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Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Whenever a young and healthy athlete gets sick, it always gets the attention of the press. The news is even more dramatic when the condition can be life-threatening, as in the case of Serena Williams, who reportedly developed a pulmonary embolism in late February 2011. While it is possible to recover fully from a pulmonary embolism, it is indeed a serious condition and requires serious medications. In addition, Ms. Williams also reportedly required treatment for a hematoma, a collection of clotted blood that forms outside of a blood vessel.
A pulmonary embolism (PE) happens when a blood clot (thrombus) forms in the one of the body's large veins (known as deep vein thrombosis or DVT), breaks off, and travels (embolizes) in the circulatory system back to the heart and out into the arteries that carry blood to the lungs to load up oxygen. There the clot in the lungs (embolus) then clogs the artery that provides blood supply to part of the lung, preventing the normal exchange of oxygen and carbon dioxide. It also reduces the blood supply to the lung tissue itself. Lung tissue can die (infarct) if circulation is impaired.
Essentially anything that increases the potential for blood clots to form in the veins can increase your chances of developing a pulmonary embolus. While some medications and chronic medical problems can increase the tendency of blood to clot, even those who are healthy and fit can be at risk for pulmonary embolism due to prolonged immobilization (as with extended car or plane travel or hospitalization and bed rest) or circumstances that damage the blood vessel walls, making a clot more likely to form. Surgery and trauma to the leg are examples of conditions that can make a vein more likely to clot. Sudden chest pain and shortness of breath are the main symptoms of pulmonary embolism, but coughing may also occur. The pain is usually worse when taking a breath (known as pleurisy). The affected individual may have signs such as a blue-tinged discoloration of the skin and feel lightheaded or weak. In severe cases, the heart stops beating and sudden death results. Fortunately, treatment for pulmonary embolism is available, and most patients survive when appropriately diagnosed and treated with anti-clotting drugs. A higher incidence of death from pulmonary embolism occurs in patients who are older, have other underlying illnesses, or have a delay in diagnosis.
What is a pulmonary embolism?
The lungs are a pair of organs in the chest that are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and blood. The lung is composed of clusters of small air sacs (alveoli) divided by thin, elastic walls (membranes). Capillaries, the tiniest of blood vessels, run within these membranes between the alveoli and allow blood and air to come near each other. The distance between the air in the lungs and the blood in the capillaries is very small, and allows molecules of oxygen and carbon dioxide to transfer across the membranes.
The exchange of the air between the lungs and blood are through the arterial and venous system. Arteries and veins both carry and move blood throughout the body, but the process for each is very different.
Arteries carry blood from the heart to the body.
Veins return blood from the body to the heart.
The heart is a two-sided pump.
Oxygen-carrying blood travels from the left side of the heart to all the tissues of the body. The oxygen is extracted by the tissue, and carbon dioxide (a waste product) is delivered back into the blood.
The blood, now deoxygenated and with higher levels of carbon dioxide, is returned via the veins to the right side of the heart.
The blood is then pumped out of the right side of the heart to the lungs, where the carbon dioxide is removed and oxygen is returned to the blood from the air we breathe in, which fills the lungs.
Now the blood, high in oxygen and low in carbon dioxide, is returned to the left side of the heart where the process starts all over again.
The blood travels in a circle and is therefore referred to as circulation.
If a blood clot (thrombus) forms in the one of the body's veins (deep vein thrombosis or DVT), it has the potential to break off and enter the circulatory system and travel (or embolize) through the heart and become lodged in the one of the branches of the pulmonary artery of the lung. A clot that travels through the circulatory system to another location is known as an embolus (plural emboli).
A pulmonary embolus clogs the artery that provides blood supply to part of the lung. The embolus not only prevents the exchange of oxygen and carbon dioxide, but it also decreases blood supply to the lung tissue itself, potentially causing lung tissue to die (infarct).
A pulmonary embolus is one of the life-threatening causes of chest pain and should always be considered when a patient presents to a healthcare provider with complaints of chest pain and shortness of breath.
Non-thrombus causes of pulmonary embolus are rare but include:
- fat emboli from a broken femur,
- an amniotic fluid embolus in pregnancy, and
- in some cases, tumor tissue from cancer.
The presentation is the same as that of a blood clot, caused by blockage of part of the arterial tree of the lung. It is Obvious that any drug that causes a Pulmonary embolism must be uses with caution. Yaz birth control pills have shown to cause pulmonary embolism in young women. Call the yaz Birth Control Pills Helpline and Sperak to a female Medical social worker and a yaz lawyer.
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