A pulmonary embolism happens when there is blood clotting in the arteries located in the lungs. This complication results from blood clots traveling from different parts of the body, especially the legs, through the right part of the heart to the lungs (Morrone,2018). Furthermore, it can lead to damage in parts of the lungs due to the limited flow of blood and, therefore, negatively impact the other organs (Morrone, 2018). Pulmonary embolism is a serious condition that can cost a life, mainly when the clots are many, or they are large.
The estimated number of patients by the World Health Organization all over the world ranges from a rate of 0.75 to 2.69 per 1000 persons in a year (WHO, 2018). The rate of mortality of persons with pulmonary embolism is estimated to be 7% to 11% in a year. It is also estimated that it cost more than $30000 in the healthcare system of the United States’ during the first year of diagnosis.
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Etiology and risk factors
In most cases, many blood clots are significant reasons for pulmonary embolism. Sometimes this condition can also be caused by other materials rather than blood clots. These can either be tumor parts, fat, or bubbles of air (Fukumoto, 2017). Blood clots can be formed in any person, but some factors put one at a high risk of diagnosed with this condition. These risks include heart diseases, surgery, cancer, inherited blood clotting disorder, and Coronavirus disease (COVID-19) (Morrone 2018). Some other risk factors can be pregnancy, being overweight, extra estrogen, and smoking.
Age can also be crucial concerning pulmonary embolism. Older people are more prone to pulmonary embolism than young younger people (Konstantinade et al., 2016). For instance, a patient suffering from lung or heart complications in his 30s can exhibit few signs compared to someone in their 80s. However, when it comes to gender, it is indefinite which gender is at risk, but according to the mortality rates of pulmonary embolism patients, men are 20% to 30% higher than women. The genetic condition also still stands as one of the risk factors of pulmonary embolism, as the blood clotting disorder can be inherited by a member of the family (Konstantinade et al., 2016). The way of living also contributes to this condition. This is possible through smoking, gaining too much weight, and prolonged inactiveness.
Pathophysiological processes
Pulmonary embolism usually arises from a thrombus that originates deep in the venous system of the lower pelvis. A blood clot is formed and is pumped in the pulmonary circulation and sticks in a pulmonary artery. The clots can be large, causing hemodynamic instability and failure in the right ventricle (Morrone, 2018). They sometimes might body to blockage and platelets, small aggregated red cells and fibrin are formed and moved repeatedly in the venous circulatory system. Pulmonary embolism has several signs and symptoms, which can vary depending on the clot size and the involvement of the lung. Signs and symptoms include chest pains, cough, shortness of breath, heart palpitation, dizziness, fever, and pain in the leg or swelling.
Clinical manifestations: subjective and objective findings.
Clinical check-up makes the crucial step in identifying the presence of the complication. The majority of pulmonary embolism patients have at least one of the following symptoms, dyspnea, fainting, chest pains, or hemoptysis. These symptoms may indicate several body systems; this includes the lungs, brain, and heart (Fukumoto, 2017). Some physical assessment findings can be classified into four groups that are substantial pulmonary embolism, severe pulmonary infarction, severe embolism without infarction, and multiple pulmonary embolisms. These classified can also be tested by electro-cardiograph (ECG), MRI, chest radiography, pulmonary angiography, venography,etc.
Complications and diagnosis
Pulmonary embolism can bring about several deadly complications. These include pulmonary hypertension, simple hypoxemia, ventricular and atrial arrhythmias, infarction of the lung, etc. (Konstantinade et al., 2016). This condition, if not treated early, will cause damage to the body system and, eventually, death. The importance of carrying out the laboratory test mentioned earlier is to help identify any blockage in the arteries or blood clotting cases.
Pharmacologic recommendations.
Dabigatran 150mg – two times in a week after paracetamol – for patients having CrCL less than 30ml/min. Contraindicator: mechanical prospect valve.
Warfarin specific dose required by INR. Renal dosage adjustment: closely monitor INR. Contraindicator: the tendency in hemorrhage
Alteplase 100mg infusion over two hours. Contraindicator: active bleeding and stroke in 3 months (Fukumoto, 2017).
References
Fukumoto, Y. (2017). Diagnosis and treatment of pulmonary hypertension : from bench to bedside. Springer . (1) 34-38.
Konstantinides, S.V, Barco, S., Lankeit, & Meyer, G (2016). Management of embolism. Journal of the American College of ardiology . 67 (8), 976-990 http://doi.org/10.1016/j.jacc.2015.11061
Morrone, D., & Morrone V. (2018). Acute pulmonary embolism: focus on the clinical picture . Korean circulation journal, 48 (5), 365-381. http://doi.org/4070/kcj.2017.0314
World Health Organization. (, 2018). Recommended notifiable diseases. (1) 22-25. Doi: 10.18591/bjuik.0551
