What are the main symptoms of pulmonary embolism. How is pulmonary embolism diagnosed. What treatment options are available for pulmonary embolism. How can pulmonary embolism be prevented.

Understanding Pulmonary Embolism: A Potentially Life-Threatening Condition

Pulmonary embolism (PE) is a serious medical condition that occurs when a blood clot becomes lodged in the pulmonary artery, which carries blood from the heart to the lungs. This blockage can have severe consequences, potentially preventing blood from reaching the lungs and causing life-threatening complications.

The primary cause of pulmonary embolism is often a blood clot that originates in the deep veins of the legs, known as deep vein thrombosis (DVT). These clots can break free and travel through the bloodstream, ultimately becoming trapped in the pulmonary artery.

Recognizing the Symptoms of Pulmonary Embolism

Identifying the symptoms of pulmonary embolism can be challenging, as they may vary from person to person and can sometimes be mistaken for other conditions. However, being aware of the most common signs can help in seeking timely medical attention.

Common Symptoms of Pulmonary Embolism:

• Chest pain – sharp and stabbing, often worsening with deep breaths
• Sudden shortness of breath
• Dry cough, occasionally accompanied by blood or blood-tinged mucus
• Lightheadedness or dizziness
• Rapid heartbeat
• Excessive sweating
• Fever
• Leg pain or swelling (if associated with DVT)

Can pulmonary embolism symptoms appear gradually? In some cases, symptoms of pulmonary embolism may develop over time rather than occurring suddenly. This gradual onset can make it more difficult to recognize the condition, emphasizing the importance of being vigilant about any persistent or worsening respiratory symptoms.

Risk Factors and Causes of Pulmonary Embolism

Understanding the risk factors and causes of pulmonary embolism is crucial for prevention and early detection. While anyone can develop this condition, certain factors increase the likelihood of its occurrence.

Common Risk Factors for Pulmonary Embolism:

1. Prolonged immobility (e.g., long flights, bed rest)
2. Recent surgery or injury
3. Obesity
4. Smoking
5. Use of hormonal birth control or hormone replacement therapy
6. Pregnancy and the postpartum period
7. Cancer and its treatments
8. Genetic blood clotting disorders
9. Advanced age
10. History of previous blood clots

Are there any less common causes of pulmonary embolism? While blood clots are the most frequent cause, pulmonary embolism can also result from other substances entering the bloodstream, such as fat droplets from broken bones, air bubbles, or tumor cells. These rare cases highlight the complexity of this condition and the importance of comprehensive medical evaluation.

Diagnosing Pulmonary Embolism: A Multi-Step Approach

Accurate diagnosis of pulmonary embolism is crucial for appropriate treatment and management. Healthcare providers employ a variety of diagnostic tools and techniques to confirm the presence of a pulmonary embolism and assess its severity.

Diagnostic Methods for Pulmonary Embolism:

• Physical examination and medical history review
• Blood tests (D-dimer test)
• Chest X-ray
• Computed tomography (CT) pulmonary angiography
• Ventilation-perfusion (V/Q) scan
• Echocardiogram
• Pulmonary angiography
• Magnetic resonance imaging (MRI)

Why is early diagnosis of pulmonary embolism important? Prompt diagnosis of pulmonary embolism is critical because it allows for timely initiation of treatment, potentially preventing life-threatening complications. Early intervention can help dissolve or remove the clot, restore blood flow to the lungs, and reduce the risk of long-term damage to lung tissue.

Treatment Options for Pulmonary Embolism

The primary goal of pulmonary embolism treatment is to prevent the existing clot from growing, dissolve it if possible, and prevent new clots from forming. The specific treatment approach depends on the severity of the condition and the patient’s overall health status.

Common Treatment Strategies for Pulmonary Embolism:

1. Anticoagulant medications (blood thinners)
2. Thrombolytic therapy (clot-busting drugs)
3. Catheter-directed thrombolysis
4. Surgical embolectomy
5. Inferior vena cava (IVC) filter placement
6. Oxygen therapy
7. Pain management

How long does treatment for pulmonary embolism typically last? The duration of treatment for pulmonary embolism varies depending on the individual case. Anticoagulant therapy often continues for at least three to six months, but some patients may require longer-term or even lifelong treatment to prevent recurrence. Regular follow-ups with healthcare providers are essential to monitor progress and adjust treatment as needed.

Preventing Pulmonary Embolism: Proactive Measures for Risk Reduction

While not all cases of pulmonary embolism can be prevented, there are several steps individuals can take to reduce their risk, especially if they have known risk factors or are in situations that increase the likelihood of blood clot formation.

Strategies for Pulmonary Embolism Prevention:

• Stay active and avoid prolonged periods of immobility
• Maintain a healthy weight
• Quit smoking
• Stay hydrated, especially during long trips
• Wear compression stockings when advised by a healthcare provider
• Follow medication regimens as prescribed
• Discuss birth control options with a healthcare provider
• Take precautions during and after surgery or hospitalization

Can lifestyle changes significantly reduce the risk of pulmonary embolism? Adopting a healthy lifestyle can play a crucial role in reducing the risk of pulmonary embolism. Regular exercise, maintaining a balanced diet, avoiding smoking, and managing underlying health conditions can all contribute to improved circulation and decreased clot formation risk. However, it’s important to consult with a healthcare provider before making significant lifestyle changes, especially for individuals with existing health concerns.

Living with Pulmonary Embolism: Long-Term Outlook and Management

For many individuals who have experienced a pulmonary embolism, life after the acute event involves ongoing management and follow-up care. Understanding the long-term implications and adopting strategies for optimal health can significantly improve quality of life and reduce the risk of recurrence.

Key Aspects of Long-Term Pulmonary Embolism Management:

1. Adherence to prescribed anticoagulant therapy
2. Regular medical check-ups and monitoring
3. Awareness of potential complications
4. Lifestyle modifications to reduce risk factors
5. Participation in pulmonary rehabilitation programs
6. Management of associated conditions (e.g., deep vein thrombosis)
7. Psychological support and coping strategies

What is the recurrence rate for pulmonary embolism? The risk of recurrence varies among individuals, but studies suggest that approximately 30% of people who have had a pulmonary embolism may experience another episode within 10 years. This underscores the importance of ongoing management and preventive measures. Factors such as the cause of the initial embolism, adherence to treatment, and underlying health conditions can influence the likelihood of recurrence.

Emerging Research and Future Directions in Pulmonary Embolism Care

The field of pulmonary embolism research is dynamic, with ongoing studies and clinical trials aimed at improving diagnosis, treatment, and prevention strategies. Staying informed about these advancements can provide hope and potential new options for those affected by this condition.

Areas of Active Research in Pulmonary Embolism:

• Novel anticoagulant medications with improved safety profiles
• Advanced imaging techniques for more accurate diagnosis
• Personalized risk assessment tools
• Minimally invasive interventional procedures
• Gene therapy approaches for inherited clotting disorders
• Artificial intelligence applications in diagnosis and management
• Tailored rehabilitation programs for post-PE recovery

How might future advancements change the landscape of pulmonary embolism care? Ongoing research holds the promise of more targeted and effective treatments, improved diagnostic accuracy, and enhanced prevention strategies. These advancements may lead to reduced mortality rates, decreased incidence of complications, and improved quality of life for individuals at risk of or living with pulmonary embolism. As with all medical research, it’s important to approach new findings with cautious optimism and consult with healthcare providers about their potential applicability to individual cases.

In conclusion, pulmonary embolism remains a serious medical condition that requires prompt recognition, accurate diagnosis, and appropriate treatment. By understanding the symptoms, risk factors, and available management strategies, individuals can take proactive steps to reduce their risk and seek timely medical attention when needed. As research continues to advance our understanding of this condition, the outlook for those affected by pulmonary embolism continues to improve, offering hope for better outcomes and quality of life.

Pulmonary embolism – Healthily

What is a pulmonary embolism?

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A pulmonary embolism is a blockage in the pulmonary artery, the blood vessel that carries blood from the heart to the lungs.

This blockage – usually a blood clot – is potentially life-threatening because it can prevent blood from reaching your lungs.

The symptoms of a pulmonary embolism can sometimes be difficult to recognise because they can vary between individuals. However, the main symptoms include:

• chest pain – a sharp, stabbing pain that may be worse when you breathe in
• shortness of breath – which can come on suddenly or develop gradually
• coughing – this is usually dry, but may include coughing up blood or mucus that contains blood
• feeling faint, dizzy or passing out

You should visit your doctor as soon as possible if you have a combination of these symptoms.

If your symptoms are particularly severe, call for an ambulance immediately.

Read more about diagnosing a pulmonary embolism .

What causes a pulmonary embolism?

A pulmonary embolism is often caused by a blood clot travelling up from one of the deep veins in your legs to your heart and lungs.

A blood clot in one of the deep veins of the legs is known as deep vein thrombosis (DVT) . DVT can occur for no apparent reason, but it often develops after long periods of inactivity, such as during a long-haul flight or if you’re ill in hospital.

DVT can also occur during pregnancy or as a result of some medical conditions, such as cancer or heart failure , or if the wall of a blood vessel becomes damaged.

Read more about the causes of a pulmonary embolism .

Diagnosing a pulmonary embolism

Diagnosing a pulmonary embolism can be difficult because the symptoms are common to many other conditions. However, an accurate diagnosis is important because treating a pulmonary embolism isn’t always easy and the treatment used can cause side effects.

A number of tests can help determine whether you have a pulmonary embolism or rule out other causes of your symptoms. For example, you may have a chest X-ray or tests to check how well your lungs are working.

Read more about how a pulmonary embolism is diagnosed .

How a pulmonary embolism is treated

Pulmonary embolisms are treated with anticoagulant medicines . These stop the blood clot getting bigger while your body slowly reabsorbs it, and reduce your risk of further clots developing.

If you’re diagnosed with a pulmonary embolism, you’ll usually be given regular anticoagulant injections for about five days to begin with. You’ll also be prescribed an anticoagulant tablet called warfarin to take for several months.

As part of your treatment, you’ll need regular blood tests to check that the dose of warfarin you’re receiving is correct. If the dose is too high you may experience bleeding and if it’s too low you may have further blood clots.

Keeping mobile will also help you maintain good blood circulation and prevent further blood clots forming.

Read more about treating a pulmonary embolism .

Preventing a pulmonary embolism

A number of methods may be recommended to prevent a pulmonary embolism if you’re at risk of developing blood clots. These include:

• taking anticoagulant tablets, such as warfarin
• wearing compression stockings or using compression devices
• avoiding long periods of inactivity
• leading a healthy lifestyle, such as giving up smoking (if you smoke) and eating a healthy, balanced diet low in fat and including plenty of fruit and vegetables

Read more about preventing a pulmonary embolism .

Symptoms of pulmonary embolism

Signs and symptoms of a pulmonary embolism (a blockage in the artery to the lungs) include chest pain, shortness of breath and coughing.

