embolism must always be considered. Recent surgery is the most common cause of pulmonary embolism.
In most cases, the symptoms occur suddenly, for example:
- Patients in hospital with and without surgery or injury
- Chest pain while breathing
- Congestion of the veins in the neck
- Accelerated breathing
- Pulse acceleration
- Feeling of impending doom
- Cold sweats
- Cough or coughing up blood
- Decreased blood pressure
The diagnosis is performed safely and quickly by means of computed tomography (CT). An alternative to this is scintigraphy – using a contrast agent to create an image of the blood vessels.
Can pulmonary embolism be prevented?
According to a recent survey commissioned by the International Society for Thrombosis and Haemostasis Research (ISTH), 50 percent of the respondents have never heard of the term pulmonary embolism.1 Those who do not know about this clinical picture do not know their risk factors and cannot protect themselves. Therefore, clarification is necessary: There are effective preventive measures. The prevention of pulmonary embolism largely corresponds to the prophylaxis of thrombosis. Medicinal and physical measures are used.
Therapy and treatment of pulmonary embolism
If pulmonary embolism is suspected, call an emergency doctor immediately
- Oxygen delivery with mask
- Elevating the upper body in case of shortness of breath
- Anxiolytic agents used to calm breathing
- Administration of blood-thinning medication for the slow dissolution of the blood clot
- If necessary, removal of the clot by way of a catheter or surgery (pulmonary embolectomy) and monitoring in the intensive care unit
Duration of healing: Patients with pulmonary embolism usually have to take blood-thinning medications for three to six months. The risk of recurrence is relatively high during this time. As a rule, the pulmonary embolism heals without consequences, especially in mild to moderate cases. Aftercare and prevention of further pulmonary embolism is carried out by the general practitioner or a vascular specialist (angiologist). These include, but are not limited to:
- Taking medically prescribed blood thinners
- Wearing medical compression stockings
- Regular movement/exercise
- Sufficient liquid
- Weight loss in obese patients
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1 Hofmann J, Nissen H, Strube K. Thrombose und Lungenembolie. Venenratgeber. Deutsche Gesellschaft für Angiologie – Gesellschaft für Gefäßmedizin e. V. 2019;7:12.
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