How to Diagnose Pulmonary Embolism

Three Parts:Recognizing Signs and SymptomsInvestigating FurtherTreating a Pulmonary Embolism

A pulmonary embolism is a sudden blockage of an artery in the lung. It is caused by a blood clot, most often that originated in a vein of the lower extremity.[1] To diagnose a pulmonary embolism, it is key to recognize suspicious signs and symptoms, and also to undergo a series of diagnostic tests and evaluations. If you suspect that you may have a PE (pulmonary embolism), go to the Emergency Room immediately or call 911 depending on the severity of the symptoms.

Part 1
Recognizing Signs and Symptoms

  1. Image titled Strengthen Your Lungs After Having Pneumonia Step 4
    Recognize the signs and symptoms of a potential pulmonary embolism.[2] If you notice these signs and symptoms, it is important to go to the Emergency Room immediately. Seeing a doctor for prompt diagnosis and treatment is key. (It is also important to understand, however, that half of people with a pulmonary embolism present with no symptoms.) Symptoms to look out for include:
    • Shortness of breath and/or rapid respiratory rate
    • Sudden onset chest pain (often a sharp, localized chest pain that gets worse when you take a breath)
    • A fast heart rate
    • Coughing and/or "hemoptysis" (coughing up blood)
  2. Image titled Identify Enlarged Heart Symptoms Step 29
    Seek treatment if you have signs of an already-present DVT (deep venous thrombosis).[3] A DVT (deep vein thrombosis), that normally occurs in one of your legs, is often the precursor to developing a PE (pulmonary embolism). It is for this reason that, if you notice signs and symptoms of a DVT (a blood clot in your leg), it is also key that you seek medical treatment immediately. The therapy for both DVT and PE are not identical, but they are similar, so if you seek treatment for your DVT it will both treat the problem and also prevent a future PE from developing. Signs and symptoms of a DVT include:
    • Leg pain over the calf or lower thigh, often on one side, but it is possible to have DVTs in both legs
    • Swelling over the affected area, sometimes accompanied with a feeling of tightness on the leg
    • Skin redness or changes in skin color over the affected area
    • Warmth over the skin over the affected area
  3. Image titled Cure a Yeast Infection in Your Lungs Step 15
    Consider your risk factors. Certain risk factors may increase your likelihood of developing a pulmonary embolism.[4] In addition to recognizing signs and symptoms, there are risk factors that make you more susceptible to developing a pulmonary embolism. These include:
    • Being pregnant
    • Having kidney problems
    • Being overweight or obese
    • Having cancer
    • Being immobilized (either from surgery, disability, or other conditions leading to bedrest)
    • Having heart failure
    • Smoking
    • Having a previous history of blood clots
    • Taking certain medications (such as birth control pills and/or other hormone replacement therapy, erythropoietin, thalidomide, and tamoxifen)

Part 2
Investigating Further

  1. Image titled Determine Your Blood Type Step 3
    Get blood tests.[5] If you are presenting with signs and symptoms that may be indicative of a pulmonary embolism, one of the first things the doctor will do when you arrive in the Emergency Room is order a series of blood tests. There is a blood test test called a "D-dimer," which can be used to rule out a pulmonary embolism, but not to rule it in. What this means is that, if your D-dimer is negative, you can rest assured that you do not, in fact, have a pulmonary embolism. If it is positive, however, it is suspicious (but not diagnostic) of a possible pulmonary embolism.
    • A D-dimer test measures "fibrin degradation fragments" in the blood. In other words, it is a measure of the presence of clotting factors in the blood (hence why it is useful in the investigation of a potential blood clot in the lung - aka a pulmonary embolism).[6]
    • Other blood tests will also be performed to rule out other medical conditions that may present similarly to a pulmonary embolism, such as a heart attack or heart arrhythmia.
    • For instance, your doctor will test your troponin levels (a heart-related enzyme) to assess for a possible heart attack.
  2. Image titled Cope with a Heart Murmur Step 21
    Have an electrocardiogram, or ongoing cardiac monitoring. Another test that will be done immediately when you arrive in the Emergency Room with symptoms suggestive of a pulmonary embolism is an ECG (electrocardiogram). You may also receive ongoing cardiac monitoring - which is basically continuous ECGs recorded on a monitor that your doctor can see and watch over a period of time.
    • The ECG (or cardiac monitor) may show characteristic signs of a pulmonary embolism, such as the characteristic S1Q3T3 pattern.[7]
    • Alternatively, a completely normal ECG (or an ECG with no abnormalities other than a faster than usual heart beat) may also be indicative of a pulmonary embolism, as this condition does not always present with overt signs on the ECG tracing (or cardiac monitor).
    • An ECG (or cardiac monitor) can also be used to rule out other conditions, such as a heart attack (which may show elevated "ST segments," an abnormality not consistent with a pulmonary embolism).
  3. Image titled Identify Enlarged Heart Symptoms Step 16
    Receive a CT angio scan.[8] A CT angio scan is one of the most effective ways to identify and diagnose a pulmonary embolism. A dye will be injected intravenously prior to the CT angio scan. The purpose of this is to allow your doctor to clearly visualize the blood flow in the arteries of your lungs (due to the intravenous contrast) when the CT angio scan is performed.
    • That way, if there is a blockage of blood flow in your lungs due to a pulmonary embolism, the location and size of the embolism(s) can be detected.
    • The diagnosis of a pulmonary embolism can be confirmed via a CT angio scan, and treatment can be initiated following diagnosis.
  4. Image titled Identify Enlarged Heart Symptoms Step 11
    Opt for a V/Q (ventilation-perfusion) scan.[9] Another diagnostic test that can be used to identify a pulmonary embolism is the V/Q - ventilation-perfusion - scan. This is similar to a CT angio scan, but it is used much less frequently (it was the more prevalent diagnostic test for pulmonary embolism in the past) and it is not as effective as the CT angio scan. A V/Q scan may be used if there is a contraindication to the iv contrast such as an allergy, or kidney problem.
    • What happens in a V/Q scan is that a radioactive substance is injected into your bloodstream (which will then travel up to the blood in your lungs). The injection is the Q (perfusion), and then the V part comes when the patient inhales another radioactive tracer.
    • A picture is then taken, which detects the pattern of the radioactive materials the patient had injected and inhaled.
    • Similar to the CT angio scan, a V/Q scan can identify the location and size of a potential pulmonary embolism based on absent or disrupted blood flow to a certain area(s) of the lung.
  5. Image titled Identify Enlarged Heart Symptoms Step 7
    Ask your doctor for a pulmonary angiography.[10] If a CT angio scan and/or V/Q scan are insufficient to diagnose (or rule out) a pulmonary embolism, your doctor may recommend a more invasive diagnostic test called pulmonary angiography. In this test, a catheter (tube) is inserted through your femoral vein (a vein in your groin area), and guided up towards the blood vessels in your lungs. Contrast material is then released, which spreads through your lungs according to the pattern of blood flow. Your doctor will then perform an x-ray to look at the distribution of the contrast and to hopefully diagnose (or rule out) a pulmonary embolism.
    • Because pulmonary angiography is the most invasive diagnostic test, it is generally used as a last resort when the other tests prove inconclusive or have confusing results. But even though it is not used commonly for diagnosis, it can be a good option since an IVC filter can be placed at the same time, or in some cases the clot can be extracted.

