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How To Treat A Pulmonary Embolism
A pulmonary embolism (PE) occurs when a blood clot (embolus) enters a pulmonary artery (blood vessel) in the lungs and blocks normal blood flow. In most cases, the blood clot originates in a deep vein in the leg (known as deep vein thrombosis) and breaks free, traveling through the bloodstream and to the lungs.
When a pulmonary embolism blocks blood flow to the lungs, your body's oxygen level can drop to dangerously low levels. Without prompt treatment, PE can cause organ damage or death. Treatment may involve blood thinning or clot-busting medications depending on the severity and size of the PE. If medications are ineffective, surgery may be necessary to remove life-threatening clots.
Most people with PE require hospitalization and will receive initial treatments in the intensive care unit. A team of healthcare providers—including pulmonologists (doctors who specialize in diseases affecting the lungs), vascular surgeons (doctors who specialize in treating blood vessel conditions), and hematologists (doctors who specialize in treating blood disorders)—treat people with pulmonary embolism.
Most people with PE will receive initial treatments in the hospital until the clot clears. Your healthcare team will work together to assess your condition, determine the most appropriate treatment plan, and monitor your recovery.
Medications are the first-line treatments for a pulmonary embolism. Depending on your symptoms and the size of your blood clot, healthcare providers may use blood thinners, clot-busting medications, or both. Anticoagulants Anticoagulant therapy is the primary treatment for a pulmonary embolism. Anticoagulant drugs (blood thinners) prevent the blood clot from getting bigger and stop new clots from forming. These medications do not dissolve the clot but prevent it from getting bigger, while your body dissolves the clot over time. You will receive anticoagulant drugs, such as Heparin (Heparin) or Lovenox (enoxaparin), in the hospital through intravenous (IV) infusion or injection. Once you leave the hospital, you will take oral blood thinners by mouth for at least three months. Some people take blood thinners indefinitely to prevent new clots from forming. Common oral blood thinner pills include Coumadin (warfarin), Jantoven (warfarin), Xarelto (rivaroxaban), and Pradaxa (dabigatran). Thrombolytics Clot-busting medications, known as thrombolytics, help break up and dissolve large blood clots. These medications work by activating enzymes that break down fibrins (proteins) that form blood clots. Thrombolytics are given intravenously for people with severe blood clot symptoms and a high risk of complications. They work quickly to restore normal blood flow to the lungs. The most common clot-busting drugs include Activase (alteplase), Streptase (streptokinase), and Kinlytic (urokinase). Surgery and other specialist procedures are sometimes necessary when medication is ineffective or for people with large, life-threatening blood clots. These procedures mechanically remove or dissolve the clot or use catheters to deliver clot-busting medications directly to the blood clot. Catheter-Directed Embolectomy Catheter-directed embolectomy, or thrombolectomy, uses a thin, flexible tube (catheter) to reach the affected pulmonary artery and dissolve or break up the blood clot. During this procedure, your healthcare provider will make a small cut in your groin or neck and guide the catheter to the blood clot. Your provider can also insert a tool in the tube to manually break up the blood clot, suction it, or deliver clot-busting medications directly. Surgical Embolectomy This procedure is usually only performed in life-threatening scenarios, when a massive PE causes serious symptoms, such as dangerously low blood pressure or septic shock. It is an invasive procedure that comes with the same risks as open-heart surgery. During the surgery, a surgeon makes an incision (cut) in the chest to access the affected pulmonary artery. The surgeon then carefully removes the clot from the artery using specialized surgical tools. Vena Cava Filter A vena cava filter (IVC filter) is a small, metal device placed in the inferior vena cava—the large vein in the abdomen that carries blood from the lower body to the heart. The filter traps blood clots that travel from the lower body and prevents them from reaching the lungs, where they can cause a pulmonary embolism (PE). People who are not good candidates for blood thinners (anticoagulants) may get an IVC to prevent future PE. Pulmonary embolism can be life-threatening. Unfortunately, about 12% of people die from PE. With prompt diagnosis and treatment, most people with pulmonary embolism recover. People who have had a PE are at an increased risk of having another PE in the future. Generally, about one-third of all cases will have a recurrence (another PE) within ten years. Adhering to your treatment plan and taking your medications as prescribed, such as anticoagulants, is the best way to prevent recurrent PE. Practicing healthy lifestyle choices, like eating a heart-healthy diet, exercising regularly, and quitting smoking, can also reduce the risk or prevent blood clots from occurring. Pulmonary embolism (PE) is a serious, potentially life-threatening condition that occurs when a blood clot blocks a major artery in your lungs. Anticoagulant (blood-thinning) medications are the first-line treatment for PE. Clot-busting medications and specialist procedures may be necessary for large PE or for clots causing severe symptoms. With prompt medical attention and treatment, most people experiencing PE recover. The risk of recurrence is high, but following your treatment plan and making healthy lifestyle choices can help prevent future blood clots in the lungs.Endovascular Catheter Opens Blocked Arteries Deep Within Lungs
The BASHIR™ Endovascular Catheter (THROMBOLEX, Inc.), recently approved by the U.S. Food and Drug Administration (FDA), is paving the way to more effective and safe treatment for acute pulmonary embolism. Already shown to be effective for reducing blockages in lung arteries, new research at the Lewis Katz School of Medicine at Temple University shows that the BASHIR™ catheter also reduces blockages in the smaller segmental pulmonary artery branches. These branches are ultimately responsible for oxygenating the blood in the lungs.
