UPMC Tower - Pittsburgh Skyline for the UPMC Breathing Breakthroughs blog series with Team PHenomenal Hope. Photo credit: UPMC

UPMC Breathing Breakthroughs

March 17,2015

Taking on Pulmonary Embolism, a risk factor for developing pulmonary hypertension

Pulmonary embolism (PE) is a serious health problem. It’s a blood clot that travels to the lung, often having started as a blood clot in the legs, known as a deep venous thrombosis (DVT). According to the Centers for Disease Control, approximately 300,000 to 600,000 Americans will have a DVT or PE each year, and 60,000 to 100,000 will die from it. As many as 3 of every 10 of those affected will have another blood clot in the next decade, and at least half of the survivors have chronic issues from their blood clot.

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How do you know if you have a PE or DVT?

PE can present in a variety of ways, though usually a person with PE experiences suddenly new or increased shortness of breath, which can be mild or severe. Other symptoms include chest pain, fast heart rate, dizziness. In the case of DVT, a patient may have leg pain or one leg that swells more than the other, or they may have no symptoms at all.

What are risk factors for these conditions?

There are many risk factors for PE and DVT, including personal or family history of blood clots, increased estrogen (through oral contraceptive pills, postmenopausal hormonal replacement therapy, or due to pregnancy), injury to a vein in the legs through an accident, decreased blood flow from sitting continuously, having an IV catheter in a large vein, and chronic medical conditions such as heart disease, lung disease, cancer.

What to do if you suspect a blood clot?

DVT/PE is a life-threatening condition, and if you suspect a blood clot you should seek immediate medical attention.

DVT/PE can be treated in a variety of ways, and that treatment course depends on the severity of the disease. In most cases, patients are put on blood thinners immediately. In severe cases, a clot busting medication might be used. In some cases where the PE is large and the patient has evidence of heart strain, the clot busting medication might be used, and sometimes a catheter with an ultrasound on the tip is used to deliver the medicine right to the area of the clot.

When treatment goes well, the DVT/PE goes away and the patient goes on to live a normal life. However, in many cases, there can be long-term issues after a blood clot. The most common chronic problem is post-thrombotic syndrome, where people have issues with pain or swelling due damage to the leg vein from the blood clot.

In cases where patients have a PE, they may not have complete resolution of the clot and it can lead to chronic thromboembolic pulmonary hypertension (CTEPH). This happens in approximately 0.5-1.5% of patients, and was found to be as common as in 3.8% of patients within 2 years after PE., according to researchers Pengo and colleagues published in the New England Journal of Medicine in 2004.

At UPMC, we have developed an acute PE team to help make time-critical decisions in the treatment of acute PE, offer the latest therapies to help improve survival and work to reduce chronic problems, and follow patients to make sure that the blood clot resolves 100 percent. In cases where patients develop chronic issues such as CTEPH, we have medical and surgical experts to offer life-saving surgical and medical treatments of this disease.

Our PE team, organized by Dr. Belinda Rivera-Lebron, brings together lung doctors, heart doctors, vascular surgeons, cardiothoracic surgeons and more in the comprehensive treatment of this disease. One of those doctors is also Team PHenomenal Hope member Patricia George, who is using her passion for raising awareness about pulmonary hypertension (PH) to help to educate and raise awareness about CTEPH, a potentially preventable and/or curable form of PH. Together, these doctors are hosting a Spring Lung Conference on March 20, featuring members of the PE team and discussing the latest treatments and issues in management of acute and chronic PE. The conference, for health care providers of all specialties who deal with PE, offers free continuing medical education credits and takes place from noon to 4:15 p.m. in LHAS Auditorium at UPMC Montefiore. More information at http://upmc.com/PEConference.

For more information about these conditions we treat, please go to:

Acute PE (http://www.upmc.com/services/pulmonary-hypertension/conditions/pages/acute-pulmonary-embolism.aspx)

CTEPH (http://www.upmc.com/Services/pulmonary-hypertension/conditions/Pages/cteph.aspx)

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