A clot in the heart can lead to a heart attack. Similarly, a clot in an artery in the lung can result in a health emergency, with chest pain and breathlessness. That’s pulmonary embolism, a lung condition with blocked arteries. Interestingly, it’s the upward travel of a blood clot from a limb to the lungs that creates havoc and disturbs blood supply, as experts narrate typical cases they have come across.
What is pulmonary embolism?
Dr Ranganatha R, consultant pulmonologist and head of department, pulmonology, Narayana Health City, Bengaluru, says that in most cases, the blood clots form somewhere else in your body, like your lower limbs (known as deep vein thrombosis or DVT), and then travel to the lungs. “Normal blood circulation gets affected, causing breathlessness, cough and chest pains,” says Dr Ranganatha, adding that in acute cases, the onset of pulmonary embolism and the associated breathlessness is sudden and considered a medical emergency.
Dr Sachin Kumar, senior consultant, pulmonology and critical care medicine, Sakra World Hospital, Bengaluru adds that immobility or spending prolonged periods sitting or lying down without any movement is a major risk factor for pulmonary embolism.
Dr Kumar recalls the case of a 26-year-old man who was brought to the emergency in February of 2023. The man was on his honeymoon from Bengaluru to Goa where his trip was cut short after landing. He was gasping for breath after the one-hour-long flight. He was rushed to a hospital in Goa where they found that his blood pressure levels were dropping rapidly.
Doctors who probed further found that he had a massive blood clot in his lungs. “He was brought to Bengaluru after stabilisation in Goa and we gave him blood thinner medication. The blood clot was formed in his leg as he sat without any movement for a prolonged time during air travel.”
“The man, also a smoker, had tested positive for Covid two or three weeks ago, with mild symptoms. We also found that the man had a genetic condition which made him more prone to developing blood clots,” says Dr Kumar.
Pulmonary embolism symptoms
Dr Kumar mentions that pulmonary embolism symptoms can differ based on the severity. Some of the common symptoms are:
- Difficulty in breathing
- Cough
- Chest pain
- Drop in blood pressure
- Presence of blood in sputum
- Pain and swelling in the leg (mostly in the calves and thigh region)
What causes pulmonary embolism?
Doctors say that there are multiple ways in which pulmonary embolism can occur:
- Damage to the vessel walls
“When the vessel walls (of the legs) get damaged due to injury or trauma, blood cells can get stuck to these walls, forming a clot,” says Dr Ranganatha.
- Long periods of inactivity
Dr Ranganatha says that one of the major risk factors for the formation of blood clots is long periods of inactivity or prolonged immobility. The vulnerable are elderly persons with low mobility and bedridden people including those who are bedridden post-surgery.
- Other conditions
Dr Kumar adds other conditions that may increase the chances of blood clots.
- Pregnancy
- Smoking
- Obesity
- History of pulmonary embolism
- Cancer
- Genetic conditions that make a person more prone to clot formation
How to detect pulmonary embolism
Dr VV Ramana Prasad, pulmonologist, KIMS Hospital, Hyderabad says that a CT pulmonary angiography test (CT scan for lungs) that can detect a clot in the lungs is currently considered the gold standard test for diagnosing pulmonary embolism.
Dr Prasad says that if pulmonary embolism is suspected, doctors may initially also recommend a 2D echocardiography test (to assess the functioning of the heart) and a blood test known as the D-dimer test (which can detect blood clotting).
“Generally, if any middle-aged or elderly persons with underlying comorbidities such as diabetes, hypertension, Chronic Obstructive Pulmonary Disorder (COPD), etc. with a history of travel suddenly develop breathing difficulties, we need to check for pulmonary embolism,” he says.
Treatment for pulmonary embolism
Dr Kumar says that the treatment of pulmonary embolism depends on the severity. “Normally, there is a blood-thinning medicine which is injected for the initial three to five days. After that, the person takes oral tablets which should be continued even after getting discharged,” he says.
Prevention
Dr Kumar also recommends lifestyle changes such as quitting smoking, getting enough exercise and maintaining a healthy diet to prevent obesity.
Dr Prasad adds that a follow-up for at least a year regularly is a must after an episode of a pulmonary embolism while blood thinner medication is continued to prevent chances of recurrence.
Compression clothing improves blood circulation. It can be worn on long-haul flights to reduce the risk of DVT.
“While travelling in an aircraft for a prolonged period, one must stretch legs frequently and move around. Sitting in one position for a long time is not recommended,” says Dr Kumar.
Takeaways
Blood clots that form in the limbs due to prolonged inactivity or any underlying risk factors can settle in the lung artery, a condition known as pulmonary embolism. Conditions that cause a higher risk of developing pulmonary embolism include injury, long periods of inactivity, smoking, obesity etc.
