• Deaths from Pulmonary Embolism are the leading form of accidental death for hospitalized patients, and the second most common cause of unexpected death in the general population.
• Over 200,000 deaths will occur in the U.S. this year as a result of Pulmonary Embolisms.
• The most common cause of Pulmonary Embolisms are Deep Vein Thrombosis (DVT).
• Approximately one in twenty people develop DVT during their lifetime.
• Approximately 60,000 hospitalizations for DVT will occur in the U.S. this year.

A Pulmonary embolism occurs when there is a blockage of the blood vessels in the lungs. Although a pulmonary embolism can be caused by air bubbles, fat droplets, amniotic fluid, or even clumps of parasites or tumor cells that obstruct the pulmonary vessels, they most often result from Deep Vein Thrombosis (DVT) - blood clots (thrombus) from the veins, especially veins in the legs or in the pelvis (hips). If the thrombus, or a piece, breaks free it can be carried through the vessels and the heart until it gets to a point where the vessel is too narrow, usually in the pulmonary artery or one of its branches. The clot (called an embolus once it breaks free) can then completely block the vessel and prevent blood from moving past it to the lung (called a pulmonary embolism). Thus, while the affected section of lung continues to be ventilated (supplied with air), it is not perfused (supplied with blood). This leads to acute respiratory distress and heart failure or cardiogenic shock, resulting in death or serious damage to the lungs.

When smaller clots lodge in a branch of the pulmonary artery, there may be few symptoms other than increased heart rate or shortness of breath. However, repeated episodes of smaller Pulmonary Embolism over time, can cause pulmonary hypertension, right heart failure, and death.

Risk Factors of Pulmonary Embolism

Risk factors for pulmonary embolisms include the following:

• Prolonged bed rest or inactivity (including long trips in planes, cars, or trains);
• Oral contraceptive use;
• Surgery (especially pelvic surgery);
• Childbirth;
• Massive trauma;
• Burns;
• Stroke ;
• Heart attack;
• Heart surgery; and
• Fractures of the hips or femur.

Warning Signs and Symptoms of DVT and Pulmonary Embolism

The most common symptoms of lower extremity DVT are swelling and pain. The skin may become discolored and the patient may also have a low-grade fever. If those symptoms are present in a patient who has been bed-ridden or convalescing from surgery, or who has been non-ambulatory for some other reason, or who has other substantial risk factors for DVT, then the patient's physician should consider and rule out a diagnosis of DVT.

The symptoms of a Pulmonary Embolism in many cases include one or more of the following:

• chest pain
  • under the breastbone or on one side;
  • especially sharp or stabbing; also may be burning, aching or dull, heavy sensation;
  • may be worsened by breathing deeply, coughing, eating, bending, or stooping;
• acute onset of shortness of breath at rest or with exertion;
• lightheadedness;
• fainting or dizziness;
• tachypnea (rapid breathing);
• tachycardia (rapid heart rate)
• cough
  • with sudden onset or
  • producing bloody sputum;
• sweating and
• anxiety.

Other possible symptoms include: wheezing, clammy skin, bluish skin discoloration, nasal flaring, pelvic pain, leg pain in one or both legs, swelling in the legs, a lump associated with a vein near the surface of the body (superficial vein) that may be painful, low blood pressure, anxiety.

Diagnosing DVT and Pulmonary Embolism

Diagnostic testing for DVT includes a through physical exam (including testing for "Homan's sign" - pain in the calf muscles upon forced dorsiflexion of the foot with the knee straight), and a Doppler ultrasound, in which sound waves are used to estimate blood flow through the veins so as to determine whether a clot may be partially or completely occluding a segment of the vein. A venogram involves injection of dye that can be seen on x-ray. An MRI can also disclose the existence of DVT, although its use is not yet widespread for that purpose.

Because symptoms of a Pulmonary Embolism are non-specific, specific diagnostic tests are necessary to rule out a Pulmonary Embolism. The three most common tests are a pulmonary angiography, a nuclear lung scan (VQ scan), and a spiral CT scan (which involves injecting iodines dye into a vein while the patient is scanned in a spiral CT scanner).

Treating DVT and Pulmonary Embolism

Treatment of DVT involves the use of anticoagulant medications, such as heparin and Coumadin, to prevent extension or propagation of the clots, and to avoid pulmonary embolism. Coumadin is generally administered for six months. In cases where a patient has a coagulation disorder, Coumadin may be given on a life-long basis in order to avoid recurrence.

Once the patient suffers a Pulmonary Embolism, emergency treatment and hospitalization are necessary. In cases of severe, life-threatening pulmonary embolism, treatment requires that the clot be dissolved with thrombolytic therapy. Thrombolytic therapy (clot-dissolving medication) includes streptokinase, urokinase, or t-PA. Anticoagulant therapy prevents the formation of more clots and allows the body to re-absorb the existing clots faster. Anticoagulation therapy (clot-preventing medication) consists of heparin by intravenous infusion initially, then oral warfarin (Coumadin). Subcutaneous low-molecular weight heparin is often substituted for intravenous heparin in many circumstances. In patients who cannot tolerate anticoagulation therapy, an inferior vena cava filter (IVC or Greenfield filter) may be placed to trap clots that break off from DVT. This device, placed in the main central vein in the abdomen, is designed to block large clots from traveling into the pulmonary vessels. Oxygen therapy may be required to maintain normal oxygen concentrations. To prevent recurrent DVT that could lead to a Pulmonary Embolism, a physician may also recommend that the patient use graded elastic stockings. Surgery may be indicated in patients at great risk for recurrent embolism.

Prophylactic therapies may also be used in patients who undergo surgery and have risk factors for DVT. Because prophylactic medications such as heparin or Coumadin, involve an increased risk of bleeding, they and may not be appropriate for some surgery patients. Other measures, such as the use of pneumatic compression stockings, may thus be used during surgery and the post-operative periods, in place of, or in addition to medications. Leg and calf muscle exercises and graduated compression stockings (TED hose) can also used.

Prognosis Without Treatment

Without effective treatment, the rate of recurrence of DVT and Pulmonary Embolism may be as high as 50%, and Pulmonary Embolism mortality may reach 30%. The risk of death increases with each recurrent episode of Pulmonary Embolism. With timely diagnosis and treatment, the rate of recurrence and mortality is significantly reduced.

Medical Malpractice

Any undue delay in diagnosing or treating DVT or Pulmonary Embolism can have tragic consequences. Unfortunately, too often warning signs are ignored, and treatment is delayed. The following are among the more common forms of negligence or medical malpractice by physicians and other health care providers in diagnosing and/or treating patients with DVT or a Pulmonary Embolism:

• Failing to test for DVT or Pulmonary Embolism in the presence of warning signs or symptoms
• Delaying the diagnosis of DVT or Pulmonary Embolism
• Failing to order appropriate treatment for a patient with DVT or Pulmonary Embolism
• Failing to follow-up with the patient

If someone you know has died or suffered significant injury to the heart or lungs due to complications of DVT or Pulmonary Embolism as a result of the neglect of a physician or other health care provider, you should immediately contact a competent attorney. The attorney will work with you to determine legal options that may be available.