Pulmonary embolism: vulnerable groups
The following groups of people are at higher risk of suffering from pulmonary embolism:
- Bedridden and immobile people are particularly at risk for venous thrombosis and thus pulmonary embolism.
- After surgery, the risk of thrombosis is very high; If the person then stands up or presses heavily during bowel movements, a clot can come off and get into the lungs.
- Patients with varicose veins or heart disease are at increased risk.
- Obesity and the pill also increase the risk of pulmonary embolism, especially in combination with smoking.
- In drug addicts who inject their addictive substance, embolisms occur frequently.
- In pregnant women, the risk is increased to five times.
In addition, there are some diseases in which the coagulation tendency of the blood is increased, such as cirrhosis and some malignant tumors. Such patients, for example, in long-haul flights - in which one sits long in a position in which the leg veins are kinked - particularly at risk.
Pulmonary embolism: symptoms and signs
The range of symptoms of pulmonary embolism ranges from mild respiratory distress to severe respiratory problems, coughing, chest pain, anxiety, agony, palpitations, and shock symptoms such as loss of consciousness and heart, depending on the number and size of affected vessels -cycle arrest.
Often a large embolism is preceded by several small ones, which are manifested by signs such as brief dizzy spells, heart stuttering and palpitations. If there are signs of venous thrombosis (swollen, warm leg with distension or pain), a doctor should be consulted, even with such discrete symptoms.
How is the diagnosis of pulmonary embolism made?
When collecting the medical history (medical history) and the physical examination - in addition to the inquiry of the current complaints - especially for risk factors and signs of thrombosis is sought. The first signs of embolism may be the result of listening to the heart and lungs.
In the laboratory tests, especially the blood gases, coagulation values and D-dimers are of importance. The former give an impression of the oxygen supply of the body and thus the severity of the possible embolism, the coagulation values give indications of certain risk factors, an increase of the D-dimers shows that there is an increased activity of fibrinolysis, ie the breakdown of blood clots. A normal X-ray examination of the lungs and an ECG are rather unspecific and at best increase the suspicion or exclude other causes.
An ultrasound examination can give indications of the load of the right heart; sometimes a big clot can also be seen. Pulmonary scintigraphy, in which radioactive labeled substances are injected, allows the blood circulation and ventilation of the lungs to be assessed and put into proportion. Certain pictures suggest a pulmonary embolism, but do not allow definitive diagnosis.
CT angiography is more suitable for this, in which an X-ray contrast agent is injected into the vein, as in blood collection, and its accumulation in the vessels is shown in spiral CT. However, small embolisms in the peripheral areas can not be demonstrated - a catheter must then be inserted over the artery (pulmonary angiography).