The American Heart Association (AHA) and the American College of Cardiology (ACC) have recently released the first guideline for acute pulmonary embolism, a condition in which a blood clot blocks the arteries in the lungs.
"The first clinical practice guideline on acute pulmonary embolism (PE) from the American Heart Association and the American College of Cardiology introduces a new Acute Pulmonary Embolism Clinical Category system to define the severity of an acute pulmonary embolism and assist in developing a treatment strategy for adults with this condition. The guideline details risk factors for acute PE, such as recent surgery or hospitalization, trauma, prolonged immobility, pregnancy, obesity, cancer and blood clotting disorders, among others," the AHA/ ACC say in the guideline.
Why is pulmonary embolism dangerous?
Approximately 1 in 5 high-risk patients die in this, as per the data shared by the AHA.
In India, pulmonary embolism holds the second position in terms of mortality rates, trailing closely behind myocardial infarction (MI), a study says. Another autopsy study conducted at a tertiary care center in northern India identified this as the primary cause of mortality in 16% of hospitalized patients.
That headache you just Googled might be nothing or something serious: Why you should stop self-diagnosing and talk to a doctor"When a clot of blood in your leg vein travels to the lungs and causes blockage of a pipe going to the lung (pulmonary artery) this is called a pulmonary embolism (PE). PE causes blood flow to be reduced and therefore, there is less oxygen in the blood. The pressure on the heart will increase. PE can develop very quickly and can be fatal. If PE is not treated quickly it could lead to collapse or death," Dr. Ranjan Modi, Senior Consultant-Interventional Cardiology, Medanta Hospital Noida told TOI Health.
In the new guideline, the AHA/ACC has classified acute PE into 5 clinical categories: Patients in Categories A and B have no or mild symptoms and low risk of experiencing severe complications; they often can be safely discharged from the emergency department. Categories C-E include people with symptoms of acute PE who are at higher risk of adverse outcomes and require hospitalization.
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How to identify it?
Dr. Modi says, pulmonary embolism symptoms may be very hard to detect and can easily be confused with conditions such as acid reflux, panic attacks and/or infections of the lungs.
"Commonly reported symptoms of PE are sudden onset of difficulty breathing, mild to moderate pain in the chest area that gets worse when taking a breath, increased heart rate, coughing which may contain blood, and swelling or discomfort in the legs," the doctor adds. "Many individuals fail to seek medical help for mild symptoms therefore PE underdiagnosis is common so it is very important to highly suspect PE and get medical attention as soon as possible."
The risk factors
The AHA/ACC recommends clinicians to assess patients for the following risk factors:
- Major surgery or trauma
- Hospitalization
- Prolonged immobility (such as bed rest or long travel)
- Pregnancy and postpartum (within 6 weeks after delivery)
- Use of oral contraceptives or estrogen treatment
- Obesity (defined by BMI ≥ 30)
- Smoking
- Atherosclerotic cardiovascular disease
- Cancer
- Thrombophilias (blood clotting disorders)
- Age (risk increases after age 40
Follow-ups and clinic visits
The AHA stresses on follow-up communication and clinic visits. First, you’ll need a quick "safety check" within a week of leaving the hospital. This is just to make sure your medications are sitting well with you, there’s no unexpected bleeding, and you’re clear on the game plan. By the three-month mark, you’ll sit down for a more strategic talk. This is the "big picture" visit where you and your doctor decide how much longer you need to stay on blood thinners and if any extra testing is required to see how you're healing.
For at least a year after your diagnosis, every check-up should include a quick screen for long-term complications like CTEPD. This happens when old clots don’t fully dissolve, blocking lung arteries and causing lingering shortness of breath or fatigue. If you end up staying on anticoagulants long-term, your medical team will periodically weigh the pros and cons to ensure the protection they provide still outweighs any risks. It’s all about staying proactive so a temporary hurdle doesn't become a long-term setback.
Adding to this, Dr. Binay Kumar Pandey, Director & HOD- Interventional Cardiology, Electrophysiology, Yatharth Super Speciality Hospital Faridabad Sector-88 said, “following discharge from the hospital, patients need to continue to take their medications as prescribed and must not skip any doses. Patients need to actively monitor for any "red flag" symptoms including but not limited to: shortness of breath, chest pain, or swelling of the legs; these symptoms can indicate a recurrence of the disease. Patients need to continue to be active but also to avoid extended bouts of prolonged inactivity. Patients need to stay hydrated and keep all scheduled follow-up appointments. Any unusual or excessive bleeding that develops as a result of blood thinner medication should be reported to your provider immediately.”
Medical experts consulted This article includes expert inputs shared with TOI Health by:
Dr. Binay Kumar Pandey, Director & HOD- Interventional Cardiology, Electrophysiology, Yatharth Super Speciality Hospital Faridabad Sector-88
Dr. Ranjan Modi, Senior Consultant-Interventional Cardiology, Medanta Hospital Noida
Inputs were used to explain why pulmonary embolism is dangerous and what are its symptoms. The doctors have simplified the new guidelines released by the American Heart Association and the American College of Cardiology.
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