Physiotherapy and Pulmonary embolism

PULMONARY EMBOLISM

Bismillahirahmanirahim , Today I have been asked by one of my patient , he is worried regarding his fracture can cause Pulmonary embolism , I have explain to him it is prevented case if we take it seriously and understand our body condition.

·         Pulmonary embolism is a condition that occurs when an artery in lung becomes blocked. In most cases, the blockage is caused by one or more blood clots that travel to lungs from another part of your body.

·         Most clots originate in legs, but they can also form in arm veins, the right side of your heart or even at the tip of a catheter placed in a vein.

·         In most cases, a pulmonary embolism isn't fatal. Still, pulmonary embolism is a leading cause of hospital deaths and an increasing threat to passengers on long airplane flights. when pulmonary embolism does occur, treatment with anti-clotting medications can greatly reduce the risk of death

CAUSES

·         Human body have two lungs, one on each side of heart. Blood is constantly being pumped from the right side of heart to the lungs and back to the left side of your heart. In lungs, blood picks up oxygen and releases carbon dioxide, a waste product of metabolism. Blood vessels called arteries take the oxygen-rich blood to tissues throughout body, and veins bring oxygen-poor blood back to the heart. Capillaries — the smallest blood vessels — connect the veins and arteries.

·         Clots that form in the veins throughout body can dislodge, travel through the bloodstream to the right side of the heart, and then enter the pulmonary arteries, where they may cause a blockage. A blockage can occur in any small artery. Most often, a number of clots will shower your lungs during an episode of pulmonary embolism; it's unusual for just one clot to take place

UNDERSTANDING BLOOD CLOT

·         A blood clot is a plug of platelets — colorless blood cells that repair injured blood vessels — enmeshed in a network of red blood cells and fibrin, a type of protein. Clots normally develop to help stop bleeding after being cut or injured, but sometimes clots form for no apparent reason

·         A blood clot that forms and remains in a vein is called a thrombus. A clot that travels to another part of your body is an embolus. Occasionally other substances, such as pieces of a tumor, globules of fat from fractured bones or air bubbles, may enter the bloodstream and become an embolus that blocks arteries

·         Most clots that cause problems originate in a vein in leg or pelvis. The affected vein may be near the surface of skin (superficial thrombosis) or deep within a muscle (deep vein thrombosis, or DVT). Clots in superficial veins usually aren't serious and often clear on their own. But clots in the deep veins may detach and migrate through  bloodstream to lungs

Illustration of Blood clot for example review

FACTOR INVOLVE IN CLOT FORMATION

SURGERY.

·         especially operations to replace major joints, such as the hip and knee.

LONG PERIODS OF INACTIVITY.

·          Inactivity caused by prolonged bed rest (exp after surgery, heart attack or serious injury) or long plane or car trips that decreases blood flow in veins, making clots more likely.

·         In recent years, attention has also focused on the increasing incidence of deep vein thrombosis and pulmonary embolism among otherwise healthy travelers on long plane trips. Cramped seats with little legroom have contributed to the problem - deep vein thrombosis and is sometimes referred as "economy class syndrome." Not everyone who has DVT goes on to develop pulmonary embolism, however. For many people, the DVT causes few symptoms and is diagnosed long after the episode has passed.

INCREASED LEVELS OF CLOTTING FACTORS IN THE BLOOD

·         -Some types of cancer, especially pancreatic, lung and ovarian cancers, cause increased blood levels of procoagulants — substances that contribute to blood clotting. The female hormone estrogen found in birth control pills and hormone therapy (HT) also increases the amount of clotting factors in the blood

CERTAIN MEDICAL CONDITIONS

·         -People who have cardiovascular disease associated with clot formation, such as heart attack (myocardial infarction) or stroke, are more likely to develop blood clots in their veins

INJURY TO THE VEINS.

·         -occur during certain surgical procedures, especially hip surgery or knee replacement. It may also result from direct injuries to the legs or from leg or pelvic fractures.

SIGNS AND SYMPTOMS

·         Common signs and symptoms include:

·         Sudden shortness of breath, either when in active or at rest.

·         Chest pain that often mimics a heart attack. The pain can occur anywhere in chest and may radiate to shoulder, arm, neck or jaw. It may be sharp and stabbing or aching and dull and may become worse when you breathe deeply (pleurisy), cough, eat and bend. The pain will get worse with exertion but won't go away when you rest.

·         cough that produces bloody or blood-streaked sputum.

·         Rapid heartbeat (tachycardia).

·         Pt may have stable vital signs (BP, HR, RR, SPO²) but frequently present with elevated HR. Severe PE can present with shock ( low BP) or cardiac arrest, particularly when large clot blocks blood outflow from Rt side of the heart to lungs. In many case, HR and RR elevated to compensate.

·         SPO² may decreased

OTHER SIGNS AND SYMPTOMS THAT CAN OCCUR WITH PE INCLUDE

·         Wheezing

·         Leg swelling

·         Clammy or bluish-colored skin

·         Excessive sweating

·         Anxiety

·         Weak pulse

·         Light headedness or fainting (syncope)

·         Fever

IN COME CASES, PE PRESENT WITH

·         Sudden death, where pt collapse, stops breathing and heart stop beating (cardiac arrest).

RISK FACTOR

1.       Inactivity - prolonged sitting in a cramped position during lengthy plane or car trips increase risk.

2.       Prolonged bed rest-Being confined to bed for an extended period after surgery, a heart attack, leg fracture or any serious illness makes it more vulnerable to blood clots.

3.       Certain surgical procedures-Especially likely to cause blood clots are hip, pelvic and knee surgeries as well as some obstetric or gynecologic procedures

4.       Some medical conditions- - Certain cancers, especially pancreatic, ovarian and lung cancers can increase levels of substances that help blood clot, and chemotherapy further increases the risk. Women with a history of breast cancer who are taking tamoxifen or raloxifene also are at risk. High blood pressure and cardiovascular disease make clot formation more likely, as does having an inflammatory bowel disease such as ulcerative colitis or Crohn's disease.

5.       Being overweight-- one theory links the formation of clots to leptin, a hormone produced by fat cells in the body. People who are overweight have more leptin- so may be more prone to develop clots

6.       Pacemakers or venous catheters-  Having a pacemaker or catheter — a soft, flexible tube — in a central vein makes the formation of clots more likely in that vein.

7.       Pregnancy and childbirth

- Some women who have pregnancy-related venous thromboembolism also have an inherited clotting disorder.

8.       Supplemental estrogen. - The estrogen in birth control and in hormone replacement therapy can increase clotting factors in blood, especially if smoking or overweight

9.       Family history.

- Having a personal or family history of venous thromboembolism increases the risk of blood clots.

10.   Smoking

tobacco use predisposes some people to blood clot formation, especially when combined with other risk factors.

COMPLICATION

High blood pressure in your lungs (pulmonary hypertension)

- occurs when a large number of clots obstruct blood flow in the blood vessels in lungs for months or years, making the right side of heart work hard against great resistance.

        - most common symptoms of pulmonary hypertension are breathlessness (dyspnea) when you exert yourself and general fatigue. Fainting, dizziness, swollen legs or ankles, and pressure or pain in chest also are common when pulmonary hypertension becomes severe.

Heart damage.

In a condition called cor pulmonale, the lower right pumping chamber of heart (right ventricle) becomes enlarged and eventually fails as a result of problems in your lungs.

So this is the info regarding a pulmonary embolisme , the cause , effect and what is the symptom of this problem I have explain in this blog , insha Allah for my next entry I will share with all og you how to diagnoses and prevention measurement for this problem .Wallahuaklam.