Recognising the signs and symptoms of a pulmonary embolism can be difficult because they can vary between individuals. Small clots may cause no noticeable symptoms.

Symptoms of a pulmonary embolism can include:

• chest or upper back pain – a sharp, stabbing pain that may be worse when breathing in
• shortness of breath – which can come on suddenly or develop gradually
• coughing – this is usually dry, but may include coughing up blood or mucus that contains blood
• feeling lightheaded or dizzy
• fainting

Many pulmonary embolisms are caused by a blood clot in the leg, known as a deep vein thrombosis (DVT) , travelling towards the lungs. Some people with a pulmonary embolism therefore also have symptoms of DVT , such as pain, redness and swelling in one leg (usually the calf).

Seeking medical help

You should visit your doctor as soon as possible if you experience any combination of the above symptoms.

If it isn’t possible for you to visit your doctor, you can call NHS 111 or contact your local out-of-hours service for advice.

Dial 999 immediately to ask for an ambulance if your symptoms are severe.

Causes of pulmonary embolism

A pulmonary embolism occurs when the artery that carries blood to the lungs becomes blocked.

The blockage is usually a blood clot , but it can also be a fat droplet, an air bubble or amniotic fluid (fluid that surrounds unborn babies).

If it’s a blood clot, this will have usually come from one of the deep veins in your legs and is known as deep vein thrombosis (DVT) .

The main reasons why blood clots develop are outlined below.

Inactivity

If you’re inactive, blood tends to collect in the lower parts of your body, particularly in your lower legs. This isn’t usually a problem because when you start to move, your blood flow increases and blood begins to move evenly around your body.

However, if you’re immobile for a long time, the flow of blood around your body can slow down considerably. You’re likely to be immobile:

• after a serious illness such as a stroke
• after an injury or operation
• when travelling on a long journey by plane, train or car

If your blood flow slows down because of a long period of inactivity, your risk of developing a blood clot increases.

Blood vessel damage

If a blood vessel is damaged, the inside of the blood vessel can become narrowed or blocked. This can result in a blood clot forming.

Blood vessels can be damaged by injuries such as broken bones or severe muscle damage. If a blood vessel is damaged during surgery, a blood clot may develop, particularly in operations carried out on the lower half of the body.

Conditions such as vasculitis (inflammation of the wall of a blood vessel) and some types of medication, such as chemotherapy medication, can also cause blood vessel damage.

Blood that clots too easily

Your risk of developing a pulmonary embolism is increased if you have a condition that causes your blood to clot more easily than normal.

Conditions that increase the likelihood of your blood clotting include:

• cancer – also, cancer treatments such as chemotherapy and radiotherapy can make your blood clot more easily
• heart failure
• thrombophilia (an inherited condition where a person’s blood has an increased tendency to form clots)
• antiphospholipid syndrome (an immune system disorder that causes the blood to become abnormally sticky, increasing its tendency to clot)

Other factors

Other factors that increase your risk of developing a pulmonary embolism include:

• your age – people aged 60 or over have an increased risk
• having a previous blood clot
• having a family member who’s had a blood clot in the past
• being overweight or obese
• pregnancy – your risk is increased for up to six weeks after giving birth
• smoking
• taking the combined oral contraceptive pill or hormone replacement therapy (HRT)

Your chances of developing a blood clot are very small if you’re taking the contraceptive pill or HRT, and your doctor will usually assess your individual risk before prescribing either medication.

Diagnosing pulmonary embolism

It can sometimes be difficult to d iagnose a pulmonary embolism because the symptoms vary between individuals and are similar to many other conditions.

Around half of all people who develop a pulmonary embolism do so while they’re in hospital.

The condition may be suspected if:

• you have one or more associated risk factors , such as being over 60 years of age or having a previous history of blood clots
• you have a blood clot in one of your legs – known as deep vein thrombosis (DVT)
• there’s no other likely explanation for your symptoms

It’s important that pulmonary embolisms are diagnosed correctly because treating them isn’t always easy and the treatments used can cause side effects.

Tests

A number of tests may be used to help determine if you have a pulmonary embolism or to rule out other causes of your symptoms.

For example, you may have a chest X-ray or tests to check how well your lungs are working. You may also have some of the more specialised tests discussed below.

Blood tests

Blood tests can be carried out to detect a number of signs of pulmonary embolism. One of the main tests looks for a substance called D-dimer.

D-dimer is a protein found in the blood after a blood clot has broken down. A D-dimer test can be used to help diagnose blood clotting abnormalities such as thrombosis (where a blood clot develops in a blood vessel).

If your blood test result indicates high levels of D-dimer, it suggests that pieces of blood clot are loose in your bloodstream and may have become lodged in your pulmonary artery.

Computerised tomography pulmonary angiography

Computerised tomography pulmonary angiography (CTPA) is a procedure where you’re injected with a special dye before having acomputerised tomography (CT) scan . The dye makes it easier to see the blood vessels in your lungs during the scan.

A CT scan involves taking a series of X-rays to create a highly detailed image of the inside of your body. If there’s a pulmonary embolism in one of your lungs, it may show up on the scan as a gap in your blood supply.

Ventilation-perfusion scan

A ventilation and perfusion scan is used to examine the flow of air and blood in your lungs.

Before having the scan, you’ll be asked to inhale a tasteless, odourless and slightly radioactive gas through a mouthpiece. The gas helps highlight the air flow in your lungs during the scan.

You’ll also be given an injection that contains a small amount of radioactive material to highlight the blood vessels in your lungs during the scan.

If the scan shows parts of your lungs have air in them but no blood supply, it may be the result of a pulmonary embolism.

Treating pulmonary embolism

The main treatment for a pulmonary embolism is an anticoagulant, a type of medication that stops your blood clotting easily.

The anticoagulant will prevent the clot getting larger while your body slowly absorbs it. It also reduces the risk of further clots developing.

In some cases, other treatments may be needed to remove or break up the clot. This can be done with medication called thrombolytics or, less commonly, surgery.

About half of all cases of pulmonary embolism occur in hospital. If you’re not already in hospital, you’ll be admitted so you can receive treatment. If necessary, you’ll be given oxygen to help you breathe more comfortably.

Anticoagulants

Anticoagulants are often referred to as blood-thinning medicines, although they don’t actually thin the blood. Instead, they alter chemicals in the blood to prevent clots forming easily.

The main anticoagulants used to treat pulmonary embolisms are heparin and warfarin.

Heparin

Heparin is given as an injection. Regular injections of this medication are usually used as the initial treatment for a pulmonary embolism because they start working immediately.

Most people diagnosed with a pulmonary embolism will initially need injections of heparin for at least five days. You’ll then usually continue taking warfarin only.

Heparin can cause side effects, including:

• a high temperature (fever)
• headaches
• bleeding problems, such as rectal bleeding , blood in your urine or nosebleeds

Warfarin

If you’re diagnosed with a pulmonary embolism, you’ll usually start taking warfarin tablets after you’ve have the initial injections of heparin.

Warfarin takes longer to start working than heparin injections, but as it’s more convenient to take, it’s usually recommended for a longer period after you stop having the injections.

Treatment with warfarin will usually be recommended for at least three months, although some people need to take it for longer than this. Occasionally, warfarin may need to be taken for the rest of your life.

The effects of warfarin vary from person to person, so you’ll need to be closely monitored and have regular blood tests to check you’re taking the right dosage. These tests can usually be carried out on an outpatient basis, which means you won’t need to stay in hospital.

You may need two or three blood tests a week when you first start taking warfarin until the correct dose is determined. After this, you may only need to have a blood test about once a month.

There are several factors that can alter the effectiveness of warfarin, including your diet, other medications you’re taking and how well your liver is working.

Therefore, while taking warfarin you should:

• try to keep your diet consistent
• limit your alcohol consumption and avoid drinking more than the recommended amounts (three to four units a day for men and two to three units a day for women)
• take your medication at the same time each day
• avoid taking any other medicine without first checking with your doctor, pharmacist or anticoagulant specialist
• avoid taking herbal medicines

Warfarin can cause a wide range of side effects, including:

• bleeding problems
• headaches
• diarrhoea
• nausea and vomiting
• jaundice (yellowing of the skin and whites of the eyes)

Read more about warfarin .

Dabigatran

Dabigatran is an oral anticoagulant that specifically targets thrombin (a protein that helps blood clots form). It’s used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism in adults.

The recommended dosage of dabigatran will depend on your age and whether you’re taking other medication for other health conditions. Dabigatran isn’t recommended for people with severely reduced kidney function.

Bleeding and indigestion are the most common side effects of dabigatran.

Read the National Institute for Health and Care Excellence (NICE) guidance about dabigatran for the treatment and secondary prevention of deep vein thrombosis and pulmonary embolism (PDF, 255kb).

Rivaroxaban

Rivaroxaban is another medication that can be used to treat and prevent DVT and pulmonary embolism in adults.

The recommended dosage of rivaroxaban will depend on whether it’s being used to treat pulmonary embolism for the first time or a recurrence of the problem. How long treatment lasts will depend on a person’s bleeding risk and other clinical criteria.

Side effects of rivaroxaban can be varied and may include anaemia , dizziness, headache, fainting , rapid heartbeat (tachycardia), low blood pressure , diarrhoea, constipation and swelling, particularly of the ankles and feet ( oedema ).

Read the NICE guidance about rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism (PDF, 233kb).

Apixaban

Apixaban is another anticoagulant that’s recently been approved by NICE to treat and prevent DVT or pulmonary embolism.

It’s taken orally (in tablet form) twice a day for the first seven days. The dosage is then halved and taken twice a day for at least three months.

The most common side effects of apixaban are bleeding, bruising, nausea and anaemia. It’s also recommended that apixaban should be used with caution in people with severe kidney problems.

You can read more about apixaban for the treatment and secondary prevention of deep vein thrombosis and pulmonary embolism (PDF, 228kb).

Special considerations

If you’re pregnant, you’ll be given regular heparin injections instead of warfarin tablets for the full length of your pregnancy. This is recommended because taking warfarin tablets while you’re pregnant could harm your baby.

If you have cancer, you’ll usually be given heparin injections instead of warfarin tablets for six months or until the cancer is cured. Evidence suggests that regular injections are more effective than warfarin tablets in these cases.

Removing the blockage

In more severe cases of pulmonary embolism, treatment may be needed to remove the blockage. This is often achieved using injections of a type of medication called a thrombolytic, such as alteplase, which breaks up the blood clot.

A newer procedure may also be used called ultrasound-enhanced, catheter-directed thrombolysis. It involves using high-frequency, low-energy ultrasound waves in combination with thrombolytic medication to dissolve the blood clot. The procedure usually lasts for 12-24 hours and you’ll be continuously monitored throughout the duration of the treatment.

Read NICE guidelines on ultrasound-enhanced, catheter-directed thrombolysis for pulmonary embolism (PDF, 136kb).