The new study, which was part of the National Institutes of Health-sponsored multicenter RESCUE clinical trial, further showed a correlation between decreased numbers of blockages in the small lung arteries and functional recovery of the right ventricle of the heart, which pumps blood into the main pulmonary artery of the lungs. Compared to other devices, the BASHIR™ catheter also had significantly lower bleeding rates, a key advance in acute pulmonary embolism treatment. The findings are described in JACC: Advances.
"Blockages in these smaller, distal pulmonary arteries have never previously been explored in patients treated for acute pulmonary embolism," explained Riyaz Bashir, MD, FACC, Professor of Medicine, Director of Vascular and Endovascular Medicine in the Section of Cardiology, Department of Medicine at the Lewis Katz School of Medicine and Temple University Hospital, co-inventor of the BASHIR™ Endovascular Catheter, and first author on the new report.
The BASHIR™ catheter is a small tube-like device that consists of a helical basket with six mini-infusion catheters at its farthest end. When the infusion basket is expanded within a clot in a large blood vessel, new channels open, enabling blood to flow through the clot. Blood that flows through carries the body's clot-dissolving chemicals into the channels, accelerating clot breakdown. Researchers at THROMBOLEX™ Inc. Were involved in developing and commercializing this platform technology.
The occlusion of small lung arteries is the major reason for the reduction in blood flow in patients with acute pulmonary embolism. "The more occlusions a patient has, the lower their survival," Dr. Bashir said. "Among the treatment goals is relieving obstructions in both large and small arteries."
Patients who survive may, over more extended periods, be at high risk of developing chronic thromboembolic pulmonary hypertension (CTEPH), which is a life-threatening condition caused by increased blood pressure in the lungs.
In the new study, Dr. Bashir and colleagues observed reductions in occlusions in segmental and proximal branches of the pulmonary artery 48 hours following treatment with the BASHIR™ catheter. The blockages decreased even in those arteries that were distant from where the infusion basket was located, enabling improved blood flow and healing of the right ventricle.
"We suspect that the improvements in blood flow are due to both the expansion of the basket and the flow of the body's clot dissolving molecules into the clot, which cause the blockage to shrink," Dr. Bashir said. "As the volume of blood flow improved, right ventricular function also improved, which could translate to better survival."
In future work, Dr. Bashir and colleagues plan to investigate mechanisms behind the observed reductions in arterial blockage. More extensive trials are also needed to understand better the impact of treatment with the BASHIR™ catheter on patient survival and incidence of CTEPH.
Other researchers who contributed to the new study were Gregory Piazza, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Brian Firth, Thrombolex Inc, New Britain, Pennsylvania; Kenneth Ouriel, NAMSA (SYNTACTX), New York; Akhilesh Sista, Division of Interventional Radiology, Department of Radiology, Cornell University School of Medicine, New York; Parth Rali, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University; Anthony Comerota, Inova Heart and Vascular Institute, Inova Alexandria Hospital, Alexandria, Virginia; Vladimir Lakhter, Division of Cardiovascular Diseases, Lewis Katz School of Medicine, Temple University; Ayman Iskander, Division of Cardiology, St Joseph's Hospital, Syracuse; Malcolm Foster, Department of Cardiology, East Tennessee Heart, Turkey Creek, Knoxville; Ripal Gandhi, Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida; Amir Darki, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois; Robert Lookstein, Department of Radiology, Mount Sinai Hospital, New York; and Kenneth Rosenfield, Department of Cardiology, Massachusetts General Hospital, Boston.
Dr. Bashir is a co-founder and has an equity interest in Thrombolex, Inc., a medical device company developing interventional catheter-based therapies for the rapid and effective treatment of acute venous thromboembolic disorders. Temple University also holds financial interests in the BASHIR™ Endovascular Catheter and other Thrombolex products pursuant to the license granted to Thrombolex for the University's interest in patents co-invented by Dr. Riyaz Bashir. As a result of these interests, Temple University could ultimately potentially benefit financially from the outcome of this research. These interests have been reviewed and approved by Temple University in accordance with its Institutional Conflict of Interest policy.
What Can Cause Back Pain While Breathing?
If back pain occurs when a person breathes, it can signal an underlying medical condition. Possible causes range from improper spinal curvature to lung cancer.
Back pain while breathing can also indicate a medical emergency, such as a heart attack or pulmonary embolism, particularly if the person is also experiencing shortness of breath or chest pain.
This article investigates some possible causes of back pain while breathing and describes when to see a doctor.
Scoliosis is a sideways curvature of the spine. Although it can affect people of any age, it typically occurs in preteens or young teenagers.
In some people, the spine can become so curved that it places extra pressure on the lungs, making breathing painful.
