Only by hearing the name pulmonary embolism, you could guess it is not something nice. It is actually one of the deadliest health conditions in medicine, and it is responsible for no less than one-third of those who remain undiagnosed. A pulmonary embolism is an absolute emergency, and you cannot delay getting medical help.
In simple words, pulmonary embolism is a blood clot that obstructs the blood vessels in the lungs. There’s restricted blood flow, the same that triggers a heart attack, and there’s a corresponding sense of pain right in your chest. The signs and symptoms of a pulmonary embolism may seem a bit similar from those we find in a heart attack, but looking a bit deeper they are entirely different. In all cases, the diagnose and corresponding management should be done in an emergency room by a qualified physician. In this article, you will understand the alarming signs and symptoms of a pulmonary embolism so you can look for medical assistance right away.
Chest pain
The chest pain in pulmonary embolism is especially severe, and may seem similar to a heart attack. The blood clot that’s responsible for the pulmonary embolism lodges in the blood vessels that irrigate the lungs, causing an acute pleuritis, which is the inflammation of the outside lining of the lungs. This inflammation triggers the activation of several nerve terminals located in the pleura and causes severe chest pain.
This type of pain has a very abrupt onset and comes along with the rest of the symptoms without any previous advice. One of the ways to differentiate chest pain from a pulmonary embolism from that of a heart attack is by paying attention to the rest of the symptoms, especially the shortness of breath and signs of hypoxia. Other signs and symptoms are to be identified by a professional in a medical setting.
You can also identify the chest pain from pulmonary embolism because it is strongly related with your breathing. It is a stabbing pain that aggravates every time you breathe in. Sometimes, the chest pain may extend to your arm, shoulder or jaw, which is similar to a heart attack, and only lab exams could make a contrast.
Shortness of breath
Pulmonary Embolism is a problem related to the lungs and the respiratory function. It is a blood clot that does not allow a complete area in your lungs to be fed by nutrients and oxygenated blood. Even if your lungs are the primary receptacle of oxygen, there are tissues away from the reach of the pulmonary alveoli that would need an external source of oxygenated blood to survive.
When there’s not enough oxygen in the pulmonary tissue, the respiratory function starts to become deficient, your oxygen levels start to drop, and your brain interprets that as if you were not breathing deep enough. That’s why people with pulmonary embolism feel shortness of breath, an urge to take a deep breath instead of regular respiration. However, since chest pain is aggravated after breathing in, the respiratory discomfort increases, and patients report they find it difficult to breathe.
As a result, you would see a patient with pulmonary embolism with rapid and short breathing, trying to breathe more while preventing to aggravate their chest pain while breathing in. This rapid breathing would cause pH problems in the long term because there will be a constant exchange of CO2 and oxygen that would cause modifications in the acidity of the blood.
Bluish colour of the skin
As we mentioned previously, pulmonary embolism causes an alteration in the exchange of oxygen and CO2. There will be an impaired oxygenation of the blood because the lungs are directly affected by the blood clot and the reduction of nutrients to the tissue. In some cases, there is an irreversible loss of lung tissue, which becomes unable to exchange oxygen anymore. Therefore, in principle, there’s an increase in deoxygenated blood in the organism.
Oxygenated blood runs through the arteries, which are often pictured as red. Deoxygenated blood runs through the veins, which are often portrayed as blue. These differences are only made for educational reasons, but in practice, there’s a different colour between oxygenated and deoxygenated blood. Your blood has iron, and when this element is in contact with oxygen it will show a reddish hue, but the colour turns darker when there’s no oxygen around.
That’s why people with a pulmonary embolism get a bluish colour in their skin. Their blood is not carrying enough oxygen and starts changing colours. This can be measured by blood tests when it is not visible from the outside, but the typical patient with a pulmonary embolism would enter the emergency room with cyanosis (which is the clinical name of this coloration of the skin), shortness of breath, and chest pain.
Coughing and spitting up blood
The signs and symptoms of a pulmonary embolism may vary from one person to another. Some people may not have the usual abrupt onset with severe chest pain but may start with simple respiratory symptoms such as cough and shortness of breath that aggravates progressively as the time passes by. Coughing up blood is not the most common symptom in pulmonary embolism, It’s an atypical symptom instead, but it is an alarming symptom that should advise for urgent medical attention.
This sign is called hemoptysis, and it happened when the blood vessels of the lungs rupture and the blood that circulates through them would pass on the respiratory tract. It is a very urgent sign that requires immediate medical evaluation, even if it’s not accompanied by chest pain or any other symptom.
However, the major part of the cases we won’t see any blood, just productive coughing of transparent mucus, which is caused because there’s fluid in the lungs, also called pulmonary edema, which leaks from the blood vessels affected by the clot.