Occasionally, a surgical procedure called an embolectomy may be used to treat a pulmonary embolism. This is where a surgeon makes a cut in the pulmonary artery and the blockage is sucked out. However, this is a major operation so it’s usually only recommended in particularly severe cases or if other treatments are unsuitable.

Preventing pulmonary embolism

If you’re at risk of developing blood clots, a number of things may be recommended to help prevent a pulmonary embolism.

Anticoagulants

If you’re admitted to hospital to have surgery, your care team may recommend that you take an anticoagulant, such as warfarin , during your stay in hospital and when you go home.

This medication alters chemicals in your blood so that clots don’t form easily.

Read more about anticoagulants .

Compression stockings

It may also be recommended that you wear compression stockings and use compression devices while you’re in hospital and after you go home.

Compression stockings fit tightly around your lower legs and encourage your blood to flow more quickly around your body.

Compression devices are inflatable and work in a similar way, expanding at regular intervals to squeeze your legs and encourage the flow of blood.

Increasing mobility

Pulmonary embolisms can sometimes occur when the blood flow slows down during a long period of inactivity, such as during recovery from surgery or long-distance travel.

It’s therefore important that you increase your mobility as soon as possible after surgery by moving around or doing leg exercises. Also, avoid taking long journeys for four weeks after you come out of hospital.

If you’re at risk of developing blood clots, consult your doctor before travelling long distances. They can advise about ways to reduce your chance of a clot developing during your journey, such as:

• performing simple leg exercises, such as regularly flexing your ankles
• taking occasional short walks when possible
• taking advantage of refuelling stopovers, where it may be possible to get out and walk about
• wearing elastic compression stockings

Read more about preventing blood clots when you travel.

Smoking, diet and exercise

You can also reduce your risk of developing a pulmonary embolism by:

• not smoking (if you smoke)

• eating a healthy, balanced diet that’s low in fat, with plenty of fruit and vegetables

• getting regular exercise – at least 150 minutes a week

• maintaining a healthy weight and losing weight if you’re overweight or obese

Pulmonary Embolism (PE) | Causes of a Blood Clot in the Lung

A thrombus is a clot that develops in a vein and doesn’t move. Once the clot dislodges and travels in the blood stream, it’s called an embolus. Most of the time, a pulmonary embolism starts as a deep vein thrombosis, also called a DVT, which is a clot that develops in the deep veins of the lower body — usually the pelvis, thighs and lower legs.

Once a DVT travels to the lungs, it’s called a pulmonary embolus. This type of clot blocks blood flow to the lungs and prevents the exchange of oxygen and carbon dioxide.

While researchers aren’t sure of the exact number of people who have pulmonary embolisms, they estimate the incidence is about 60 to 70 in 100,000, according to an article published in Experimental & Clinical Cardiology by Dr. Jan Belohlavek and colleagues.

Other studies estimate that more than 1 million Americans have a PE each year, and 100,000 to 200,000 of those cases are fatal, according to the American Thoracic Society.

Complications of pulmonary embolisms include lung damage, low blood oxygen level that can lead to organ damage and death.

EXPAND

A pulmonary embolism forms when a blood clot in the thigh, leg or pelvis breaks off
and travels to the lungs.

Signs and Symptoms

Half of the people with a pulmonary embolism have no symptoms, according to the U.S. National Library of Medicine. Prevention of PE is important because for about 25 percent of people who have a PE, sudden death is the first symptom, according to the Centers for Disease Control and Prevention.

Symptoms of PE may be more or less severe depending on the person’s overall health and the extent of the blockage. For example, people with poor cardiovascular health or diseases such as chronic obstructive pulmonary disease, also called COPD, or coronary artery disease may have more severe symptoms.

Fact

A pulmonary embolism is a medical emergency, and anyone with symptoms should seek medical attention right away.

For some people, the only symptom may be shortness of breath with rapid breathing and feelings of anxiety or restlessness. This may be accompanied by chest pain and rapid, irregular heartbeat.

If the clot is very large, the first symptoms are light-headedness or loss of consciousness. A sudden loss of consciousness may cause body shakes similar to seizures and low blood pressure, which could lead to sudden death.

Confusion and mental deterioration because of lack of oxygen are early symptoms that are more common in older people.

In data from the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) trial presented by Abigail K. Tarbox and Mamta Swaroop in International Journal of Critical Illness and Injury Science, the most common symptoms were shortness of breath within seconds of PE onset, chest pain, thigh or calf pain, thigh or calf swelling and cough.

Signs of a pulmonary embolism include:

• Chest pain that is worse with breathing
• 
  Coughing or coughing up blood
• 
  Dizziness, lightheadedness or fainting
• 
  Irregular heartbeat
• 
  Low blood pressure
• 
  Racing heartbeat or palpitations
• 
  Restlessness and anxiety
• 
  Shortness of breath that comes on suddenly
• 
  Sweating

In addition to symptoms of PE, some people may have symptoms of DVT, including pain in one or both legs, swelling, soreness or tenderness and redness, or discolored skin in the affected area.

Causes and Risk Factors

The most common cause of pulmonary embolisms is DVT, almost all of the clots start in the veins of the leg. But PEs can also develop from clots that form in the arms or pelvis.

Less common causes of PE include:

• Amniotic fluid
• 
  Clots on an indwelling intravenous catheter
• 
  Fat released into the bloodstream after surgery, bone fractures, severe burns or other trauma
• 
  Infectious material that forms small masses
• 
  Rapidly growing cancer cells that form tumors
• 
  Substances or air bubbles that enter the blood from surgery, trauma or other medical procedures
• 
  Upper body DVT

Sources: Stanford Health Care and Cedars-Sinai

Risk Factors

Some people are at greater risk for PE. Some risk factors can be controlled, such as smoking or obesity. But others such as family history and age can’t be controlled.

Risk factors for PE include:

• Genetic conditions that increase blood clot risk
• 
  Family history
• 
  Orthopedic surgery such as knee or hip replacement surgery
• 
  Leg injuries
• 
  Having limited mobility or paralysis
• 
  Extended bed confinement
• 
  Traveling long distances by plane or other vehicle
• 
  Having previous blood clots
• 
  Older age
• 
  Cancer and cancer treatments such as chemotherapy
• 
  Having other medical conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), high blood pressure, stroke and inflammatory bowel disease
• 
  Pregnancy
• 
  Being obese or overweight
• 
  Varicose veins, enlarged veins in the legs
• 
  Smoking cigarettes

Certain medications may increase the risk of developing blood clots in the lungs. These include certain types of hormonal birth control such as Yaz (drospirenone) or NuvaRing, estrogen replacement therapy, testosterone replacement therapy or Xeljanz (tofacitinib).

For example, in July 2019, the U.S. Food and Drug Administration approved new warnings for Xeljanz for an increased risk of blood clots and death with the 10 mg twice-daily dose of tofacitinib used for ulcerative colitis patients.

Always tell your health care provider about all medication you are taking, especially if you are already at increased risk for PE.

Side Effect Information

A 2019 FDA safety alert stated that rheumatoid arthritis patients who took a higher dose of Xeljanz or Xeljanz XR had an increased risk of pulmonary embolism and death. Learn more.

View Side Effects

How Is a Blood Clot in the Lung Diagnosed?

Pulmonary embolism can be difficult to diagnose because its symptoms mimic those of other health problems. Because less than half of patients who die from the condition were diagnosed before death, PE has earned the reputation of being a “silent killer,” according to the American Thoracic Society.

Tests

Health care providers will take a patient’s full medical history and perform a physical exam. Although there are several possible tests, most of them vary on accuracy for diagnosing PE. The most common tests are blood tests, CT scan, ultrasound and echocardiogram, according to the American Thoracic Society.

It may take more than one of these tests to diagnose PE.

Blood Tests

Health care providers use blood tests to check the blood’s clotting status and arterial gas levels. Abnormal arterial gas levels can indicate lack of oxygen and respiratory impairment. Blood tests are also used to check for genetic disorder that may be causing abnormal clotting.

CT scan

A CT scan uses a computer and X-rays to make detailed images of the body. A CT scan with contrast dye injected into the blood stream allows doctors to see the blood vessels in the lungs. This is the most common test for PE. But some people can’t undergo CT because of the contrast dye and radiation.

Duplex Ultrasound

A type of vascular ultrasound, a duplex ultrasound uses high-frequency sound waves to assess blood flow and the blood vessels in the legs. Most pulmonary embolisms begin as clots in the legs.

Echocardiogram

An echocardiogram is a type of ultrasound. Health care professionals often perform an echocardiogram of the heart to assess the severity of PE pressures and heart function.

PERC Rule for PE

Health care professionals may use the Pulmonary Embolism Rule-Out Criteria, or PERC, rule to see if someone needs to be tested for PE. According to the PERC rule, if a patient meets all eight criteria, they don’t need to be tested.

PERC Criteria

• Age less than 50 years
• 
  Heart rate less than 100 beats/minute
• 
  No exogenous estrogen use
• 
  No hemoptysis (coughing up blood)
• 
  No prior PE or deep venous thrombosis
• 
  No recent trauma or surgery
• 
  No unilateral leg swelling
• 
  Oxygen saturation greater than 94 percent

Treating PE

People who require treatment for PE will usually have to be in the hospital so they can be monitored. The severity of the clot determines the course and length of treatment.

Treatment options may include anticoagulant medications, thrombolytic therapy and compression stockings. Sometimes a doctor will recommend surgery or interventional procedures to improve blood flow and reduce the risk of blood clots in the future.

Anticoagulant Medications

In most cases, treatment consists of anticoagulants, also called blood thinners. These help to prevent and break up smaller clots.

Heparin and warfarin, two medications that have been on the market for a while, require blood tests to get the exact dose for the individual. People taking these medications must also get routine blood tests to make sure the dose is working or isn’t too high.

Newer blood thinners such as Pradaxa (dabigatran), Xarelto (rivaroxaban) and Eliquis (apixaban) come in once-a-day doses and don’t require blood tests.

The most serious side effect of blood thinners is uncontrolled bleeding, but most blood thinners on the market now have antidotes to reverse anticoagulation for life-threatening bleeds.

In emergency cases, some patients may take thrombolytic medications, also called “clot busters.” Health care providers deliver these medications directly to the clot through a catheter, and the medication dissolves the clot.

Compression Stockings

Compression stockings, or support hose, are usually knee-high length and compress your legs to prevent the pooling of blood. They also aid blood flow in the legs. A health care provider will instruct the patient on how to use them and for how long.

Procedures

Sometimes medications and support stocking aren’t enough. If a pulmonary embolism is life-threatening, a doctor may recommend surgery to remove the clot.

Another type of invasive treatment involves the use of a small, metal cage-like device called an intravenous vena cava filter, or IVC filter. Surgeons implant the IVC filter into the vena cava, the body’s largest vein, to act like a trap for blood clots. The IVC filter catches clots as they travel through the blood stream and prevents them from reaching the lungs.

