How fatal pulmonary embolism can occur

It often starts harmlessly: with a slight pulling sensation in the calf or a pinch in the thigh. What seems so undramatic can, however, be the initial symptom of venous thrombosis. And it’s insidious: While you’re still wondering where the sudden sore muscles come from, a clot in the vein can already be on its way to the lungs and trigger a pulmonary embolism.

Pulmonary embolism is the third most common cause of cardiovascular-related death after stroke and heart attack. According to estimates, it kills around 100,000 people every year in Germany alone. In general, the sooner a thrombosis is detected and treated, the better the chance that its growth can be restricted and normal blood flow can be restored.

If a leg suddenly swells and becomes red, you should always consider the possibility of a thrombosis. Uneven sensations can also indicate the beginning of a vascular occlusion. “You sometimes have a feeling of heaviness, of tension. It can feel like a muscle cramp,” says Dr. Katja Mühlberg, vascular specialist at the Leipzig University Hospital. “Unfortunately, there are also thromboses that occur with almost no symptoms,” she explains.

Even a clot that has already broken off and traveled up to the lungs can remain hidden. At the latest when it has reached the pulmonary circulation, says Dr. Mühlberg, however, make it noticeable. It can only cause very mild symptoms such as a cough; sometimes the patient coughs up blood. Very superficially, however, shortness of breath and sudden loss of consciousness, known as syncope, often manifested themselves. In this case, a doctor must be consulted or called immediately.

Various risk factors apply to thrombosis. “On the one hand, women take pills containing estrogen. Especially if they smoke,” says the vascular specialist. “Hormone replacement therapies during menopause also play a role. “In addition, both overweight people and patients with tumor diseases have a higher risk,” she emphasizes. The risk also increases after operations.

Recent studies have pointed to an increased risk of thrombosis for patients with chronic inflammatory diseases, be it rheumatic diseases or intestinal diseases. A prophylactic check is not necessary, says Dr. Mühlberg. However, anyone who has already had a thrombosis or pulmonary embolism and has risk factors should definitely take part in age-appropriate preventive examinations: “We know that some of the patients who are diagnosed with a thrombosis have a tumor that was not recognized until then.” A blood test from a coagulation specialist can also help identify coagulation disorders.

The expert emphasizes that thrombosis must always be treated using two treatment pillars. On the one hand, with compression therapy, in which pressure is exerted on the leg vessels using bandages or special stockings in order to increase the flow speed of the blood again. The second pillar is the administration of blood thinners, which must be started at the time of diagnosis.

Important to know: Certain blood thinners require specific dietary requirements. According to the vascular specialist, when it comes to the older generation of blood thinners, you have to be careful not to eat too many foods containing vitamin K; for example, types of cabbage weaken the effect of the medication. Newer preparations, on the other hand, should not be taken on an empty stomach, but always with food. Can patients also help themselves? “Absolutely,” says the doctor. “Since being overweight is a major risk factor, you should normalize your weight,” she emphasizes. Last but not least, those affected should make sure they get enough exercise.

Some veins are visible from the outside: spider veins and varicose veins. These “superficial vessels” collect used blood from the tissue. They take it to the “deep veins of the legs.” Supported by the muscles, they pump the blood powerfully upwards. If a thrombus, i.e. a blood clot, forms here and closes the vein, the blood accumulates. If the thrombus breaks loose and enters the bloodstream, it has free travel towards the heart and on to the lungs. Once there, it can impede breathing: there is a danger to life.

MDR (cbr) | First published on June 19, 2023.