Anxiety and agitation
After the severe chest pain, the shortness of breath that aggravates when breathing in, and having patients coughing up blood, it is common to see anxiety and agitation as another sign that points out pulmonary embolism.
However, not all cases can be measured by the same standards, and sometimes having gradually progressive shortness of breath without any other cause is enough to suspect a pulmonary embolism, whether or not patients feel anxious about it. Anxiety and agitation are the results of the rest of the symptoms, and they are not caused by the condition itself.
Lightheadedness
Another symptom that is commonly reported in patients with pulmonary embolism is lightheadedness. Patients may feel muscular weakness, difficulty in concentrating, dizziness and tiredness. These symptoms are mainly caused by a lack of oxygen that starts affecting the central nervous system. These symptoms are more common in patients with an underlying health problem, primarily concerning the respiratory system or the central nervous system. However, it is likely to appear in any patient with or without these specific antecedents.
However, lightheadedness is not a primary symptom of pulmonary embolism, and we should look for another explanation if there is no respiratory symptom or chest pain. Remember that most of the accompanying symptoms of a pulmonary embolism are the result of an impaired respiratory function, which should serve as a guide for the diagnosis.
Fainting
In some cases, the reduction in the available oxygen for the brain is severe enough to cause fainting and other alterations of the consciousness. This typically occurs in the elderly and patients with an underlying problem, as we mentioned previously.
In some cases, additional neurological symptoms may appear, such as seizures and delirium. All of these signs and symptoms are strongly related to a lack of oxygen in the nervous system, which usually points out that the pulmonary embolism has been prolonged for too long. In these cases, it is essential to remain calm, control the symptoms of the patient in the case of delirium or seizures, and call for urgent medical attention while doing so. Most of the neurological problems associated with pulmonary embolism cause no permanent damage, but they may signal a prolonged condition that would probably cause permanent damage to the lung tissue.
Weak pulse
Patients with a pulmonary embolism will have an impaired heart function. Sometimes it is severe enough to cause a hemodynamic collapse, but in most cases, it is only a weak pulse as a result of the low levels of circulating oxygen. The heart sounds are attenuated in more than half of the patients, and their pulse is also feeble because their heart is pumping with less intensity.
Sometimes, there are additional cardiovascular signs and symptoms when examining the heart. There’s an abnormal sound called S3 or S4 gallop, and patients may have cardiac murmurs as well.
Accelerated pulse
Tachycardia is the clinical name for an accelerated pulse, and it is a heart rate of 100 or more beats in one minute at rest. Almost half patients with a pulmonary embolism have tachycardia, and it is the result of the weak pulse. Trying to balance the cardiovascular function, the heart attempts to compensate not beating hard enough with an accelerated pulse so that oxygenated blood can reach the rest of the body.
The effect is further increased by the central nervous system, which detects a lower level of oxygen and starts sending signals to the heart forcing it to double its pumping work. When sustained for enough time, this may cause a hemodynamic collapse, which is one of the reasons why we should look for urgent medical attention when suspecting pulmonary embolism.
Arrhythmia
It is the clinical name given to the condition in which the heart has an abnormal rhythm or no rhythm at all. An arrhythmia may be caused by several reasons, and one of them is an accelerated heartbeat. When patients susceptible to an arrhythmia have a pulmonary embolism, it is very likely that their heartbeat starts to increase and this, in turn, affects the normal rhythm of the heart.
There are many types and subtypes of arrhythmia, and the one that affects patients with a pulmonary embolism depends on the integrity of the electrical system of the heart. Pulmonary embolism, in general, would increase the heart activity, especially on the right side of the heart, which usually triggers an arrhythmia in this area, and sometimes atrial fibrillation.
Sometimes, in the event of atrial fibrillation, it is difficult to determine which one came first, because atrial fibrillation is a totally abnormal movement of the heart that often causes many clots inside the heart. These clots could travel through the pulmonary artery to reach the lungs and cause a pulmonary embolism.
Note that 10% of pulmonary embolisms are fatal during the first hour, which is one of the reasons why you should act quickly and without hesitation looking for urgent medical assistance if you suspect pulmonary embolism by encountering the symptoms we described above. Remember the most important symptoms are respiratory symptoms and those associated with impaired oxygenation, and not every patient would display distressing signs with a sudden onset.
When a physician is suspecting a pulmonary embolism, he would order a number of lab tests such as a white blood cell count, troponin levels, blood oxygen and CO2 levels. When it is already confirmed, they should check for your coagulation levels and may need additional imaging studies to detect the extension of the damage. This should be performed readily because a high number of patients would not survive the first hours. Thus, do not delay looking for medical attention if you suspect a pulmonary embolism, especially if you have an underlying problem in your blood clotting.