“Chest pain” is actually pulmonary embolism

Author: Li Tao Wuxi Second Geriatric Hospital

Reviewer: Xu Hongyang, Chief Physician, Wuxi People's Hospital Affiliated to Nanjing Medical University

There are many causes of "chest pain". In addition to pulmonary embolism, there are also emergencies such as myocardial infarction, pericarditis, aortic dissection, as well as costochondritis, herpes zoster... In clinical diagnosis and treatment, we often encounter patients with "chest pain" caused by these diseases, which need to be identified.

A 70-year-old female patient suffered multiple injuries all over her body, including broken ribs and limbs due to a car accident. An orthopedic doctor performed surgery on her and she was admitted to the intensive care unit (ICU). She recovered well after the surgery and was discharged from the hospital one month later.

After returning home, the patient spent most of his time lying in bed resting, fearing that carelessness would affect the healing of the fracture. Unfortunately, one week after returning home, the patient had a quarrel with his family over some things. That day, he got out of bed to go to the bathroom to defecate, and suddenly screamed, covered his chest with his hands, curled up into a ball, sweating profusely, having difficulty breathing, and looking pale. He soon fell to the ground and did not respond no matter how he was called. In a panic, the patient's family dialed "120" to call an ambulance. The doctor immediately rescued him at the scene and then sent him to the hospital, but he was ultimately unable to be rescued. According to the bedside ultrasound assessment of the patient's cause of death, pulmonary embolism was considered.

What on earth was going on? He was resting well at home, so how could he have a pulmonary embolism?

1. What is pulmonary embolism?

Pulmonary embolism refers to a group of sudden diseases in which the large blood vessels of the lungs or their branches are blocked by various emboli. Most (more than 95%) are emergencies caused by the loosening, detachment and migration of venous thrombi in the lower limbs to the blood vessels of the lungs after activities. The most common obstruction is from the venous system or right heart thrombi. In a few cases, pulmonary embolism may be caused by other substances, such as tumor emboli, air, fat, amniotic fluid, etc.

Figure 1 Copyright image, no permission to reprint

To put it bluntly, pulmonary embolism is when something gets into the lungs and blocks the large blood vessels in the lungs, so the blood in the body cannot flow normally. If you still don’t understand it, it’s like the sewer pipe on the second floor is blocked, which causes a series of troubles…

2. Who is prone to acute pulmonary embolism?

There are three common risk factors (predisposing factors) for acute pulmonary embolism.

1. Various factors that cause blood flow to slow down

(1) Lying in bed for a long time and unable to turn over due to illness, or rarely turning over or getting out of bed to move around.

(2) Sitting for long periods of time and traveling for long periods of time, also known as "economy class syndrome."

(3) Paralysis of the lower limbs, long-term illness, paralysis in bed, muscle atrophy, and slow blood flow.

(4) A huge tumor or an enlarged uterus during late pregnancy compresses the iliac vein or inferior vena cava.

(5) Patients who have undergone major surgery, including fracture, abdominal or brain surgery and are bedridden for a long time.

Lying still for a long time can cause blood flow to slow down, further leading to blood clot formation. Once a patient suddenly moves after being bedridden for a long time, or under emotional stimulation, it is easy for blood clots in the blood vessels to fall off, eventually leading to pulmonary embolism.

The female patient mentioned above did not pay attention to these risk factors after returning home, and coupled with the emotional stimulation of being angry with her family, she eventually collapsed.

2. Various factors causing abnormal coagulation

(1) Obesity or advanced age of the patient.

(2) Various diseases with abnormal coagulation function, such as leukemia, myeloma hyperviscosity syndrome, etc.

(3) Immune-related diseases, such as increased rheumatoid factor in rheumatoid arthritis leading to embolism.

(4) Various cancers and their treatment. Studies have shown that tumors can destroy normal vascular structures and produce a substance called coagulant that causes blood to coagulate. Tumors themselves also release some substances, such as platelet-activating factor and prothrombin activator, that promote thrombosis. In addition, tumor emboli may also cause pulmonary embolism. In addition, cancer treatment drugs sometimes promote blood coagulation and thrombosis, increasing the possibility of inducing pulmonary embolism.

(5) Nephrotic syndrome, inflammatory bowel disease, etc.

(6) Hormone therapy or taking birth control pills.

3. Factors causing damage to blood vessel walls

(1) Smoking, hypertension, hyperlipidemia, and diabetes.

(2) Trauma such as severe burns, severe infection, and hip fracture can cause damage to blood vessels.

(3) Recent surgical history.

(4) Central venous catheter.

3. What are the clinical manifestations of pulmonary embolism?

If the risk factors (inducing factors) mentioned above exist, and there is a sudden onset of unexplained collapse, pale complexion, cold sweats, difficulty breathing, chest pain, or even syncope, hemoptysis and other symptoms, the diagnosis of pulmonary embolism should be considered first.

In addition, patients with pulmonary embolism may also experience symptoms of cerebral hypoxia, such as extreme anxiety, fear, nausea, convulsions and coma, or acute pain, such as chest pain, shoulder pain, neck pain, precordial pain and upper abdominal pain.

In other words, the symptoms of pulmonary embolism are never fixed. Due to the size of the embolus and the location of the blockage, each person may experience different symptoms. If a patient who has been bedridden for a long time experiences the above symptoms, please seek medical attention immediately to avoid delaying the best time for treatment.

4. How to prevent acute pulmonary embolism?

As ordinary people, it is difficult to make a clear judgment in a short time because we do not have professional medical knowledge. Therefore, the best way is to prevent the occurrence of pulmonary embolism according to risk factors. In daily life, we should pay attention to maintaining good living and eating habits: first of all, do not smoke or drink. Secondly, eat a healthy diet. Finally, exercise properly. Patients who are bedridden or have undergone surgery should pay attention to proper physical activities.

Figure 2 Copyright image, no permission to reprint

For example, bedridden patients or patients who have just undergone surgery should pay attention to limb movement, and doctors generally inform their families before the patient is discharged. If a long-term bedridden patient suddenly shows signs of suspected acute pulmonary embolism, family members should remain calm and not move the patient at will. If the patient is judged to have no breathing or heartbeat (grasp the golden four minutes), immediately perform cardiopulmonary resuscitation (this is a necessary nursing skill for family members, and must be mastered in advance. It is recommended to search for "cardiopulmonary resuscitation" videos online and learn in advance in case of emergency), and at the same time call "120" to escort the patient to the nearest hospital emergency center for treatment to maximize the patient's life.