IVC Filter Information

Doctors often place IVC filters in people who are at risk for a pulmonary embolism. Learn more about IVC filter placement, uses and types.

Learn More

The Pulmonary Embolus Severity Index (PESI)

The PESI is a calculation tool that doctors can use to determine the severity of PE. People with the following criteria score higher on the PESI and are at greater risk of death following PE.

• Blood oxygen saturation levels less than 90 percent
• 
  Disorientation, coma, stupor or other altered mental status
• 
  Heart rate 110 or higher
• 
  History of heart failure
• 
  History of lung disease
• 
  Male gender
• 
  Older Age
• 
  Respiratory rate 30 or higher
• 
  Systolic Blood Pressure less than 100 mmHg
• 
  Temperature less than 96.8 degrees

Tips for Preventing Clots

The best treatment for pulmonary embolisms is prevention, especially for people who have a higher risk for DVT or PE. Many prevention tips are simple lifestyle changes. A health care provider may also recommend medications to manage health conditions that could lead to PE.

Tips for preventing PE include:

• Ask your doctor if any of the medications you take could increase you risk of PE.
• 
  Avoid dehydration by drinking plenty of fluids, but avoid caffeine and alcohol.
• 
  Get regular exercise. If you cannot exercise because you have a health condition, need bed rest or are traveling, make sure to move your feet, legs and arms for a few minutes each hour. Compression stockings can also help blood flow.
• 
  If you are obese or overweight, get to a health body weight.
• 
  If you smoke, quit.
• 
  Take medications as prescribed by your doctor.
• 
  Try not to cross your legs.
• 
  Twice a day take 30 minutes to elevate your feet.
• 
  Wear loose-fitting clothing.

What Are the Symptoms of a Blood Clot in the Leg?

Charles S. Thompson, M.D., F.A.C.S., board-certified vascular surgeon at Vascular Specialists of Central Florida, Inc. says, “One of the most common reasons patients come to visit is for blood clots in the legs.” Because of this, it’s important for us to understand why blood clots, which are normally so beneficial, cause harm at times.

Are there common symptoms that could be a warning that you’re developing a blood clot? How are these issues treated and what can you do to prevent them? We have answers that will help you understand the symptoms of a blood clot in the leg.

What Is a Blood Clot?

A clot of blood happens when the liquid solidifies into a semisolid or gel state. Clotting is the body’s way of preventing you from bleeding out when you’ve been cut or injured. A blood clot is normally good for the body and doesn’t harm you. But when the blood clot doesn’t disappear on its own, it can travel along veins to your lungs, causing serious harm.

A blood clot in the vein is called a venous clot. One of the most serious types of blood clots is known as deep vein thrombosis (DVT). Deep vein thrombosis can occur most commonly in the legs. Dr. Thompson says DVT can be associated “with periods where that patient has been at rest for a long time, such as on a long plane trip or car trip.”

What Are the Symptoms of a Blood Clot in the Leg?

You may not notice any symptoms of the blood clot at all; 50% of people with DVT have no signs. However, Dr. Thompson says, “Blood clots usually present with a painful, swollen leg.” You may also experience tenderness, warmth, and a reddish discoloration. It may feel like you have a charley horse or cramp in your leg.

If you have trouble breathing, it could mean that the blood clot has moved from your leg to your lungs. You may cough up blood or feel dizzy. Any of these symptoms are worrisome but when they happen together it’s time to call 911 for immediate medical help.

Why Would I Develop a Blood Clot in My Leg?

There are several risk factors that could cause you to develop a blood clot in your leg, including a long-term hospital stay where the body is lying still for lengthy periods. Other known risks are:

• Being over 65
• Being overly sedentary or on bed rest
• Being overweight or obese
• Cancer
• Family history of clotting disorders
• Long periods of travel in a car or plane where you’re sitting more than four hours at a time
• Pregnancy
• Smoking
• Some types of birth control pills

The blood clot, no matter where it forms, can cause a variety of complications that could be quite dangerous. For example:

• Postphlebitic syndrome, which damages the veins in an area affected by the clot
• Pulmonary embolism, occurring when a blood vessel in the lung is blocked by a clot
• Treatment complications as a result of blood-thinning medication

How Is a Blood Clot in the Leg Diagnosed?

When the patient’s history and physical exam point to the possibility of a blood clot, the most common diagnostic test ordered is an ultrasound. This is non-invasive, can be performed in our office, and provides immediate results. In some circumstances additional testing may be needed, however this is not common.

How Would a Blood Clot in My Leg Be Treated?

Dr. Thompson says, “When the patient comes into the office and we make that diagnosis, we do a confirmatory test, such as an ultrasound, and then prescribe them some medication.” However, he also says, “In some of the more advanced states, they may have to actually undergo a procedure to remove or dissolve the clot.”

The goals of blood clot treatment are threefold:

• Stop the clot from enlarging
• Stop the clot from breaking loose and traveling to the lungs
• Stop whatever risk factor caused the blood clot to form in the first place

Dr. Thompson and the team at Vascular Specialists of Central Florida, Inc. are devoted to your health. If you have any concerns or think you may be experiencing symptoms, please contact us today.

Phlebitis and Blood Clots – Preferred Vascular Group

What are Phlebitis and Blood Clots?

Phlebitis (fle-BYE-tis) means inflammation of a vein. Thrombophlebitis is due to one or more blood clots in a vein that cause inflammation. Thrombophlebitis usually occurs in leg veins, but it may occur in an arm. The thrombus in the vein causes pain and irritation and may block blood flow in the veins. Phlebitis can occur in both the surface (superficial) or deep veins.

Superficial phlebitis affects veins on the skin surface. The condition is rarely serious and, with proper care, usually resolves rapidly. Sometimes people with superficial phlebitis also get deep vein thrombophlebitis, so a medical evaluation is necessary.

Deep vein thrombophlebitis affects the larger blood vessels deep in the legs. Large blood clots can form, which may break off and travel to the lungs. This is a serious condition called pulmonary embolism.

Symptoms

The symptoms of phlebitis and blood clot symptoms can affect the leg or arm with the inflamed vein. They may include redness, swelling, tenderness, discoloration on your arm or leg, and a rope-like structure you can feel through your skin. It’s important to note that symptoms do not always arise with this condition

There is usually a slow onset of a tender red area along the superficial veins on the skin. A long, thin red area may be visible as the inflammation follows a superficial vein.

This area may feel hard, warm, and tender. The skin around the vein may be itchy and swollen. The area may begin to throb or burn.

Symptoms may be worse when the leg is lowered, especially when first getting out of bed in the morning. A low-grade fever may occur.

Sometimes phlebitis may occur where a peripheral intravenous line was started. The surrounding area may be sore and tender along the vein.

If an infection is present, symptoms may include redness, fever, pain, swelling, or breakdown of the skin.

Causes and Risk Factors

Superficial phlebitis can be a complication due to a medical or surgical procedure. Injury to a vein increases the risk of forming a blood clot. Sometimes clots occur without an injury. Some risk factors for phlebitis include the following:

• Prolonged inactivity – Staying in bed or sitting for many hours, as in a car or on an airplane, creating stagnant or slow flow of blood from the legs in a dependent position (This pooling of blood in the legs leads to thrombus formation.)
• Sedentary lifestyle – Not getting any exercise
• Obesity
• Smoking cigarettes
• Certain medical conditions, such as cancer or blood disorders, that increase the clotting potential of the blood
• Injury to your arms or legs
• Hormone replacement therapy or birth control pills
• Pregnancy
• Varicose veins
• Phlebitis Symptoms
• Superficial phlebitis

Diagnosis

Exams and Tests

Your health care provider will examine you and ask questions about your symptoms. Although blood tests do not help diagnose phlebitis, they may help identify a blood-clotting disorder. Ultrasound can detect clots or blockage of blood flow, especially in larger, more proximal (upper leg) veins. A small hand-held instrument (probe) is pressed against your skin to help identify blood clots and where the obstruction is. This is a painless, noninvasive test. Occasionally a venogram is needed to identify blood clots in the smaller, more distal veins. This is an invasive procedure that requires injecting x-ray dye or contrast material into a vein on the foot, and then an x-ray is taken of the flow of the dye up the leg.

Treatments

IVC Filter Placement and Removal

If you would like to schedule an appointment at Preferred Vascular Group to have a consult with a Board-Certified physician or would like to have one of our highly trained care providers reach out to you, please click on a button below:

People with persistent leg pain after blood clot needed for study – Washington University School of Medicine in St. Louis

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Trial evaluates whether improving blood flow in legs reduces disability

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People with chronic pain after a blood clot in the leg are needed for a clinical trial led by Washington University School of Medicine in St. Louis. The study aims to determine whether a minimally invasive procedure can reduce pain and improve mobility.

Blood clots in the legs can be life-threatening. But even after the clots resolve with treatment, some people are left with long-lasting pain, swelling and heaviness in their legs that makes it difficult to walk.

Primary physicians often have little to offer such patients beyond compression stockings, but a multicenter clinical trial led by Washington University School of Medicine in St. Louis aims to determine whether a surgical procedure to improve circulation in the legs can alleviate symptoms and restore mobility. The trial is supported by $12 million in grants from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH).

“Right now, unfortunately, when people have long-term pain after a blood clot, doctors have limited options,” said principal investigator Suresh Vedantham, MD, an interventional radiologist and professor of radiology at the university’s Mallinckrodt Institute of Radiology. “People come into our clinic after dealing with this for years and it has compromised the quality of their lives.”

From 300,000 to 600,000 people a year in the United States are diagnosed with blood clots in the leg, also known as a deep vein thromboses (DVT). Blood thinners can help clear the clots, but sometimes not before the clots irreversibly injure the veins. Some veins become too narrow for blood to flow freely. In others, one-way valves that help move blood upward from the feet to the heart are damaged and fail to shut properly, allowing fluid to pool in the legs. Blocked veins and leaky valves cause pain, swelling, heaviness, fatigue and, in severe cases, open sores on the legs.

“Small studies have suggested that opening up blocked veins and closing off backward-flowing veins can help patients, but this is the first large-scale trial to rigorously test this intervention,” said Vedantham, who is also a professor of surgery.

The Chronic Venous Thrombosis: Relief with Adjunctive Catheter-Based Therapy (C-TRACT) Trial has broad participation from experts across medical specialties that encounter patients with this condition. The trial is endorsed by national professional organizations and patient advocacy groups.

All participants in the study will receive the standard of care, which will commonly include: compression stockings and devices to improve circulation; supervised exercise programs; and/or appropriate use of medications to prevent repeat clotting and assist with ulcer healing. In addition, half of the participants will be randomly chosen to undergo minimally invasive procedures to place tiny stents inside narrowed veins and, if needed, to seal off veins with damaged valves so that blood can no longer flow backward down them.

The researchers will monitor the participants’ symptoms and mobility at six follow-up visits over two years.

