User:Mr. Ibrahem/Pulmonary embolism

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Pulmonary embolism
Chest spiral CT scan with radiocontrast agent showing multiple filling defects both at the bifurcation ("saddle" pulmonary embolism) and in the pulmonary arteries
SpecialtyHematology, cardiology, pulmonology
SymptomsShortness of breath, chest pain, coughing up blood[1]
ComplicationsPassing out, abnormally low blood pressure, sudden death[2]
Usual onsetAdvanced age[3]
Risk factorsCancer, prolonged bed rest, smoking, stroke, certain genetic conditions, estrogen-based medication, pregnancy, obesity, after surgery[3]
Diagnostic methodBased on symptoms, D-dimer, CT pulmonary angiography, lung ventilation/perfusion scan[4]
TreatmentAnticoagulants (heparin, warfarin, DOACs)[5]
Frequency~450,000 per year (USA), 430,000 (Europe)[6][7][8]
Deaths50,000–200,000 per year (USA)[7][9]

Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism).[6] Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood.[1] Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg.[1] Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever.[10] Severe cases can lead to passing out, abnormally low blood pressure, and sudden death.[2]

PE usually results from a blood clot in the leg that travels to the lung.[6] The risk of blood clots is increased by cancer, prolonged bed rest, smoking, stroke, certain genetic conditions, estrogen-based medication, pregnancy, obesity, and after some types of surgery.[3] A small proportion of cases are due to the embolization of air, fat, or amniotic fluid.[11][12] Diagnosis is based on signs and symptoms in combination with test results.[4] If the risk is low, a blood test known as a D-dimer may rule out the condition.[4] Otherwise, a CT pulmonary angiography, lung ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis.[4] Together, deep vein thrombosis and PE are known as venous thromboembolism (VTE).[13]

Efforts to prevent PE include beginning to move as soon as possible after surgery, lower leg exercises during periods of sitting, and the use of blood thinners after some types of surgery.[14] Treatment is with anticoagulants such as heparin, warfarin or one of the direct-acting oral anticoagulants (DOACs).[5] These are recommended for at least three months.[5] Severe cases may require thrombolysis using medication such as tissue plasminogen activator (tPA) given intravenously or through a catheter, and some may require surgery (a pulmonary thrombectomy).[15][16] If blood thinners are not appropriate, a temporary vena cava filter may be used.[15]

Pulmonary emboli affect about 430,000 people each year in Europe.[8] In the United States, between 300,000 and 600,000 cases occur each year,[6][7] which results in between 50,000[7] and 200,000 deaths.[9] Rates are similar in males and females.[3] They become more common as people get older.[3]

References[edit]

  1. ^ a b c "What Are the Signs and Symptoms of Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 9 March 2016. Retrieved 12 March 2016.
  2. ^ a b Goldhaber SZ (2005). "Pulmonary thromboembolism". In Kasper DL, Braunwald E, Fauci AS, et al. (eds.). Harrison's Principles of Internal Medicine (16th ed.). New York, NY: McGraw-Hill. pp. 1561–65. ISBN 978-0-07-139140-5.
  3. ^ a b c d e "Who Is at Risk for Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 15 February 2016. Retrieved 12 March 2016.
  4. ^ a b c d "How Is Pulmonary Embolism Diagnosed?". NHLBI. July 1, 2011. Archived from the original on 7 April 2016. Retrieved 12 March 2016.
  5. ^ a b c Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. (February 2016). "Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report". Chest. 149 (2): 315–352. doi:10.1016/j.chest.2015.11.026. PMID 26867832.
  6. ^ a b c d "What Is Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 12 March 2016. Retrieved 12 March 2016.
  7. ^ a b c d Rahimtoola A, Bergin JD (February 2005). "Acute pulmonary embolism: an update on diagnosis and management". Current Problems in Cardiology. 30 (2): 61–114. doi:10.1016/j.cpcardiol.2004.06.001. PMID 15650680.
  8. ^ a b Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. (November 2014). "Thrombosis: a major contributor to global disease burden". Arteriosclerosis, Thrombosis, and Vascular Biology. 34 (11): 2363–71. doi:10.1161/atvbaha.114.304488. PMID 25304324.
  9. ^ a b Kumar V, Abbas AK, Fausto N, Mitchell RN (2010). Basic Pathology. New Delhi: Elsevier. p. 98. ISBN 978-81-312-1036-9.
  10. ^ Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) (7 ed.). New York: McGraw-Hill Companies. p. 432. ISBN 978-0-07-148480-0.
  11. ^ "What Causes Pulmonary Embolism?". NHLBI. July 1, 2011. Archived from the original on 7 April 2016. Retrieved 12 March 2016.
  12. ^ Pantaleo G, Luigi N, Federica T, Paola S, Margherita N, Tahir M (2014). "Amniotic fluid embolism: review". Current Pharmaceutical Biotechnology. 14 (14): 1163–7. doi:10.2174/1389201015666140430161404. PMID 24804726.
  13. ^ "Other Names for Pulmonary Embolism". July 1, 2011. Archived from the original on 16 March 2016. Retrieved 12 March 2016.
  14. ^ "How Can Pulmonary Embolism Be Prevented?". NHLBI. July 1, 2011. Archived from the original on 7 April 2016. Retrieved 12 March 2016.
  15. ^ a b "How Is Pulmonary Embolism Treated?". NHLBI. July 1, 2011. Archived from the original on 9 March 2016. Retrieved 12 March 2016.
  16. ^ Ortel, Thomas L.; Neumann, Ignacio; Ageno, Walter; Beyth, Rebecca; Clark, Nathan P.; Cuker, Adam; Hutten, Barbara A.; Jaff, Michael R.; Manja, Veena; Schulman, Sam; Thurston, Caitlin; Vedantham, Suresh; Verhamme, Peter; Witt, Daniel M.; D. Florez, Ivan; Izcovich, Ariel; Nieuwlaat, Robby; Ross, Stephanie; J. Schünemann, Holger; Wiercioch, Wojtek; Zhang, Yuan; Zhang, Yuqing (13 October 2020). "American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism". Blood Advances. 4 (19): 4693–4738. doi:10.1182/bloodadvances.2020001830. {{cite journal}}: |access-date= requires |url= (help)
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