What is Saddle Pulmonary Embolism?
A pulmonary embolism is a blood clot that occurs in the lungs and blocks one of the arteries of the lung.
Saddle pulmonary embolism occurs when a large blood clot gets stuck in the main pulmonary artery where the artery branches off into Y shape into each lung. It forms a saddle on the top of both branch arteries.
Saddle pulmonary embolism forms 2 to 5% of all pulmonary embolism cases.(1)
A person having saddle pulmonary embolism that includes both the branches of pulmonary arteries can be life-threatening.
The person may not be able to talk about or explain the feeling but may appear clinically agitated.
As the pulmonary arteries carry deoxygenated blood to the heart and lungs and are loaded with oxygen, if a saddle pulmonary embolism blocks one or more of the pulmonary arteries, a person can suffer from heart failure or death.
Causes of Saddle Pulmonary Embolism
A saddle pulmonary embolism starts as a blood clot in the vein of the leg or any other part of the body. The clot in parts or as a whole is carried to the lungs.
There are several causes and types of blood clots that can lead to the development of saddle pulmonary embolism.
Diseases of the heart and vascular system are the main risk factors of pulmonary embolism as they affect the flow of blood into the lungs.
A few of these conditions include:
- Irregular heartbeat
- Deep vein thrombosis
- High blood pressure
- Congestive heart failure
- Venous thromboembolism (VTE)
- Peripheral vascular embolism
Other condition that may increase the risk of blood clots and thereby saddle pulmonary embolism includes:
- High cholesterol
- Chronic kidney disease
- Disseminated intravascular coagulation (DIC)
There are certain medications (known as thrombolytics) that can lead to the dissolving or breakdown of clots in the body. These can lead to pulmonary embolism as well.
This happens when a piece or a clot breaks off the wall of a blood vessel and travels to the lungs.
These medications include:
- Anistreplase (Eminase)
- Reteplase (Retavase)
- Streptokinase (Streptase)
- Tissue plasminogen activator class of drugs (Activase)
Other medication and treatments that can lead to clot formation in the body include:
- Birth control pills
- Blood transfusion
- Hormone therapy
- Hemophilia drugs
- Some vitamin, minerals, and supplements
Symptoms of Saddle Pulmonary Embolism
The symptoms of saddle pulmonary embolism are the same as those of pulmonary embolism. They include:
- Chest pain
- Shortness of breath
- Blood-streaked spit on coughing
- Low blood pressure
- Blue skin
- Clammy skin
- Fast heart rate
- Leg pain and swelling
- Irregular heartbeat
How is Saddle Pulmonary Embolism Treated?
Treatment of saddle pulmonary embolism is similar to pulmonary embolism treatment. The treatment options include:
- Blood thinner injections and oral medications
- Thrombolytics (clot-dissolving medications)
- Clot removal via catheter
Is it Possible to Prevent Saddle Pulmonary Embolism?
It is not always possible to prevent pulmonary embolism as there is no exact reason for its occurrence.
However, the risk can be reduced, if the risk factors of blood clots are checked. There are a few things that can be done to prevent blood clot formation, which include:
- Quit smoking
- Sitting or lying for long stretches
- Wearing compression stockings
- Keeping up with the exercise routine
- Keeping a check on the blood pressure regularly
- Keeping the blood sugar level in control
Outlook for People with Pulmonary Embolism
Saddle pulmonary embolism is treatable, but urgent medical care is required.
The outlook is similar to pulmonary embolism. Sometimes the clot dissolves on its own.
A person may have to stay in the hospital for several days to make sure the clot has cleared. Some people are advised blood thinners for at least 3 months after they have a pulmonary embolism.
Depending on the cause of pulmonary embolism additional medications might be required.
A study found the mortality rate for saddle pulmonary embolism was 3.62 % compared to 3.19 in those with other pulmonary embolism types.(1)
The health complications are higher in those with saddle pulmonary embolism. These include:
- Heart attack or heart failure
- Respiratory failure
- Further thrombolytic treatment
Saddle pulmonary embolism is a rare kind of pulmonary embolism and like all pulmonary embolisms require urgent medical treatment. If treated well the survival rate of saddle pulmonary embolism is good.