“If these procedures work, it would be pretty dramatic for people living with this disability,” Vedantham said. “Many of our patients are unable to work. Some can’t even do normal household daily activities. We’re trying to restore their ability to function normally in life.”

Participants must be at least 18 years old, have been diagnosed with a blood clot in the leg more than three months ago, and be experiencing leg pain, severe swelling or other symptoms. There are 22 sites nationwide participating in C-TRACT. For more information, visit bloodclotstudy.wustl.edu/c-tract, email [email protected] or call 1-866-974-CLOT (2568).

Related: Clot-busting drugs not recommended for most patients with blood clots

Large clinical trial concludes such treatment does not prevent long-term complications

Washington University School of Medicine’s 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Deep Vein Thrombosis: A Dangerous Blood Clot

Veins deep in the legs and pelvis can harbor a dangerous blood clot known as a deep vein thrombosis (DVT). If the blood clot breaks off, it can travel into the lungs where it can result in a pulmonary embolism (PE) – a life-threatening condition where the clot becomes lodged in the pulmonary arteries and restricts the blood supply to the heart.

“Pulmonary embolism results in more than 100,000 deaths per year in the United States alone, but both DVT and PE can be treated if they are recognized early,” says Dr. Samuel Z. Goldhaber, director of the Thrombosis Research Group at Brigham and Women’s Hospital and founder of the North American Thrombosis Forum (NATF). “Risks can also be minimized to prevent these conditions.”

Risk Factors and Symptoms for DVT and PE

DVT and PE can affect anyone, and the risk factors are broad. Some of the major risk factors include:

• Obesity
• Surgery, fractures, or severe muscle injury (especially involving the abdomen, pelvis, hip, or legs)
• Pregnancy or use of birth control pills containing estrogen
• Being extremely sedentary, such as confinement to bed for medical condition or after surgery or sitting for a long time (especially with crossed legs) during an overseas plane ride
• Chronic medical conditions, such as heart or lung disease, cancer, or inflammatory bowel disease (IBD)
• Personal or family history of DVT or PE

While DVT and PE can present without symptoms, the most common signs of these conditions include:

• DVT – Pain, heat, or swelling at the site of the clot, sometimes described as a persistent “charley horse” cramping in the calf or other part of the leg
• PE – Sudden shortness of breath, chest pain, fainting, or severe anxiety

Treatment for DVT and PE

Primary treatment for DVT and PE includes blood thinners (anticoagulants). Clots that are found in the veins can be dissolved in other ways as well. One newer technique is the use of ultrasound treatment in combination with anticoagulants.

“We have been pioneers in the development new treatments for DVT and PE and ways to prevent these conditions,” said Dr. Goldhaber. “One example is the use of a filter in the largest vein that can catch a large DVT before it becomes fatal.”

Preventing DVT and PE

There are numerous ways to reduce your risk for developing DVT and PE, including:

• Staying hydrated and changing positions/moving as frequently as possible when traveling
• Daily exercise, such as 30 minutes of moderate activity each day
• Nutritious diet with plenty of fruits and vegetables
• Awareness of concerning symptoms or changes in your body.

“If you have multiple risk factors for DVT or PE, it is important to work with a vascular medicine specialist who can help manage these risks,” said Dr. Goldhaber.

Samuel Goldhaber, MD, Director, Thrombosis Research Group at Brigham and Women’s Hospital, discusses deep vein thrombosis (DVT) and pulmonary embolism (PE).

Blood Clot Lung – UCLA Lung Cancer, Los Angeles, CA

Patient Education – Lung Cancer Program at UCLA

Educating yourself about lung cancer:

Signs and symptoms: Blood clot – lung

Pulmonary embolus

Definition

A pulmonary embolus is a blockage of an artery in the lungs by fat, air, blood clot, or tumor cells.

Alternative Names

Venous thrombo-embolism; Lung blood clot; Blood clot – lung; Embolus; Tumor embolus

Causes

Pulmonary emboli are most often caused by blood clots in the veins, especially veins in the legs or in the pelvis (hips). More rarely, air bubbles, fat droplets, amniotic fluid, or clumps of parasites or tumor cells may obstruct the pulmonary vessels.

The most common cause of a pulmonary embolism is a blood clot in the veins of the legs, called a deep vein thrombosis (DVT). Many clear up on their own, though some may cause severe illness or even death.

Risk factors for a pulmonary embolus include:

• Prolonged bed rest or inactivity (including long trips in planes, cars, or trains)
• Oral contraceptive use
• Surgery (especially pelvic surgery)
• Childbirth
• Massive trauma
• Burns
• Cancer
• Stroke
• Heart attack
• Heart surgery
• Fractures of the hips or femur

Persons with certain clotting disorders may also have a higher risk.

Symptoms

Symptoms of pulmonary embolism may be vague, or they may resemble symptoms associated with other diseases. Symptoms can include:

• Cough
  • Begins suddenly
  • May produce bloody sputum (significant amounts of visible blood or lightly blood streaked sputum)
• Sudden onset of shortness of breath at rest or with exertion
• Splinting of ribs with breathing (bending over or holding the chest)
• Chest pain
  • Under the breastbone or on one side
  • Especially sharp or stabbing; also may be burning, aching or dull, heavy sensation
  • May be worsened by breathing deeply, coughing, eating, bending, or stooping
• Rapid breathing
• Rapid heart rate (tachycardia)

Additional symptoms that may be associated with this disease:

• Wheezing
• Clammy skin
• Bluish skin discoloration
• Nasal flaring
• Pelvis pain
• Leg pain in one or both legs
• Swelling in the legs (lower extremities)
• Lump associated with a vein near the surface of the body (superficial vein), may be painful
• Low blood pressure
• Weak or absent pulse
• Lightheadedness or fainting
• Dizziness
• Sweating
• Anxiety

Exams and Tests

Tests to evaluate the function of the lungs:

• Arterial blood gases
• Pulse oximetry

Tests to detect the location and extent of embolism:

• Chest x-ray
• Pulmonary ventilation/perfusion scan
• Pulmonary angiogram
• CT angiogram of the chest

Tests to detect DVT:

• Doppler ultrasound exam of an extremity blood flow studies
• Venography of the legs
• Plethysmography of the legs

An ECG may show abnormalities caused by strain on the heart.

This disease may also alter the results of the following tests:

• Echocardiogram
• D-dimer level
• Chest CT scan
• Chest MRI scan

Treatment

Emergency treatment and hospitalization may be necessary. In cases of severe, life-threatening pulmonary embolism, definitive treatment may consist of dissolving the clot with thrombolytic therapy. Anticoagulant therapy prevents the formation of more clots and allows the body to re-absorb the existing clots faster.

Clot-dissolving medication (thrombolytic therapy) includes streptokinase, urokinase, or t-PA. Clot-preventing medication (anticoagulation therapy) consists of heparin by intravenous infusion initially, then oral warfarin (Coumadin). Subcutaneous low-molecular weight heparin is substituted for intravenous heparin in many circumstances. Patients who have reactions to heparin or related medications may need other medications.

Patients who cannot tolerate anticoagulation therapy may need an inferior vena cava filter (IVC filter). This device, placed in the main central vein in the abdomen, is designed to block large clots from traveling into the pulmonary vessels. Oxygen therapy may be required to maintain normal oxygen concentrations.

Surgery is sometimes needed in patients at great risk for recurrent embolism.

Outlook (Prognosis)

It is difficult to predict how the patient will do in the future. Often, the outlook is related to the disease that puts the person at risk for pulmonary embolism (for example, cancer, major surgery, trauma). In cases of severe pulmonary embolism, where shock and heart failure occur, the death rate may be greater than 50%.

Possible Complications

• Heart palpitations
• Heart failure or shock
• Severe breathing difficulty
• Sudden death
• Hemorrhage (usually a complication of thrombolytic or anticoagulation therapy)
• Pulmonary hypertension with recurrent pulmonary embolism

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of pulmonary embolus.

Prevention

Prevention of deep venous thrombosis (DVT) among at-risk patients is very important. Walking and staying active as soon as possible after surgery or during a prolonged medical illness can reduce the risk for pulmonary embolus. Heparin therapy (low doses of heparin injected under the skin) may be used for those on prolonged bedrest. Other preventive measures include compression stockings (plastic sleeves that fit around the legs and help circulate the blood).

References

Perrier A, Roy PM, Aujesky D, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-Dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. March 2004;116:291-299.

Ramzi DW, Leeper KV. DVT and Pulmonary Embolism: Part II. Treatment and Prevention. Am Fam Physician. June 15 2004;69:2841-2848.

Merli G. Diagnostic assessment of deep vein thrombosis and pulmonary embolism. Am J Med. August 2005;118:3S-12S.

90,000 Blood during urination in women with pain at the end of urination – causes and treatment

The main organ that filters blood and frees the body from harmful metabolic products – the kidneys. Through two ureters, urine from them enters the bladder, and when urinating through the urethra (urethra) is excreted from the body.

Healthy kidneys at normal arterial pressure do not allow erythrocytes to pass through. With some renal diseases and diseases of the urinary tract, blood enters the urine – hematuria occurs.With gynecological problems, it comes from the genital tract of a woman. Hematuria can be determined visually, accompanied by a change in the color of urine to pink or red. This condition is called gross hematuria. If the impurity is minimal, the color of the urine is usually not changed and the blood is determined by the presence of red blood cells in the general urine analysis (OAM).

Hematuria should alert a woman and force her to see a doctor, if this does not apply to the ingestion of menstrual blood in the urine.

What diseases of the kidneys and urinary tract can cause blood when urinating?

There are several reasons why blood may appear in the urine.Let’s tell you more about them.

Cystitis

Cystitis (inflammation of the bladder) is the most common cause of hematuria in women. In this case, the appearance of blood occurs more often at the end of urination, accompanied by pain in the lower abdomen. With cystitis, the urge to urinate becomes more frequent, urine is excreted in small portions.

Cystitis can be caused by nonspecific flora (Escherichia coli, staphylococci, streptococci, enterococci and others) and pathogens of genital infections. Most often, microorganisms enter the organ “from the bottom up” (through the urethra): this is due to the anatomical features of the female urethra (short and relatively wide).It is possible for an infection to enter the bladder with the flow of blood and lymph during inflammatory processes in other organs, as well as with urine from the kidneys or ureters.

Urethritis

Urethritis – inflammation of the urethra. In women, it rarely leads to the appearance of blood in the urine. It is accompanied by burning sensation, discomfort when urinating. It can be a manifestation of genital infections – gonorrhea, chlamydia, genital herpes. Urethritis can also occur with a high concentration of various salts and acids in the urine, their crystallization and the formation of “sand”.In this case, the urethral mucosa becomes irritated and small amounts of blood impurities may appear in the urine.

Diseases of the external genital organs

Various diseases of the external genital organs of a woman – inflammatory, oncological, especially with the formation of skin defects of the external labia and the mucous membrane of the entrance to the vagina in the form of ulcers and erosions, cracks – another reason. At the same time, an admixture of blood in small quantities may appear in the urine, or microhematuria may be registered – the presence of erythrocytes in the OAM.

