Sudden shortness of breath, chest pain or cough are signs that do warn the patient that something is wrong but minor indicators like swelling of legs or discoloration of skin usually go unnoticed and are ignored by patients. All these signs and symptoms are likely to lead to severe situations like Pulmonary embolism blood clots in the lungs and hence should be considered significant as neglect can cause death.

WHAT IS PULMONARY EMBOLISM: – A Silent Condition which could be fatal:

Pulmonary refers to lungs and embolism is a collection of mass moving through the bloodstream.

An embolism occurs when a lump dislodges from a vein, travels through the bloodstream, and lodges within the arteries of the lung, occluding them leading to pulmonary embolism.

They mostly develop in the deep venous system of the lower extremity; nevertheless, they may sometimes form in the pelvis, renal, or upper extremities or the right heart chambers.

Sometimes, an embolism may result from an embolus that's created from the humour, fat droplets, or another particle that enters the bloodstream.

The alarming signs and symptoms include – anxiety, shortness of breath, general soreness, chest pain, pain within the legs or arms, forcing out pink foam, and therefore the loss of complexion below the clot.

The condition can only be treated by a medical professional and needs urgent medical attention.

For diagnosis, lab tests or imaging studies are required. The case can last several days or weeks. Common for ages 60 and older but may be dangerous or life-threatening. Case history also has an impression and will increase the likelihood.

SYMPTOMS OF PULMONARY EMBOLISM:

Symptoms of Pulmonary embolism differ depending on how much of the lung is involved, the size of the embolus, and whether there is any underlying lung or heart disease.

Common symptoms include:

-Shortness of breath: which occurs suddenly and is exacerbated on exertion

-Chest pain: This can be confused with the Chest pain of angina. Pain aggravates on inspiration (pleurisy), cough, bending. pain worse on exertion but does not decrease on rest

-Cough: cough may be related to blood or blood-streaked sputum production

Additional symptoms that can happen include:

-Pain or swelling in the leg; preferably in the calf region

-Discolored skin

-Fever

-Excessive sweating

-Rapid or irregular heartbeat

-Dizziness or light-headedness

WHAT CAUSES PULMONARY EMBOLISM?

Pulmonary embolism is caused by an occluded artery in the lungs. The most common cause of such a hindrance is a blood clot that forms in a deep vein in the leg and that proceeds to the lungs, where it gets fixed in a smaller lung artery.

Maximum blood clumps that cause pulmonary embolism are formed in the deep leg veins. Clots furthermore can form in the deep veins of the arms or pelvis.

Sometimes blood clots appear in surface veins. But these clots rarely lead to pulmonary embolism.

In rare cases, pulmonary embolism may result from other substances. These are:

-Small clumps of infectious material.

-Fat is released into the bloodstream after some bone fractures, surgery, trauma, or severe burns.

-Air bubbles or materials that get entrapped into the blood from trauma, surgery, or medical approaches.

-Tumors due to rapidly growing cancer cells.

-Amniotic fluid.

PULMONARY EMBOLISM WHO IS AT RISK?

Though anyone can develop blood clots and subsequent pulmonary embolism, certain factors can increase the risk

1-Medical conditions and treatments

Higher risk prevails if any of the family members have had venous blood clots or some medical conditions prevails and some treatments that can rise possibility, such as:

-Heart disease. Cardiovascular disease, especially heart failure, makes clot formation more likely.

-Cancer: Malignant cancers escalate the risk of blood clots, and chemotherapy further increases the uncertainty. Women with a family history of breast cancer who use tamoxifen or raloxifene also are at elevated risk of blood clots.

-Surgery. One of the leading causes of blood clots. For this reason, medication to prevent clots is given before and after major surgery, such as joint replacement.

-Disorders that affect clotting. Few inherited disorders affect the blood, making it more likely to clot. Other medical disorders such as kidney disease are also prone to form blood clots.

-Coronavirus disease 2019 (COVID-19): Patients with severe symptoms of COVID-19 possess an increased risk of pulmonary embolism.

