When a blood clot obstructs the blood vessel and is stuck inside it, this is known as an embolism. When the blockage occurs specifically inside the blood vessel of the lungs, it is known as a Pulmonary Embolism.
Saddle pulmonary embolism happens when a relatively large blood clot lodges inside or “saddles” the major pulmonary artery at its point of division, where it divides into the left and right lungs.
Saddle pulmonary embolism is a serious and life-threatening condition that should be treated on an immediate basis. If the treatment is neglected or delayed, the condition can cause the death of the patient.
In this blog, we will briefly describe saddle pulmonary embolism, its causes, risk factors, signs, and symptoms. Saddle pulmonary embolism’s treatment and prevention will also be discussed.
What is meant by Saddle Pulmonary Embolism?
Saddle pulmonary embolism is a kind of sudden or acute pulmonary embolism. However, its incidence is only around 3 to 5% of all acute PE cases, and we can say it is rare.
This condition occurs when a large clot of blood sits back at the intersection where the major pulmonary artery is divided and eventually branches off into the right and left lungs.
The main pulmonary artery carries deoxygenated blood from the heart to the lungs, where it is filtered and becomes reoxygenated.
Due to the obstruction at the main pulmonary artery, where it is branched, blood flow is halted; as a result, blood pressure drops or deviates from the stable range. This results in an insufficient blood supply to the body. Inadequate blood flow causes organ damage, including the brain, heart, and kidneys.
If urgent medical treatment is not given, Saddle pulmonary embolism can also result in heart failure and sudden death.
Causes & Risk factors of Saddle Pulmonary Embolism:
According to the American Society of Hematology, blood clotting is usually a body process that helps seal wounds and prevents blood loss. Gradually, by natural means, the body splits the blood clot and soaks it up into the bloodstream.
Nevertheless, blood clots can potentially cause numerous issues if they have formed without any injury or have not dissolved back into the bloodstream.
The most common reason behind pulmonary embolism is the blood clot that forms in the deeper veins of arms, legs, and pelvis. This condition is known as Deep Venous Thrombosis or DVT.
Everyone can develop blood clots, but if we talk about incidence percentage, then men are at a higher risk of developing blood clots than women. Some of the common risk factors of a blood clot of developing blood clots are mentioned below.
Increased Amount of Estrogen:
If estrogen levels are elevated in the body, it consequently increases the risk of blood clotting. The factors that may result in the rise of estrogen levels are as follows:
- Pregnancy – it increases the risk of blood clots seven times
- Childbirth – the risk of a blood clot is high after six weeks post delivery
- Contraceptive pills – Along with hormonal medicines, contraceptives increase the risk of blood clotting three times
- Hormonal Replacement Therapy – HRT is a type of therapy that regularises the estrogen levels in your body. However, if taken beyond normal limits, it can cause blood clotting.
Decreased or Diminished Blood Flow:
Due to diminished blood flow, blood starts pooling in the blood vessels, which subsequently increases the danger of blood clots. The elements that can cause reduced blood flow are as follows:
- Staying static for extensive periods of time because of persistent bed rest, trauma, or accidental injury.
- Sitting in the same position or at the same place for long periods of time, for example, during long travels in an airplane or car
- Wearing a fracture cast on the upper or lower limbs
- Full or partial body paralysis
Injury to any vein in the body can cause blood clotting. If the human body does not dissolve or split the blood clot and take it back into the bloodstream, it can deteriorate blood flow. Blood clotting also will affect the passage of blood to different parts of the body. The factors behind venous injury included the following.
- Any type of surgery, particularly hip replacement surgery
- Serious muscle injury
Severe and Chronic Medical Conditions:
A few chronic medical conditions that can be potentially severe could increase the risk of blood clotting. Examples are mentioned below.
- Heart diseases
- Lung diseases
- Inflammatory Bowel Disease (IBD)
Other Factors of Saddle Pulmonary Embolism:
Some of the additional factors that elevate the risk of the formation of blood clots in the body, also linked with DVT and pulmonary embolism, are as follows:
- Blood disorders/ blood cancers
- Inherited blood clotting disorder, which affects Factor V Leiden
- Negligence in taking blood thinners that your doctor has prescribed
- Varicose veins
Signs and Symptoms Saddle Pulmonary Embolism:
Some known signs and symptoms of saddle pulmonary embolism are as follows:
- Spontaneous dyspnea and shortness of breath
- Lightheadedness or dizziness
- Fainting or sudden loss of consciousness
- Rapid and abnormal heartbeat
- Chest discomfort and pain
- Excessive sweating
- Coughing up and throwing blood
- Bluish and discolored nails and skin
Point to note:
It is crucial to note and understand that the symptoms of a pulmonary embolism can be strikingly similar to those of a heart attack.
Treatment of Saddle Pulmonary Embolism:
Saddle pulmonary embolism requires immediate medical intervention. Things can go to the extent that a patient might need admission to the intensive care unit at the hospital.