Contact of urine on the vulva or perineum in these cases is accompanied by temporary burning sensation and discomfort.

Urolithiasis

Urolithiasis is a metabolic disorder, which is accompanied by the formation of stones in the kidneys or urinary tract. The predisposing factors for the formation of ICD are hereditary metabolic disorders, the composition of water in the region, violation of the drinking regime and nutrition.

Blood in urine in these cases appears after an attack of renal colic, when the stone “moves” along the ureters or urethra, causing trauma to the mucous membranes.This condition is accompanied by severe pain in the lower back or lower abdomen, frequent urge to urinate, a violation of the general condition in the form of nausea, and vomiting is possible.

The behavior of a woman with an attack of renal colic is usually restless and requires pain relief. Often, against the background of urolithiasis, pyelonephritis develops – inflammation of the kidneys and pelvis, which pass into the ureters. Pyelonephritis is characterized by an increase in temperature, pain in the lumbar region from the side of the lesion.

Important! Until a certain time, the stones do not manifest themselves in any way.In these cases, there is no pain syndrome, there is no blood during urination, pathology in the analysis of urine is not determined.

Glomerulonephritis

Glomerulonephritis is a serious disease caused by damage to the kidney structures that filter the blood. The color of urine is usually pink-red with this pathology, there is no pain when urinating. It is accompanied by a pronounced increase in blood pressure, the formation of edema of the face and extremities.

The causes of glomerulonephritis can be hypothermia, throat infections, scarlet fever, autoimmune diseases.

Malignant tumors

Malignant tumors of the kidneys, ureters, bladder – the causes of hematuria. Rarely accompanied by painful and uncomfortable urination. In such cases, a decrease in the level of hemoglobin occurs, due to which there is general weakness, drowsiness, pallor of the skin and mucous membranes.

Benign tumors

Benign tumors in the form of “polyps” of the urethra or bladder – another reason.In case of impaired blood circulation in the area of ​​polyps, their traumatization, an admixture of blood in urine is also possible.

Injury

Blows, falls, bruises in the abdominal cavity and lower back can lead to internal bleeding.

After cystoscopy

After diagnostic manipulation to visualize the mucous membranes of the urethra and bladder using a special apparatus, blood may appear in the urine. This is due to the fact that cystoscopy predisposes to mucosal trauma.

This procedure is prescribed only when necessary: ​​when it is impossible to make an accurate diagnosis using other methods.

What is the role of infections of the genitourinary system in the appearance of blood during urination in women?

Infections of the genitourinary system can be caused by nonspecific flora and specific pathogens that are sexually transmitted. The causative agents of gonorrhea, trichomoniasis, chlamydia, urogenital mycoplasmosis, herpes viruses and human papillomavirus (HPV) are transmitted through intimate contact and can cause inflammation of both the female genital organs and the urinary tract.

Urethritis and cystitis, inflammation of the vagina (colpitis) and cervix (cervicitis) are the most frequent foci of specific inflammation.

STIs do not cause blood impurities in women as often as they do in men. If the infection is so active that with inflammation of the vagina or cervix, a violation of the integrity of the mucous membranes is formed, then the appearance of small impurities of blood in the urine is possible.

Genital warts are a manifestation of sexually transmitted papillomavirus infection, with a “favorite” localization in the external genital area.In some cases, condylomas are multiple, often subject to trauma, compression, rejection during friction. In these cases, mild contact bleeding occurs, which can cause blood to appear when urinating.

What gynecological diseases may cause blood when urinating?

Any pathology that is accompanied by bleeding from the female genital organs can give blood impurities in the urine. It appears under the following conditions:

1. Intermenstrual spotting as a sign of a cycle disorder.
2. Threat of termination of pregnancy.
3. Erosion of the cervix. It can be inflammatory and hormonal in nature. The most common sign of cervical erosion is the appearance of blood impurities after sexual intercourse, but minimal hematuria is also possible.
4. Vaginitis and vulvitis – inflammation of the vagina and external genitalia. They can be combined with urethritis and proceed in isolation. Rarely are the causative factors for the appearance of blood impurities in the urine.
5. Endometriosis is a hormonal disease of women, which is accompanied by the formation and growth of a special tissue of the uterine mucosa, not only in the area of ​​the internal genital organs of a woman, but also in the area of ​​the urethra, bladder, vagina, cervix.The main symptom of foci of endometriosis is cyclical bleeding that occurs at a certain phase of the menstrual cycle. If the focus of endometriosis is located in the path of urine excretion, then hematuria may appear.

Painful urination is not typical for hematuria in gynecological diseases. Blood is present not only in urine, but also in underwear.

Thus, the symptom of the appearance of blood during urination can be a sign of various diseases of the genitourinary system and proceed in different ways:

• in the form of macro- and microhematuria;
• accompanied by dysuria (discomfort when urinating), pain and flow without subjective sensations;
• cause a disturbance in the general condition of the patient, an increase in temperature and not lead to general symptoms.

What is “functional hematuria”?

In some cases, after significant physical exertion, blood impurities can appear in the urine normally. In addition to erythrocytes, protein is found in OAM. This condition is not accompanied by discomfort during urination, a change in general condition and is of a short-term nature. In a re-analysis carried out outside the load, all indicators return to normal.

The color of urine can sometimes mimic the presence of blood impurities in it.For example, when eating beets, blackberries, prunes, some drugs (metronidazole, rifampicin).

Possible complications

Complications of hematuria are associated both with the presence of the blood itself and with those diseases that led to this symptom.

Blood is a good breeding ground for the reproduction of microorganisms, therefore, the inflammatory process in the urinary tract with hematuria is very often present.

The extreme degree of inflammation of the kidneys and the outcome of pyelonephritis is a purulent-necrotic inflammation called the “carbuncle of the kidney”.It is accompanied by a serious general condition, high fever and intoxication, the onset of urosepsis (bacterial infection of the blood with a primary focus in the kidney). In this case, secondary purulent foci can occur in any organs: heart, lungs, brain. This condition is life threatening and requires urgent treatment. Sometimes, in order to save a person, you have to make a difficult decision to remove an organ.

Renal failure is a condition when renal functions for the exchange of water, electrolytes and nitrogenous substances are impaired or terminated.In acute renal failure, the flow of urine stops. This can be due to a variety of reasons, including blockage of the ureters with stones, blood clots, and swelling.

Chronic renal failure is formed in various forms of glomerulonephritis, pyelonephritis, tumors of the kidneys and urinary tract, complicated urolithiasis, vascular diseases (systemic vascular inflammation, diabetes mellitus). All these conditions at the initial stage can be manifested by the presence of blood impurities in the urine.

When the organs do not provide a full exchange and excretion of toxins, intoxication of the body with products of nitrogen metabolism occurs, the indicator of which is the level of creatinine and blood urea. This condition is accompanied by weakness, itchy skin, toxic damage to the nervous system, organs of the gastrointestinal tract, pleurisy and damage to the heart and bones. To relieve the symptoms of self-poisoning of the body with products of nitrogen metabolism, the patient undergoes hemodialysis procedures – blood purification with the help of an “artificial kidney” apparatus and is awaiting transplantation of the donor organ.

Thus, blood impurities in urine can be the first sign of a threat to life and health. In such cases, it is important to timely contact a specialist, make an accurate diagnosis and complete treatment. Doctors of MedCenterService see patients in 17 clinics in Moscow. Each of them is located near the metro, and you can make an appointment with a specialist at any convenient time.

Which doctors should I contact if I have hematuria?

When a symptom of hematuria arises for the first time, you can consult a therapist.If there is a suspicion of ICD, the presence of a tumor, bleeding as a result of an injury, a urologist or surgeon will provide specialized assistance.

Examination by a gynecologist is necessary for all women who have blood impurities in the urine to exclude female diseases as causal or background factors of the symptom.

Nephrologist is a specialist who treats and monitors patients with kidney diseases that do not require surgery.

The venereologist will help with sexually transmitted infections.

In any case, it is necessary to identify the causative disease that led to the appearance of blood in the urine.

Diagnostics

To diagnose hematuria you need:

• Initial consultation with a specialist detailing complaints, medical history, clinical examination with palpation, percussion (tapping), blood pressure measurement, examination on a gynecological chair.
• Laboratory analyzes. They may include general and special urine tests (according to Nechiporenko, Zimnitsky, bacterial cultures), a blood test to assess the volume of bleeding and the degree of anemia, a biochemical blood test for creatinine and urea (these are indicators of kidney function), studies for nonspecific and genital infections by various methods ( bacterial cultures, microscopy, PCR).
• Instrumental diagnostic methods. They include: ultrasound of the kidneys, bladder, pelvic organs; X-ray studies of the kidneys and urinary tract, including CT; MRI of the pelvic organs and retroperitoneal space; cystoscopy (examination of the state of the bladder using an apparatus that is inserted through the urethra).

Treatment

Depending on the cause of hematuria, treatment can be conservative and surgical.

Conservative treatment is prescribed for inflammatory diseases of the genitourinary system and the detection of infections, renal colic.It includes antibiotic therapy, taking into account the identified pathogens and test results, the appointment of anti-inflammatory drugs, pain relievers and antispasmodics, in some cases – hormones and cytostatics (with glomerulonephritis).

In the presence of stones that are not able to leave on their own, benign and malignant tumors, endometriosis of the genitourinary system, surgical interventions are performed with various approaches – through open incisions in the skin and endoscopic methods through the urethra.With ICD, lithotripsy is used – crushing stones using ultrasound through the abdominal wall or transurethral. Against the background of the surgical treatment, the woman receives anti-inflammatory and antibacterial therapy, hemostatic agents and replenishing the volume of lost blood.

The conditions that lead to the appearance of blood in the urine of a woman are very multifaceted. Professional approaches to diagnostics and treatment of MedCenterService specialists and timely access to doctors will preserve the health and full life of patients.

Hemorrhagic cystitis in women – causes, symptoms

Causes of the disease

Hemorrhagic cystitis is a form of inflammation of the bladder mucosa. It is characterized not only by dysuric phenomena, but also by the presence of blood in the urine, the presence of which can be determined visually or by tests. [22]

Blood is a sign of deep damage to the epithelium of the bladder mucosa.Often, bloody impurities indicate the destruction of the tissue that covers the blood vessels from the inside (endothelium). [16]

The hemorrhagic form is the most dangerous variant of cystitis. Therefore, in all cases, in the presence of the slightest signs of such an illness, the patient must be urgently hospitalized. In a urological hospital, doctors can carry out high-quality differential diagnostics, exclude urolithiasis, cancer of the cervix, bladder, tumors of the upper urinary tract.[22]

Hemorrhagic cystitis: causes of the development of the disease

Hemorrhagic cystitis can occur after radiation therapy and chemotherapy, taking certain antibiotics. The risk group includes patients with any diseases that reduce immunity, with diseases of the endocrine system, with oncology during the period of radiation, chemotherapy.

