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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What are the symptoms when pulmonary embolism becomes severe?

Pulmonary embolism can vary in severity, with serious cases primarily causing unstable vital signs. The disease primarily arises from venous thrombi in the venous system, which travel with the venous blood back to the right heart, and then with the blood flow from the right heart back to the aorta. If the thrombus is relatively large, it can easily become lodged in the pulmonary artery, forming a pulmonary embolism. The symptoms of pulmonary embolism can range from mild to severe. Based on the patient's symptoms and vital signs, pulmonary embolism is categorized into low risk, intermediate risk, and high risk. Low and intermediate risk typically indicate that the patient's vital signs are relatively stable, with normal blood pressure, heart rate, and pulse oximetry saturation. In severe cases, patients may exhibit noticeable symptoms such as coughing up blood, difficulty breathing, low blood pressure, shock, and oliguria. These represent the more severe cases of pulmonary embolism.

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Written by Yuan Qing
Pulmonology
1min 10sec home-news-image

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

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 Li Qiang
Intensive Care Unit
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Can pulmonary embolism result in a vegetative state?

After a pulmonary embolism, if it is an acute and extensive embolism and not treated promptly, it can lead to severe hypoxemia. If hypoxemia is not addressed quickly and persists, it will affect the oxygen supply to vital organs throughout the body, including the brain. The brain is the organ most vulnerable to oxygen deprivation. If there is complete lack of oxygen for just four minutes, irreversible damage occurs to the cerebral cortex, and the patient will not wake up, leading to a vegetative state. Therefore, in cases of acute extensive pulmonary embolism, if treatment is delayed, there is a significant risk of the patient entering a vegetative state, and the mortality rate is also very high. Many patients may experience sudden death.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Pulmonary embolism should be treated in the department of respiratory medicine or cardiology.

Pulmonary embolism is a pathological process in which a blood clot in the vessels detaches, affecting the pulmonary artery and its branches. After the occurrence of a pulmonary embolism, patients generally visit the respiratory medicine department. Clinically, a pulmonary artery CTA can be performed to further confirm the diagnosis. The treatment methods in clinical practice are mainly as follows: If the patient experiences circulatory disturbances, emergency thrombolytic therapy may be considered; if the patient's circulation is stable, treatment with low molecular weight heparin and warfarin anticoagulation can be considered. Of course, it is important to monitor the patient's respiration and blood pressure.

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Written by Wang Li Bing
Intensive Care Medicine Department
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What are the precursors of pulmonary embolism?

Pulmonary embolism is also relatively common in clinical practice. Its precursors may include varying degrees of respiratory difficulty, chest tightness, and shortness of breath, among others. If such symptoms occur, medical attention should be sought promptly, primarily to rule out the possibility of acute myocardial infarction. Pulmonary artery CTA can further confirm whether there is a pulmonary embolism. In cases of extensive pulmonary embolism, there is a high risk of sudden death, and aggressive thrombolytic and anticoagulation treatments should be administered. If the patient's chest tightness and shortness of breath are relieved after the aforementioned treatments, hospitalization for observation and treatment is still necessary.