A pulmonary embolism (PE) occurs when a blockage develops in one of the pulmonary arteries within the lungs. This blockage impedes blood flow, straining the heart and potentially leading to life-threatening complications. Recognizing the signs and seeking immediate medical attention is important.
Understanding Pulmonary Embolism
A pulmonary embolism results from a blood clot, known as a thrombus, that forms elsewhere in the body and then travels to the lungs. These clots most commonly originate in the deep veins of the legs, a condition referred to as deep vein thrombosis (DVT). When a piece of this clot breaks off, it becomes an embolus and can lodge in the pulmonary arteries, obstructing blood circulation to lung tissue.
Symptoms of PE include a sudden onset of shortness of breath, sharp chest pain that often worsens with deep breaths, and a cough that may produce bloody sputum. Other signs include rapid heart rate, dizziness, or lightheadedness. Any suspicion of a PE warrants urgent medical evaluation.
Pulmonary Embolism Mortality Rates
Pulmonary embolism mortality rates vary based on diagnosis and treatment. In the acute phase, specifically within 30 days, the mortality rate is around 8.7%. If a PE remains undiagnosed or untreated, the mortality rate is as high as 30%.
Long-term mortality risk continues even after initial survival. One-year mortality rates for individuals who have experienced a PE are around 19.7%, increasing to 37.1% at five years.
PE severity also influences rates. Low-risk PE has a 90-day mortality rate of less than 2%, while intermediate-risk PE has a 90-day mortality rate of 15%. High-risk or “massive” PE, characterized by severe drops in blood pressure and potential shock, has a 90-day mortality rate as high as 58%.
Factors Influencing Mortality
Several factors influence PE mortality rates. Advanced age is linked to higher mortality, with older adults experiencing worse outcomes. Underlying health conditions, or comorbidities, also play a role, including chronic heart failure, chronic lung disease, and kidney disease.
Active cancer is a strong risk factor for death, especially within the first three years after a PE diagnosis. This increased risk is partly due to cancer’s association with a higher risk of thrombosis. Anemia also predicts increased mortality in PE patients.
PE severity, determined by clot size and location, directly impacts immediate mortality. Hemodynamic instability (unstable blood pressure and circulation) indicates high-risk PE and elevates the chance of early death. Timely diagnosis and prompt treatment are important, as delayed intervention can lead to severe complications and increased mortality.
Improving Outcomes and Long-Term Considerations
Improving outcomes for pulmonary embolism involves immediate treatment, long-term management, and prevention. Initial treatment involves anticoagulants (blood thinners) to prevent further clot formation and allow the body to reabsorb existing clots. For more severe cases, clot-dissolving medications (thrombolysis) or surgical removal of the clot (embolectomy) may be necessary to restore blood flow.
Preventive measures are also important, especially for high-risk individuals like those recovering from surgery, experiencing prolonged immobility, or engaging in long-distance travel. Strategies like early ambulation, using compression stockings, and prophylactic anticoagulation can reduce the likelihood of clot formation.
Despite effective acute treatment, some individuals experience long-term complications, known as post-PE syndrome, which can manifest as persistent shortness of breath, fatigue, or reduced exercise tolerance. A more severe, less common complication is chronic thromboembolic pulmonary hypertension (CTEPH), where unresolved clots or scar tissue in the pulmonary arteries lead to high blood pressure in the lungs. Regular follow-up care is important for monitoring these long-term issues and managing ongoing symptoms, improving quality of life and long-term prognosis.