2-Prolonged immobility

Blood clots more likely arise during periods of inactivity, such as:

-Bed rest: Confined to bed for an extended period after surgery, a heart attack, injury or any sequential illness makes blood clots more pronounced.

When the lower extremities are horizontal for long periods, the flow of venous blood slows and blood pools in the legs, mostly resulting in blood clots.

-Long trips. Sitting in a constricted position during lengthy airplane or car trips slows blood flow to the legs which promotes the formation of clots.

3-Other risk factors

-Smoking. For reasons that aren't well comprehended, tobacco use predisposes to blood clot formation, particularly when combined with other risk factors.

-Being overweight. Obesity increases the risk of blood clots — especially in people with other risk factors.

-Supplemental estrogen. Estrogen in birth control pills and hormone replacement therapy can add up to blood clotting.

-Pregnancy. The weight of the baby compressing veins in the pelvis can slow blood return from the legs. Clots more possibly form when blood slows or collects.

WHAT ARE SOME COMPLICATIONS?

Pulmonary embolism is life-threatening. About one-third of people with unidentified and unattended pulmonary embolism usually don't get through. When the condition is diagnosed and treated accordingly, nevertheless, that number drops automatically.

Pulmonary embolism can also give rise to pulmonary hypertension, a defect in which the blood pressure in the lungs and the right side of the heart is too high. When there are obstructions in the arteries inside the lungs, the heart must work harder to push blood through vessels, which increases blood pressure and eventually weakens the heart.                                     

In few cases, small emboli occur frequently and develop over time, resulting in chronic pulmonary hypertension, also known as chronic thromboembolic pulmonary hypertension.

WHEN TO RUSH TO THE EMERGENCY ROOM?

If there is blood in the sputum on coughing, the patient should head over to emergency room as soon as possible and get emergency care. Children may present with a blue stain on their skin or a visible trailing of their skin on their ribs when they breathe, which should also be a sign that needs immediate concern and the patient should be rushed to the ER.

HOW TO DIAGNOSE?

-Electrocardiogram (ECG or EKG): To exclude myocardial infarction, angina, or any other heart disease.

-CT pulmonary angiogram: Test to foresee the distribution and expanse of the emboli.

-X-ray: To differentiate pneumonia or pneumothorax

-Spiral CT: To study any abnormalities in the arteries of the lungs.

-Ventilation-perfusion scan: To check the flow of air and blood into the lungs.

-D-dimer test: D-dimer levels are accelerated in response to clots.

-CD-10 code I82.9 for Embolism and thrombosis of an unspecified vein is a medical classification as listed by WHO under the range. 

-Septic embolism with acute hypertrophy Billable Code I26.01 is a sound billable ICD-10 diagnosis code for Septic embolism with acute hypertrophy. it's found within the 2021 version of the ICD-10 Clinical Modification (CM) and may be employed in all HIPAA-covered transactions from Oct 01, 2020.                                                                                             

TREATMENT OF PULMONARY EMBOLISM?           

Treatment of pulmonary embolism is focused on keeping the blood clot from getting larger and avoiding new clots from forming. Essential treatment is essential to avert serious complications or death.

Medications:                                                                                                                                        Medications include various types of blood thinners.

-Blood thinners (anticoagulants). These drugs stop existing clots from enlarging and new clots from forming while the body works to break up the clots. Heparin is a commonly used anticoagulant that can be given intravenously.

It acts immediately and is often potentiated for several days with an oral anticoagulant, such as warfarin, until it becomes effective, which usually takes days.

Newer oral anticoagulants work more rapidly and have fewer interactions with other medications. Some have the advantage of being given orally, without the need for adding heparin.

However, all anticoagulants have various side effects, but bleeding is the most common.

-Thrombolytics: Clots usually dissolve on their own, however sometimes thrombolytics induced intravenously render clots swiftly. As these clot-dissolving drugs can cause sudden and severe bleeding, they usually are reserved for life-threatening situations.

