How to determine if a pulmonary embolism is acute or chronic?

Written by Yuan Qing
Pulmonology
Updated on October 26, 2024
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Pulmonary embolism can be distinguished between acute and chronic based on the duration of the patient's illness, symptoms, and supplemental examinations. Typically, patients with acute pulmonary embolism have no prior similar symptoms and suddenly experience severe symptoms such as chest pain, difficulty breathing, and coughing up blood. Additionally, through supplemental examinations like blood tests, abdominal ultrasound, and pulmonary artery CT angiography, it is possible to determine whether the thrombus is fresh or old. In contrast, chronic pulmonary embolism often presents with prolonged symptoms. Patients usually do not experience chest pain or cough, and the main issue is chronic breathing difficulty. In severe cases, pulmonary heart disease may occur, and patients may have swelling in the face and limbs. Ultrasound and pulmonary artery CT angiography can reveal the characteristics of the thrombus, which differ from those seen in acute pulmonary embolism. Thus, these examinations can help determine whether the condition is acute or chronic.

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Written by Yuan Qing
Pulmonology
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Why do patients with pulmonary embolism feel sleepy?

Patients with pulmonary embolism primarily suffer from emboli within the venous system, which travel back to the right heart and then become lodged in the pulmonary artery, forming a pulmonary artery thrombus. This reduces pulmonary blood flow and impacts the exchange of air in the lungs, leading to hypoxia in the patient. Following hypoxia, the brain tends to enter a sleepy state, thus many patients with pulmonary embolism exhibit sleepiness. This sleepiness is related to the pathophysiological mechanisms of pulmonary embolism. At this point, it is crucial to provide sufficient oxygen to the patient to address their hypoxemia. Ultimately, the most fundamental treatments are prompt thrombolysis or anticoagulation therapy to resolve the embolus, addressing the condition fundamentally.

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Written by Yuan Qing
Pulmonology
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Why should one lie flat for acute pulmonary embolism?

When acute pulmonary embolism occurs, it is primarily due to a thrombus from the venous system being carried by the venous blood flow back to the right heart, and then due to the ejection from the right heart, this thrombus gets lodged in the pulmonary artery, forming a pulmonary embolism. After the onset of pulmonary embolism, the primary treatment measure is to have the patient lie down and remain still. The reason is mainly that if the patient is standing or moving, it is very likely that the thrombus in the venous system could continue to detach and move within the venous system. This can worsen the symptoms of pulmonary embolism or lead to new embolic sites, so the treatment for the patient involves immobilization and lying down to avoid further movement, making this the most basic approach to treatment.

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Written by Yuan Qing
Pulmonology
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Can a secondary recurrence of pulmonary embolism be treated?

Pulmonary embolism, even if it recurs for the second time, is treatable, but the approach should differ from the first recurrence. It's vital to determine the cause of the pulmonary embolism, although many patients with this condition do not have an identifiable cause. For such patients, long-term oral anticoagulants might be recommended. With long-term use of oral anticoagulants, the likelihood of thrombosis, especially in the venous system, significantly reduces. This means that the chance of recurrence in patients also decreases considerably. However, if the cause can be identified, it is better to address and eliminate it. For instance, if the cause is long-term use of oral contraceptives or the presence of varicose veins, these primary or secondary factors should be resolved. The treatment should not just focus on anticoagulation or thrombolytic therapy, as there could still be a possibility of a future pulmonary embolism recurrence.

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Written by Wei Shi Liang
Intensive Care Unit
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Can a pulmonary embolism be detected by a CT scan?

CT can detect acute pulmonary embolism, using CT angiography, which is the preferred imaging method for diagnosing pulmonary embolisms. It mainly shows central filling defects, as well as eccentric and abdominal wall filling defects, and complete filling defects. A diagnosis of pulmonary embolism can be made through the visualization of these filling defects on a CT scan. Additionally, some indirect signs, such as pulmonary hypertension, right ventricular enlargement, and the common mosaic sign, can also be observed. These are characteristic CT manifestations of acute pulmonary embolism.

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Written by Li Qiang
Intensive Care Unit
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Why does pulmonary embolism cause cardiac arrest?

The mechanisms causing cardiac arrest due to acute pulmonary embolism mainly encompass several aspects. One is a large-scale acute extensive pulmonary embolism, which prevents the blood from being ejected from the right heart, potentially leading to acute right heart failure. At this time, the entire body's blood circulation will encounter issues. Another scenario is that following the pulmonary embolism, it causes severe hypoxia. This hypoxia can lead to oxygen deficiency in all organs of the body, including the heart. The coronary arteries that supply nutrients to the heart can also become ischemic. Both of these factors can cause the heartbeat to lead to sudden cardiac arrest. These are the primary mechanisms that can cause a sudden stop in the heartbeat.