In some cases, haemorrhagic cystitis can also be caused by bacteria. The most common causative agent of cystitis is Escherichiacoli.This is a conditionally pathogenic bacterium that lives and develops without the presence of oxygen. It enters the urethra and bladder ascending from the rectum. The bacterium suppresses the immune system, which leads to an increased risk of developing dangerous diseases of the urinary and reproductive system. [22]

Hemorrhagic cystitis: symptoms, treatment of the disease

The first sign of the disease is frequent urge to use the toilet with a minimum volume of urine excreted.Urination is accompanied by a burning sensation, cramps, pain in the lower abdomen may be felt. Patients often show signs of body intoxication, such as fever, chills, and weakness. [22]

The intensity of symptoms, as a rule, increases with each urge to urinate. Blood in the urine, which is a clear sign of the disease, is sometimes not visualized, but it can be detected in the laboratory. [22]

Sometimes blood clots are present in the urine, which color it in the range from pink to brownish brown.Blotches of blood in any quantity indicate a violation of the integrity of the bladder mucosa, a decrease in its elasticity and resistance to caustic compounds that are part of the urine. [22]

Diagnosis of the disease

Most often, hemorrhagic cystitis occurs in women, and its symptoms appear almost immediately, but the diagnosis and treatment for each patient is determined individually. The disease has specific signs, so the diagnosis is often made on the basis of patient complaints.To determine the true cause of the development of the disease, you need to do some research:

• General analysis, urine culture. In the composition of urine with hemorrhagic cystitis, there are many leukocytes, protein and erythrocytes. If the disease is caused by bacterial microflora, then pathogens will be found in the urine. Sowing allows you to identify specific bacteria as accurately as possible, to choose a cure for cystitis.
• Ultrasound of the kidneys, bladder. Allows you to determine the localization of the inflammatory process, eliminate the likelihood of kidney infection.

In some cases, it is advisable to perform excretory urography, MRI of the bladder and kidneys. With hemorrhagic cystitis in women, treatment is prescribed only after gynecological diseases have been excluded. In differential diagnosis, instrumental research methods are of great importance. [22]

Treatment of hemorrhagic cystitis in women and men

Because of the severity of the symptoms of hemorrhagic cystitis, it is often treated in a urological hospital.With a mild form of the disease (microhematuria, normal patient well-being), therapy can be performed on an outpatient basis. Basic treatment involves taking medications, auxiliary treatment consists of drinking enough fluid to maintain normal urination, diet and bed rest. [46]

If the cause of hemorrhagic cystitis is medication or radiation, it is required to stop exposure to the provoking factor and adjust the treatment.[46] Pathogenetic treatment may also include prescribing anti-inflammatory drugs. If the disease is caused by bacteria, antibiotics are needed. The choice of antibacterial drugs depends on the microflora found in the urine.

In combination with antibiotics, phytopreparations can be prescribed that help to reduce inflammation, spasms, and have a diuretic effect [7]. One of them is Fitolysin®. It is available in the form of a paste for the preparation of oral suspension [6].In this form, the active components are better absorbed, so the suspension acts faster than the tablets. [2]

Phytolysin® contains plant extracts obtained in a high-tech way. It contains a large amount of antioxidants that have a detrimental effect on the causative agents of cystitis. Phytolysin® is produced in Europe according to GMP standards [3]. It helps [1]:

• relieve inflammation;
• fight false urge to urinate;
• reduce pain.

The drug also has an immunomodulatory, antispasmodic effect. [13]

Cough with blood

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct prescription of treatment, you should contact your doctor.

Coughing up blood – the causes of the appearance, for what diseases it occurs, the diagnosis and methods of treatment.

Cough is one of the most common symptoms of respiratory diseases.

But if the cough is accompanied by the separation of not ordinary sputum, but with streaks and even blood clots, this is an alarming signal that may indicate a serious illness.

To designate the discharge of blood from the respiratory system, a special term was introduced – hemoptysis.The volume of blood secreted with sputum varies: it can be single streaks of blood before massive bleeding. The development of bleeding is accompanied by shortness of breath, pain, warmth or burning sensation in the chest.

It should be remembered that, regardless of the amount of blood in the sputum, hemoptysis is a dangerous condition and requires seeking medical attention to identify and eliminate the causes that led to the appearance of this symptom.

Types of hemoptysis

It is important to distinguish between true and false hemoptysis.

True hemoptysis occurs when blood flows from the vessels of the respiratory system. In this case, blood can mix with phlegm and saliva.

False hemoptysis occurs when blood enters the respiratory system from other organs, for example, from the stomach during gastric bleeding or from damaged vessels in the oral cavity.

Causes of hemoptysis

In most cases, hemoptysis is caused by pathological changes in the vessels of the bronchi and lungs .

pulmonary tuberculosis and its complications are of great importance. Mycobacterium tuberculosis in the process of the disease causes the destruction of lung tissue, sometimes with the formation of cavities (cavities). In this case, the vascular bed is rebuilt: obliteration or proliferation of small vessels occurs, which becomes the cause of subsequent bleeding.

Hemoptysis accompanies many infectious diseases of the respiratory system: bronchitis, pneumonia.Some bacteria have the ability to destroy lung tissue and increase the permeability of the pulmonary vessels.

If pneumonia develops, fever, chills, shortness of breath, chest pain, night sweats are added to the blood-streaked cough.

For children, hemoptysis is characteristic of aspiration (inhalation) of small objects – toys and their parts, caps from pens, seeds.

If the foreign body has passed deeply, then there will be no pronounced shortness of breath and signs of suffocation.The only symptom may be a long, excruciating cough with a small amount of phlegm, sometimes with blood.

Rarely enough, the cause of hemoptysis can be helminths (in particular, roundworms). During migration, parasites damage small vessels, which causes the appearance of blood in the sputum.

Another cause of hemoptysis is bronchiectasis .

Bronchiectasis is an irreversible pathological expansion of the bronchi and bronchioles.Often occur in children with cystic fibrosis, with foreign body aspiration, whooping cough, and frequent respiratory infections.

Sometimes bronchiectasis are congenital – in violation of the formation of the bronchial tree.

Quite often, the cause of the appearance of blood when coughing is traumatic injury to the chest . Hemorrhage occurs in the lung tissue with the release of part of the blood with sputum.

In adult patients, the causes of the appearance of blood when coughing are more often cardiovascular pathologies.In diseases of the heart muscle, be it myocardial infarction , myocarditis , blood stagnation occurs in the pulmonary circulation (in the lungs). Blood seeps through the capillary wall into the alveoli – small sacs at the ends of the bronchi. The resulting mixture of alveolar fluid, bronchial mucus and blood comes out when you cough.

With a pronounced degree of acute heart failure, pink foam appears – an extreme manifestation of pulmonary edema.

Many heart defects also cause pulmonary congestion with dyspnea and hemoptysis.With acquired heart defects, hemoptysis most often occurs in patients with mitral valve lesions. Among the vascular diseases that cause sudden hemoptysis, pulmonary embolism (PE) should be distinguished.

Hemoptysis accompanies about a third of all cases of pulmonary embolism. The main symptoms are severe shortness of breath, cough, and chest pain.

More than half of lung cancer patients have hemoptysis.The main risk group for the development of malignant neoplasms of the lungs includes smokers over 40 years of age. In the case of lung cancer, bleeding can occur when the tumor breaks down, after which the sputum mixes with the blood and takes on the appearance of “raspberry jelly”.

Benign lung tumors rarely cause hemoptysis.

Relatively rare causes of coughing up blood include aneurysm and subsequent breakthrough of the vessel in the bronchus.

Congenital pathology of the blood coagulation system, for example, hemophilia , , can cause both acute pulmonary hemorrhage and prolonged small volume hemoptysis. Hemoptysis can be one of the symptoms of various autoimmune pathologies . So, for example, in granulomatosis with polyangiitis (Wegener’s disease), inflammation of the vascular wall occurs with the involvement of the upper and lower respiratory tract in the process.

Overdose of certain drugs with an increased risk of bleeding can lead to hemoptysis.

These drugs include: anticoagulants (warfarin, rivaroxaban, dabigatran), antiplatelet agents (acetylsalicylic acid, ticagreol).

The use of narcotic substances (in particular, cocaine) leads to damage to the vessels of the nasopharyngeal mucosa, followed by hemoptysis.

Which doctor should I contact if I have a cough of blood?

The appearance of blood when coughing requires a visit to a doctor of a therapeutic profile:
therapist or
pediatrician.After the examination, the doctor will prescribe a set of instrumental and laboratory studies and refer, if necessary, to a narrow specialist. You may need to consult a pulmonologist, cardiologist, otolaryngologist, rheumatologist, phthisiatrician, oncologist.

If there is a suspicion of injury, bleeding from the respiratory tract is profuse, dizziness, difficulty breathing and rapid heartbeat appear, you should call an ambulance.

Diagnosis and examination in case of coughing up blood

During the examination, the following is carried out:

• clinical blood test;

Wisdom tooth extraction

Definition

Wisdom teeth (third molars) – eighth in a row, counting from the middle.These four permanent adult teeth are located last in the dentition, above and below. The operation to remove a wisdom tooth is performed by a dentist or a dental surgeon. An indication for removing a wisdom tooth may be associated with inconvenience, for example, a lack of space in the dentition, which leads to pain, infection or other problems.

Some doctors recommend removing an unerupted (impacted) wisdom tooth, even if the patient has no complaints, as a preventive measure.

Is it necessary to remove an unerupted wisdom tooth

Wisdom teeth are the last of all teeth to erupt, usually between the ages of 17 and 25, that is, in the formed bone tissue. In some people, they do not appear at all, this is considered a variant of the norm. In other people, wisdom teeth grow normally, like other molars, and do not cause problems.

But sometimes the wisdom tooth does not erupt completely or gets stuck under the gum surface and grows at an angle, which can cause complications.

Such phenomena are called “retention”. The reasons are different, but, more often than not, it all comes down to the fact that at the time of eruption there is too little space for the tooth. For example, a wisdom tooth:

– grows at the wrong angle to the adjacent tooth (second molar),

– grows at an angle to the back of the mouth,

– grows at right angles to other teeth, as if “lies” inside the jawbone,

– Grows straight up or down like other teeth, but gets stuck inside the jaw bone.

Extraction is required if the impacted wisdom tooth has become the source of the following problems:

– pain

– infection

– pressure on the adjacent tooth

– cyst formation

– damage to the surrounding bone

– complication of orthodontic treatment to align other teeth

Prevention possible problems

There are different opinions among dental professionals about removal of impacted wisdom teeth , which are not cause for concern.

Here are the arguments for prophylactic disposal:

– It is quite difficult to predict the development of wisdom teeth.

– The disease may be asymptomatic.