Surgical and other procedures

-Clot removal. If there is a life-threatening clot in the lung, the doctor may suggest removing it via catheterization.

-Vein filter. A catheter can be used to place a filter in the inferior vena cava ( an important vein). This filter helps keep clots from going to the lungs.

-This procedure is mostly reserved for people who can't take anticoagulants or they have recurrent clots despite the use of anticoagulants.

Ongoing care

Because the patient might be at risk of another deep vein thrombosis or pulmonary embolism, it's important to continue treatment, such as continuing blood thinners and being monitored as often as suggested by the physician.

SOME HOME FIXES/PREVENTIVE MEASURES OF PULMONARY EMBOLISM:

1-Improve Your Diet

It is believed that consuming foods with vitamin K might increase Pulmonary Embolism risk. However, this doesn’t seem to be the case.

In fact, foods like leafy greens that naturally give vitamin K are very healthy options. They have many anti-inflammatory properties.

Eating nutrient-dense, unprocessed foods, especially: leafy vegetables, non-starchy veggies like cruciferous veggies, avocado, sweet potatoes, olive oil, berries, and bananas should be prioritized.

These foods are high in crucial electrolytes, antioxidants, and other nutrients. However, vitamin K can interact with blood-thinning drugs.

Other foods, herbs, and supplements that possess natural anticoagulant and anti-inflammatory effects to reduce the risk for PE are:

-Foods with vitamin E and vitamin D: found in fruits, vegetables, and certain types of mushrooms

-Spices and herbs, including garlic, turmeric, oregano, and ginger

-Real dark cocoa/chocolate

-Fruits such as papaya, berries, and pineapple

-Raw honey

-Apple cider vinegar

-Green tea

-Fish oil and omega-3 fatty acids from wild-caught fish

-Beans, pulses,, nuts, fish, and graze-raised meat in restraint.

-Enough plain water and other hydrating liquids like herbal teas should be consumed. Too much alcohol or caffeine should be avoided.

2. Stay Active

Exercising regularly and avoiding prolonged inactivity, immobilization can help lower the risk for PE. 

The best types of exercises for keeping the blood pressure at a healthy level, protecting the lungs, and maintaining a strong heart and veins demand aerobic exercises combined with strength training.

It’s highly recommended to maintain a regular exercise program.

3. Maintain A Healthy Weight

Being obese puts more pressure on the heart, vital organs, lower extremities, and blood vessels. Estrogen stored in fatty tissue also contributes to clot formation, inflammation, and other problems that can help develop a potentially dangerous clot. Keeping a healthy weight even by reducing intake of processed foods and taking a whole foods diet, being active, taking enough sleep, and decreasing stress are also essential.

4. Check Your Medications

Medications such as birth control pills, hormone replacement drugs (usually used by menopausal, postmenopausal women, or those treating infertility), and medications used to control blood pressure are all linked to increased incidence of blood clots, DVT and Pulmonary Embolism. Medicaments used in cancer treatments or for controlling autoimmune diseases may also interfere with blood coagulation

5. Take Precaution After Trauma, Injury, Surgery, When Traveling or When Hospitalized

Treatment options following surgery or trauma; now bring concern that few drugs and venous filters should be used only for patients who cannot take any other form of care.

HOW TO PREVENT PULMONARY EMBOLISM?

Pulmonary embolism can be avoided by blocking clot propagation in the deep veins of the legs (deep vein thrombosis). This is accomplished by:

-Anticoagulants: Given to those patients who are susceptible to blood clots.

-Compression stockings: Help the veins and muscles of the leg to drive blood efficiently.

-Leg elevation: Physical activity: movement as soon as possible after major surgery.

-During traveling: the risk of development of clots elevates with an increase in traveling time. Following measures should be taken:

-Drinking plenty of water.

-Avoiding sitting for a long duration. Moving around in the flight and flexing ankles every 15-30 minutes