The main goal of treatment is to disassemble the blood clot and resume normal blood flow to the lungs. On the other hand, the aim of the treatment is also to prevent blood clots from multiplying. Following are the fundamental treatment options for Saddle Pulmonary Embolism.
Medicines for Saddle Pulmonary Embolism:
Physicians suggest these medicines to patients with Saddle Pulmonary Embolism.
Anticoagulants – Heparin and Warfarin:
Heparin and warfarin stop existing clots from multiplying and growing bigger. Anticoagulants put a halt to the new blood clot formation. These medicines can be administered via the intravenous route, or the patient can take them orally in tablet form.
This category of medicine dissolves blood clots. Nonetheless, they can divulge a side effect which is bleeding. This is the reason why doctors usually avoid and only prescribe thrombolytics in fatal conditions such as Saddle PEs.
Vena Cava Filter:
This process includes the placement of a tiny metal filter within the largest vein of the body, known as the “vena cava”. It helps in preventing blood clots from reaching the lungs. Vena Cava filter is important and helps people who are contraindicated to blood thinners.
A flexible, hollow tube is inserted inside the blood vessel known as a catheter.”. This helps in breaking the blood clot. There are two approaches to its use. One is to suction up the blood clot into the catheter. The second approach is manually interjecting tiny instruments to split up the blood clots. A patient will be put under general anesthesia for the process of percutaneous thrombectomy.
Prevention of Saddle Pulmonary Embolism or Blood Clotting:
According to the Disease Control Centre, people who are at the highest risk of developing blood clots can take the following precautions.
- Regular physical activity
- Weight maintenance
- Comfortable and loose clothing
- Movement post-injury or surgery
- Use of compression stockings
- Use of aspirin
Those whose working routine involves sitting for more than 4 to 5 hours can take the following steps to maintain circulation in their lower limbs.
- Start walking every 1 to 2 hours
- Releasing and relaxing the lower limb muscles
- Lowering the toes and direct your heels toward the floor
- Lowering the heels and direct your toes toward the floor
Outlook of Saddle Pulmonary Embolism:
Saddle Pulmonary Embolism can result in fatal and life-threatening complications. Almost 2 in 6 people who suffer from pulmonary embolism die immediately. The remaining 40% of patients die within the next month of diagnosis.
According to a study conducted in 2021 stated that out of 120 patients admitted with Saddle Pulmonary Embolism, 10% died while remaining in the hospital. The other 8 to 9% die within 6 months after being discharged from the hospital.
The most decisive factor in recognising the patient’s outlook is whether the treatment has been started after the initial few hours of the vessel obstruction. Early diagnosis and urgent medical intervention decrease the fatality and severity of the disease, and patients can recover completely.
A patient suffering from saddle PE should be administered anticoagulant injections for almost 5 to 6 days. However, after 3 to 4 months, patients can be shifted to anticoagulant tablets.
All You Need to Know:
While Saddle Pulmonary Embolism is a rare medical occurrence, it is also potentially fatal.
In saddle pulmonary embolism, a blood clot sits back at the bisecting point of the pulmonary artery, which is branched off into the right and left lungs. Instant treatment is crucial to redeem the flow of blood to the lungs. Immediate medical intervention will prevent the chances of possible complications and inclusive death.
How common is a saddle pulmonary embolism?
Saddle pulmonary embolism is an acute or sudden type of embolism that rarely occurs in humans. Hence, it only makes up about 2% to 5% of all pulmonary embolism cases.
What causes a saddle pulmonary embolism?
The medical condition occurs when a large blood clot blocks and prevents blood flow in the intersection. There, the main pulmonary artery divides into the left and right lungs causing the blood pressure to drop and insufficient blood flow to the organs.
What are the early warning signs of a pulmonary embolism?
Some early signs and symptoms include chest pain, fainting, shortness of breath, and coughing blood. Moreover, irregular heartbeat, dizziness, fever, excessive sweating, leg pain or swelling, and bluish or discolored skin are also major signs to monitor.
What is the survival rate of a saddle pulmonary embolism?
Patients who suffer from saddle pulmonary embolism die within a month of diagnosis. In some cases, the condition is so severe that they die instantly. However, if diagnosed and treated immediately, the survival rate gets higher.
How long does it take to recover from a saddle pulmonary embolism?
The time it takes to recover from saddle pulmonary embolism may differ from person to person. For some, it takes months or even years to get treated. However, some people may recover completely within weeks. Moreover, It depends on the severity of your disease.
How is a saddle pulmonary embolism removed?
It can be removed through the two most commonly used procedures. The Vena cava filter involves a small metal filter inserted inside the vena cava to prevent blood clots from reaching the lungs. Percutaneous thrombectomy, in which the doctor inserts a catheter to remove or break the blood clot. Furthermore, medications like thrombolytics dissolve the blood clots but might lead to bleeding.
Do lungs heal after pulmonary embolism?
Most people recover fully from pulmonary embolism, but some patients suffer long-term complications of PE. Furthermore, causing blood clots or chronic damage to the lungs.