– Having impacted wisdom teeth increases the likelihood of gum disease and tooth decay.

– Removal reduces the risk of problems.

– Complications are rare in young people.

– Older people have higher bone density and are at risk of complications.

Other experts say that it is not necessary to remove the third molar if it does not bother the patient. There is no evidence that an impacted tooth will cause problems later in life. Therefore, the costs and risks of the surgical procedure are not considered to justify the expected benefits.

Risks

Most wisdom tooth extractions are performed without long-term complications. However, some complications are still possible:

– Dry socket syndrome , in which a protective blood clot does not form in the socket after tooth extraction.This complication causes pain and interferes with healing.

– Inflammatory process in the hole caused by a bacterial infection or food particles.

– Damage to the sinuses of the upper jaw next to the wisdom teeth.

– Weakening of the lower jaw bone.

– Numbness of the lips, tongue or chin due to nerve damage.

How to Prepare

What Questions Ask Dentist or Dental Surgeon

Sometimes the dentist removes the tooth himself.However, in more difficult cases, he will refer you to a dental surgeon. Here are some questions you can ask at the reception:

– How many wisdom teeth need to be removed?

– Which is best for me, local anesthesia (mouth and jaw will go numb) or sedation (you will fall asleep)?

– How difficult will the procedure be?

– How long does the procedure take?

– Are adjacent teeth damaged due to misaligned wisdom teeth?

– Is there a risk of nerve damage?

– What other dental procedures will I need after the removal surgery?

– How long does it take for a full recovery and return to normal activities?

Prepare for operation

Wisdom tooth extraction is almost always performed on an outpatient basis, that is, you will return home the same day.

The healthcare professional will give you instructions on what to do before your surgery and on the day of your planned surgery. Ask the following questions:

– Do I need to ask someone to drive me home after the procedure?

– When do I need to come to the dental clinic?

– Should I avoid eating any food or drink? If so, how many days before the surgery?

– Am I allowed to take my prescribed medications before surgery? If so, how long before the operation should the next dose be taken?

– Should I refrain from taking any over-the-counter medications before surgery?

During during procedures

A dentist or surgeon uses one of three types of anesthesia.The choice of anesthesia depends on the complexity of the procedure and the individual characteristics of the patient. Possible options:

Local Anesthesia . First, your doctor will apply a topical medicine to your gums to numb your gums. The doctor will then numb the tooth and surrounding tissues with one or more injections near the extraction site. You will be awake during the tooth extraction. You will feel some pressure and movement, but you will not experience pain.

Sedation .Your doctor will give you an intravenous sedative. Sedative anesthesia induces sleep and reduces anxiety, so you will not feel pain during the procedure. You will also be given a local anesthetic to numb your gums.

General Anesthesia . In special cases, general anesthesia is offered. You inhale medicines through your nose, fall asleep and feel no pain. A team of doctors closely monitors the condition, breathing, temperature and blood pressure of the patient under general anesthesia.

How remove tooth wisdom

The dentist makes an incision in the gum to expose the tooth,

removes bone if it blocks access to the tooth,

first cuts the tooth into pieces if necessary,

extracts tooth,

cleans the hole from tooth or bone debris,

sometimes stitches to speed up healing,

places a gauze swab on the well to stop bleeding and help form a blood clot.

After procedure

After sedation or general anesthesia, the patient is sent to the ward to recover from the procedure. If you have received local anesthesia, you will recover in a short time right in the dental chair.

Follow the doctor’s instructions after surgery:

Physical Loads . After surgery, you should rest for the rest of the day. The next day, you can return to your business, but for at least a week, stop exercising, because they can lead to the loss of a blood clot from the hole.

Beverages . Drink plenty of water after surgery. Avoid drinking alcoholic drinks, carbonated drinks, hot drinks, or caffeinated drinks within the first 24 hours. Do not drink with a straw for at least a week, as sucking will dislodge the blood clot from the well.

Food Food . For the first 24 hours, eat only soft foods such as yogurt or applesauce. Switch to medium soft foods when you can.Avoid solid, hot, or spicy foods that can get stuck in the hole or irritate the wound.

Painkillers . To relieve pain, take a prescription pain reliever or an over-the-counter pain reliever such as paracetamol. A cold compress on the cheek can also help reduce soreness and swelling.

Bleeding . On the first day after the extraction of a wisdom tooth, blood sometimes oozes from the hole.Try not to spit so that the blood clot does not fall out of the hole. Change the gauze in place of the extracted tooth, as directed by your doctor.

Edema and bruising . Swelling and bruising on the cheeks usually go away in two to three days. Attach an ice pack if advised by your doctor.

Cleansing mouth. Do not brush your teeth during the first 24 hours after the procedure, just rinse your mouth or use a mouthwash.After this time, gently rinse your mouth with warm salt water every two hours and after meals for a week after surgery. Stir 1/2 teaspoon (2.5 ml) table salt in a glass of water. One day after removal, resume brushing your teeth, but be very careful not to touch the stitches and the hole.

Tobacco use . If you smoke, abstain for at least 24 hours after surgery, or longer if possible. If you usually chew tobacco, do not do it for at least a week.Using tobacco after oral surgery interferes with healing and increases the risk of complications.

Seams . The stitches can be made of material that dissolves within a few weeks. The stitches may not be stitched at all. If stitches need to be removed, make an appointment with your doctor.

When needs again contact dentist or surgeon

See your dentist or dental surgeon if you have any complications.The following signs or symptoms may indicate infection, nerve damage, or other problems:

– The edema worsened after two or three days.

– You have a high fever.

– Severe pain does not go away after taking pain medication.

– Bad taste in the mouth remains even after rinsing the mouth with salt water.

– Blood oozes from the hole.

– There is blood in the discharge from the nasopharynx.

– You have persistent numbness or loss of sensation in the tissues of your mouth or skin on your face.

If a complication occurs, the doctor will recommend an appropriate treatment option.

Results

You do not need a second visit to the doctor after the extraction of a wisdom tooth, if:

– No need to remove stitches.

– The procedure went without complications.

© 1998-2017. All rights reserved.

03.02.2014

90,000 What do you know about varicocele?

2020.01.07

About dilated veins of the legs, almost everyone understands and knows that these are enlarged veins that sometimes appear and develop in the legs of both men and women.

But you may have never heard of varicocele, which is also varicose veins. Varicocele is only found in guys. It’s not in the legs, but in a slightly more private and much softer area – the scrotum.It is usually harmless and essentially the same as varicose veins in the leg.

But what is varicocele and how to get rid of it?

What is varicocele?

An important part of the reproductive system for all guys, which ensures the normal function of the testicles, is the spermatic cord, which contains the arteries, veins, nerves, the tube that drains the produced sperm (sperm). This is the connection between the testicle and the body. The blood vessels in the bloodstream circulate to and from the testes.Veins drain blood from the testicles to the heart, and valves in the veins ensure that blood flows to one side and stops it from returning. In other words, valves regulate your blood flow and make sure everything flows in the right direction.

But sometimes these valves can fail. When this happens, some of the blood may start flowing in the opposite direction. This blood begins to accumulate in the veins, the veins stretch and the network of dilated veins expands. This is called varicocele.

What are the signs of varicocele?

Most of the time guys have absolutely no symptoms. The guy may not know he has varicocele. When symptoms develop, usually in the heat, after heavy exercise, or when the guy is standing or sitting for a long time.

Turns out:

• Sleeping testicular pain

• feeling of heaviness or stretching in the scrotum

• swollen veins in the scrotum that can be felt (described as worms or spaghetti)

• discomfort in the testicle or on one or the other side of the scrotum

• the testicle is smaller on the side where the veins are dilated (due to different blood flow)

In most cases, varicocele develops slowly and imperceptibly.Fortunately, most cases of varicocele are easy to diagnose and most do not require treatment. If varicocele is causing symptoms, it can often be corrected with surgery.

When to see a doctor?

Since varicocele usually does not cause any symptoms, it often does not require treatment. Varicocytes can be detected by fertility assessments or routine medical examinations.

However, if you feel pain or swelling in your scrotum, notice swelling in your scrotum, or notice that your testicles are a different size, or you have fertility problems, see your doctor. Testicular enlargement or pain can be caused by many conditions, some of which require immediate treatment.

Risk factors

There are no significant risk factors for the development of varicocele.

90,000 Blood when brushing your teeth. Professional teeth cleaning. Dentistry Prosmile.Ru

The unexpected appearance of blood while brushing your teeth can be frightening. Try not to panic.The gums can bleed due to mechanical damage. You may not have been very good with your toothpick, or you may have used too much force when using the dental floss. It is not uncommon for a toothbrush to cause injury when it is pressed firmly against the area to be cleaned. Usually minor injuries to the gums heal quickly, and blood disappears with them when brushing teeth.
However, if blood appears every time you brush your teeth, then it is worth considering the causes of this problem.

It is widely believed that soft toothbrushes help get rid of blood when brushing.Most likely, it is based on the “by contradiction” method: if a hard toothbrush can damage the delicate gum tissue and cause bleeding, then when using a soft brush, the effect will be the opposite.
Unfortunately, this is a big mistake. A soft toothbrush cannot remove plaque properly. It stays on the teeth and makes an excellent food for all sorts of bacteria that cause inflammation. As a result, the gums bleed even more when brushing.

Professional teeth cleaning

The reasons for bleeding teeth may not depend on oral hygiene.People with high blood pressure or blood clotting problems can develop blood while brushing their teeth. Bleeding gums can be a symptom of another disease, often not associated with dentistry (kidney, liver, AIDS, etc.) In women, bleeding gums may appear at the beginning of the monthly cycle. If you get bleeding while brushing your teeth, check if it happened for one of the above reasons.

As a rule, if the problem is in the hygiene of the oral cavity, or rather, in its insufficient hygiene, then the gums become inflamed and bleed due to dental plaque, which after a while turns into tartar.If an ordinary toothbrush of medium hardness can cope with plaque (if used correctly, of course), then any brush is already powerless against tartar.
Unfortunately, professional toothpastes are not a panacea either. They fight against the formation of tartar by maintaining dental health, but if the tartar has already formed, professional hygiene is necessary.

Professional hygiene is the first procedure that should be performed in the presence of a stone.
In some situations, a more intense and deeper impact is required with

systems “Vector”.”Vector” is a device that has proven its high efficiency in
treating gum disease. In addition, the Vector polishes the tooth surface (especially the root surface), reduces inflammation around the teeth and stabilizes the gums, while reducing tooth mobility.
With the Vector it is possible to remove calculus located deep in the gum pocket. In the early stages of periodontitis, the vector can be an alternative to surgical periodontology. The positive result after the vector is felt immediately.

You should not completely trust the advertising on TV, where actors in white coats say that some kind of toothpaste or toothbrush can quickly and permanently help in a situation where the gums bleed when brushing your teeth. It’s actually not that simple. That is why in the same advertisement in small print there is necessarily information that it is necessary to contact specialists.