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Pulmonary embolism

  1. A pulmonary embolism is a clot that occludes one or more blood vessels in your lungs. Part of your lung no longer receives blood and therefore no longer works properly. How does a pulmonary embolism develop and what can be done about it?

What is a pulmonary embolism?

  1. The pulmonary arteries supply your lungs with blood. When such a blood vessel is blocked, for example by a blood clot, a part of your lung no longer receives blood. This is called a pulmonary embolism. Your lung works less well because of the poorer blood flow. It is more difficult for your lung to absorb oxygen from the air, which makes you short of breath. Sometimes a piece of lung dies (pulmonary infarction) due to the lack of oxygen. A pulmonary embolism can be in various places in the lung. Sometimes multiple embolisms develop, occluding different branches of your pulmonary artery. The greater the part of the lung that is no longer receiving blood, the more serious the consequences.

  2. The pulmonary arteries supply your lungs with blood. When such a blood vessel is blocked, for example by a blood clot, a part of your lung no longer receives blood. This is called a pulmonary embolism. Your lung works less well because of the poorer blood flow. It is more difficult for your lung to absorb oxygen from the air, which makes you short of breath. Sometimes a piece of lung dies (pulmonary infarction) due to the lack of oxygen. A pulmonary embolism can be in various places in the lung. Sometimes multiple embolisms develop, occluding different branches of your pulmonary artery. The larger the part of the lung that is no longer receiving blood, the more serious the consequences.

Causes of pulmonary embolism

  1. In a pulmonary embolism, the pulmonary artery is usually blocked by a blood clot. Blood clots often form elsewhere in the body, for example in the legs (thrombotic leg). If a piece of such a clot comes off, it is carried to the rest of the body and can end up in the pulmonary artery and occlude it. In addition to a blood clot, a fat plug can also block the pulmonary arteries. Sometimes an air bubble is the cause of a pulmonary embolism, for example after an injection or in divers who ascend too quickly (caisson disease). In rare cases, a tumor is the cause of a pulmonary embolism.

Symptoms

  1. Not everyone suffers from a pulmonary embolism equally. This depends on, among other things, where the blood vessel is occluded and the size of the pulmonary embolism. The most common symptoms of a pulmonary embolism are: stuffiness chest or upper back pain when breathing cough, often with blood breathing faster dizziness to sweat faster and weaker heartbeat or palpitations Two thirds of all people with a pulmonary embolism also have a thrombotic leg. A clot in the blood vessels makes the leg thick, red and painful. Some people with a thrombotic leg do not suffer from this. Contact your doctor immediately if you suddenly become short of breath, are breathing much faster than normal, your breathing is painful and your phlegm is coughed up with blood. Also tell your doctor if your lower legs get thicker or painful.

How is pulmonary embolism diagnosed?

  1. It is often difficult to diagnose a pulmonary embolism. The doctor will first ask you a number of questions to determine what your symptoms are and whether you have risk factors for a thrombotic leg or pulmonary embolism. During the physical examination, your doctor will listen to your heart and lungs with a stethoscope, among other things. In addition, additional tests are needed to determine whether you have a pulmonary embolism: Blood test: the level of a certain substance (D-dimer) is measured, as well as the oxygen level and blood clotting Lung scan: to view the flow of blood vessels in the lungs X-ray of the lungs: to rule out other lung diseases Echo of the legs: the blood flow in the legs is examined and any clots (thrombotic bone) can be seen Heart movie (electrocardiogram or ECG) to measure the activity of the heart

Risk factors

  1. Several factors increase the risk of developing a blood clot, which can become lodged in the pulmonary arteries and cause a pulmonary embolism. Women have a higher risk of pulmonary embolism than men, and the chance increases with age. Other risk factors for a pulmonary embolism are: less movement, for example after an operation, a bone fracture or during a long flight increased coagulation, for example due to coagulation diseases overweight smoking and secondhand smoke use of hormones as contraception or against menopausal complaints pregnancy and postpartum period other diseases and conditions, such as diabetes, high blood pressure, high cholesterol, heart disease, lung disease and cancer

Treatment of a pulmonary embolism

  1. Your body usually clears the blood clot itself. In rare cases, the clot has to be removed during surgery. To prevent you from getting new blood clots, doctors prescribe blood thinners (anti-clotting drugs). You usually get injections of heparin first. You will also receive tablets: coumarin or DOAC (direct acting anticoagulants = direct acting blood thinners). You must use these tablets for at least six months. If you use coumarin, you must remain under control by the thrombosis service. They take blood samples every one to two weeks to measure blood clotting. They adjust the dose of the coumarins based on the results of this study. It can therefore vary how many tablets of coumarines you have to take every day. If you use DOAC, you take the same dose every day and you do not need to be checked by the thrombosis service. Be careful with alcohol, antibiotics and pain relievers such as aspirin, ibuprofen, naproxen and diclofenac when taking blood thinners. These drugs can thin the blood even more, increasing your risk of bleeding. Contact your doctor or the thrombosis service if you get bleeding, for example nose bleeds, bleeding gums, bruises or blood in your urine or stool. Blood thinners can also be harmful during pregnancy. Therefore, consult your doctor first if you are taking blood thinners and want to become pregnant. You can also do things yourself to minimize the chance of a new blood clot: sufficient exercise, drink enough water, maintain a healthy weight and no smoking or secondhand smoke. During a long flight it is best to get up every two hours to get some exercise and possibly wear compression stockings. Talk to your doctor about the most appropriate contraception - because hormones like those in 'the pill' and the contraceptive injection slightly increase the risk of thrombosis and pulmonary embolism.

Forecast

  1. Most people make a full recovery from a pulmonary embolism. If a part of your lung is damaged, for example by a pulmonary infarction, you can continue to suffer from shortness of breath or a reduced condition. You can usually stop the blood thinners after six to 12 months. Have you had multiple pulmonary embolisms? Then doctors recommend that you keep using the blood thinners to prevent new blood clots as much as possible.

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