A pulmonary embolism is a blood clot that travels to the lungs. Often, the clot forms in another part of the body, usually in the veins of the legs. Large clots can be fatal. Pulmonary embolism is estimated to occur in one to two people per 1,000 each year in the United States. The December 3, 2003, issue of JAMA includes an article about diagnosing pulmonary embolism.
Grahic Jump Location
Sudden chest pain
Difficulty breathing
Cough with blood
Lightheadedness and fainting
Excessive sweating
Bluish tint to skin
Anxiety
Recent surgery
Long periods of immobility (such as bedrest because of an illness)
Cancer
Heart problems
Older age
Taking oral contraceptives
Previous stroke or heart attack
Pulmonary embolism can be difficult to diagnose because the symptoms are broad and resemble those of other diseases. Results of the patient's history and physical examination are very important. Some other tests that may be done include
Chest x-ray
Electrocardiogram
Arterial blood gases—measurement of oxygen and carbon dioxide levels in the blood
D-dimer assay—a blood test for evidence of blood clots
Ultrasound of the legs—sound wave images to detect blood clots in the veins
Lung scan—test of blood flow through the lungs
Spiral computed tomography—detailed computerized x-ray imaging
Pulmonary arteriogram—injections to show the arteries in the lungs to detect blood clots
Immediate treatment usually includes giving injectable anticoagulants (blood thinners)—such as heparin, followed by warfarin (an anticoagulant taken by mouth)—to stabilize the clot, prevent additional clots, and restore normal blood flow in the lungs. Oxygen and sedatives may be given to make the patient more comfortable. If the clot is large, thrombolytic ("clot busting") drugs may be needed to remove it.
American Heart Association 800/242-8721http://www.americanheart.org
National Heart, Lung, and Blood Institute 301/592-8573 http://www.nhlbi.nih.gov
To find this and other JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. A previous Patient Page on pulmonary embolism was published in the February 14, 2001, issue.
Sources: American Heart Association, National Heart, Lung, and Blood Institute
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