Part 3
Treating a Pulmonary Embolism

  1. Image titled Live With Inflammatory Bowel Disease Step 4
    Take an anticoagulant (blood thinning) medication.[11] The mainstay of treatment for a pulmonary embolism are anticoagulant (commonly known as "blood thinning") medications. The purpose of an anticoagulant medication is not to dissolve the current clot, but rather, to prevent the formation of any new clots (and to allow the current clot to dissolve with your body's natural mechanisms).
    • An injected anticoagulant is often given for the first five to 10 days of therapy, followed by oral (pill form) anticoagulant medications for three to six months following the pulmonary embolism. However, in some cases the anticoagulation medication will need to be lifelong.
    • Examples of anticoagulant medications include low molecular weight heparin given by an injection under the skin (such as enoxaparin/Lovenox, or fondaparinux/Arixtra, which is a factor Xa inhibitor), unfractionated heparin given by IV injection, or oral anticoagulants given in pill form (such as rivaroxaban/Xarelto, or apixaban/Eliquis).[12]
  2. Image titled Prevent Ischemic Heart Disease Step 12
    Opt for thrombolytic therapy.[13] If the clot (pulmonary embolism) is large enough to cause severe symptoms (such as extreme shortness of breath, chest pain, or even symptoms of shock), your doctor will likely recommend "thrombolytic therapy." This is when a "clot-busting" drug is given to actively dissolve the clot. This is then followed up with anticoagulation therapy.
  3. Image titled Prepare for Heart Surgery Step 16
    Have a clot filter inserted to prevent future emboli (clots).[14] If you have "contraindications" (reasons against) being on blood thinning medications, your doctor may advise a clot filter to prevent the formation of future clots. This is typically inserted through your femoral vein (in your groin), and guided up to your inferior vena cava (the big blood vessel that feeds into the heart), where it sits. Reasons "against" anticoagulant medication (and "for" the insertion of a clot filter) include:
    • Recent surgery
    • A recent stroke
    • Significant bleeding in another area of the body, such as recent GI bleeding
  4. Image titled Get Rid of Chest Congestion Step 3
    Ask about catheter-directed thrombolysis. Catheter-directed thrombolysis may be performed to remove a blood clot from a vein or artery. In this procedure, a catheter will be inserted into an artery or vein and the images will be used to find the clot. When the clot is located, medication or a device will be used to break up the clot.
    • This procedure is minimally invasive.
    • You will be sedated during the procedure.
    • If medications are used to break up the clot, then the catheter may be left in place for up to 72 hours to break up the clot. When the clot has been broken up, the catheter will be removed and the wound will be bandaged.[15]
  5. Image titled Treat Constipation After Hernia Surgery Step 17
    Receive a surgical embolectomy.[16] If the clot is particularly large and severe, a surgical embolectomy may be recommended as a "last resort treatment." What this entails is surgical removal of the clot from the lung, to resolve blood flow in the lungs and alleviate symptoms and patient distress.
  6. Image titled Cope with a Heart Murmur Step 25
    Determine the underlying cause.[17] After diagnosing you with a PE, your doctor will want to determine what caused it in the first place, to avoid the future formation of blood clots. The cause may have been a "one-time thing," such as developing a pulmonary embolism following surgery which put you at risk due to immobilization. Or, if you have not been exposed to any recent risk factors, your doctor may perform a series of tests to assess for underlying clotting disorders or other conditions that may have been responsible for the formation of your blood clot.

Article Info

Categories: Conditions and Treatments