Symptoms of scoliosis can include:
Treatment optionsDoctors will consider many factors when deciding on treatment options, such as a person's sex, the severity of the curve, curve position, and bone maturity. For example, a doctor may recommend observation for less severe curvature in younger individuals and suggest physical therapy for adults. For people with mild-to-moderate curvature, a doctor may recommend wearing a back brace. Individuals with more severe scoliosis may require spinal fusion surgery to straighten their spine.
In some cases, back pain while breathing can be a symptom of a heart attack. This is life threatening and requires immediate medical assistance.
A heart attack can occur if the blood flow to the heart's muscles suddenly becomes blocked, by a blood clot, for example.
Symptoms of a heart attack can include:
People with symptoms of a heart attack should contact or visit emergency services immediately.
Treatment optionsTreatment depends on the type and severity of the heart attack. Typically, treatments involve techniques to restore blood flow to part of the heart muscle damaged during a heart attack. When a heart attack is severe, the doctor may pass a type of catheter through the person's groin or wrist to open the blocked artery.
Carrying excess weight can place extra pressure on a person's back, joints, and other parts of the body. Some people with obesity can have breathing problems and find it uncomfortable or even painful to take full, deep breaths.
Treatment optionsLosing weight — for example, through a calorie-restricted diet and regular exercise — may help alleviate back and joint pain. People who are having difficulty maintaining a healthy weight may wish to speak to a doctor about possible hormonal causes, such as low thyroid function.
According to the American Cancer Society, lung cancer often does not cause symptoms in the early stages. However, a common sign of lung cancer is chest pain that usually worsens during deep breathing or coughing.
If the cancer spreads to other organs, it may cause bone pain in a person's back or hips. A lung tumor can also press on nerves in the spine, affecting a person's breathing and causing back pain.
Other symptoms of lung cancer can include:
Treatment optionsTreatment for lung cancer depends on several factors, including:
Treatment options can include surgery, radiation therapy, and chemotherapy.
Kyphosis is a condition that causes a person's spine to curve forward, which can lead to a hunched posture.
This curvature can develop during adolescence, following a spinal injury, or result from aging.
Kyphosis can also cause back pain, swelling, and balance issues. Symptoms may get worse over time, which can lead to difficulty breathing or eating in some people.
Treatment optionsTreatment for kyphosis can involve attending physical therapy, wearing a brace, and taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. For severe kyphosis, a doctor may recommend surgical treatment, such as a spinal fusion.
A pulmonary embolism occurs when a blood clot develops in an artery that supplies blood to the lungs. This can block the flow of blood, which can be life threatening.
A person with a pulmonary embolism often experiences pain while taking a deep breath and pain in the upper back.
Other symptoms can include:
A pulmonary embolism is a medical emergency, and people with these symptoms should seek immediate assistance.
Treatment optionsTreatment options involve keeping the blood clot from growing and preventing the formation of new clots. Options typically include anticoagulant medications to break down the blood clot and a surgical procedure to remove or bypass the clot.
Pneumonia is an infection that causes the tiny air sacs in the lungs to fill with fluid. It can occur in one or both lungs.
Symptoms of pneumonia vary in severity, but people may experience chest, abdominal, or back pain when breathing or coughing.
Other symptoms of pneumonia can include:
Treatment optionsTreatment options will depend on the type of pneumonia a person has. When bacteria are responsible for the infection, a doctor may prescribe antibiotics. When a virus is responsible, supportive treatments are available. Severe pneumonia may require hospitalization.
Intercostal neuralgia is a condition that causes neuropathic pain in the area corresponding to the intercostal nerves (rib, chest, upper abdominal wall). This pain may be constant or intermittent and can be exacerbated by breathing.
Causes of this condition include certain surgical procedures, such as a thoracotomy, shingles, traumatic injury, and pregnancy.
Symptoms are as follows:
Treatment options for intercostal neuralgia depend on the underlying cause. Medication like opioids, anticonvulsants, or nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed for pain control. Other options include transcutaneous electrical nerve stimulation (TENS) and certain antidepressants.
People with severe, persistent, or worsening back pain should visit a doctor. This is particularly important when the pain occurs alongside tingling or numbness in the hands and feet.
Seek immediate medical assistance for back or chest pain that accompanies:
Below are some commonly asked questions about back pain when breathing.
What causes a sharp pain when breathing deeply?If a person has pain when they take a deep breath, it could be due to infection, inflammation, or spinal curvature. In more serious cases, it can point to a heart attack, pneumonia, or lung cancer.
Can lung pain be felt in the back?Severe cases of a collapsed lung can cause back pain. Similarly, lung cancer that has spread can also cause pain in the back.
How does a person know if back pain is lung related?Lung tumors can sometimes put pressure on the spine, leading to back pain. People should consider their other symptoms and speak with a doctor to understand if back pain is due to lung cancer or another cause.
Back pain while breathing may be a sign of a serious underlying condition or even a medical emergency, so it is important not to ignore the symptom.
People with severe, persistent, or worsening back pain should visit a doctor. Anyone with symptoms that could indicate a heart attack or pulmonary embolism should receive emergency medical attention.
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