Pulmonary Embolism

Pulmonary embolism (PE) is a serious condition where a blood clot blocks the arteries in the lungs. It happens more often in older adults and women. The risk of complications and death increases with age, and without treatment, up to 30% of cases can be fatal. However, starting treatment quickly with blood-thinning medication can lower the risk of death to 2-8%, showing how important it is to act early.

Overview

Pulmonary embolism (PE) is a serious medical condition that occurs when one or more arteries in the lungs become blocked by a blood clot. These clots often originate in the deep veins of the legs, a condition known as deep vein thrombosis (DVT), and travel to the lungs through the bloodstream. Because the clots block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment can greatly reduce the risk of death.

Types of Pulmonary Embolism

Pulmonary embolism (PE) is classified based on severity, location, and clinical presentation:

Type	Description	Prognosis	Symptoms
Massive Pulmonary Embolism (Severe)	Life-threatening, causing significant hemodynamic instability (e.g., hypotension, shock) due to large blockages or multiple smaller obstructions that together impair blood flow in the main pulmonary arteries.	The prognosis can be poor without immediate treatment due to the high risk of cardiovascular collapse and death.	Sudden shortness of breath Chest pain Rapid heart rate Lightheadedness or fainting Severe anxiety
Submassive Pulmonary Embolism (Moderately severe)	Moderate severity, with right heart strain or dysfunction, but without systemic hypotension.	The prognosis is better than massive PE but requires immediate treatment to prevent deterioration.	Shortness of breath Chest pain Mild low blood pressure Palpitations Anxiety
Non-massive Pulmonary Embolism (Less severe)	Smaller clots, often with no right heart strain or systemic instability, and typically milder symptoms.	The prognosis is generally good with anticoagulant treatment as long as the condition is managed properly.	Shortness of breath Chest discomfort Cough (possibly with hemoptysis) Mild fever Anxiety
Central PE	Clots are located in the main pulmonary arteries or in the main branches (left or right).	Prognosis varies based on size and patient health; larger clots in central locations pose a higher risk.	Varies based on clot size It can be severe, with massive PE symptoms Mild with smaller clots
Peripheral PE	Clots are found in smaller, distal branches of the pulmonary arteries, usually less severe.	Generally, there is a good prognosis with standard anticoagulation, especially in isolated peripheral cases.	Often mild symptoms Minor shortness of breath Minor chest discomfort Asymptomatic.
Acute PE	Sudden onset of symptoms due to rapid clot formation.	Prognosis depends on severity and promptness of treatment; high-risk cases need rapid intervention.	Rapid shortness of breath Chest pain Cough Possible hemoptysis (coughing blood).
Chronic PE	Gradual onset is due to recurrent small clots, leading to chronic thromboembolic pulmonary hypertension (CTEPH).	Chronic management is required; prognosis varies with the degree of pulmonary hypertension and right heart function.	Persistent shortness of breath Fatigue Exercise intolerance Sometimes, chest pain.
Chronic Thromboembolic Pulmonary Hypertension (CTEPH)	CTEPH is a rare and severe complication of PE where unresolved blood clots lead to increased pressure in the pulmonary arteries over time, causing scar tissue and narrowing or blocking pulmonary arteries.	The prognosis can be poor if untreated, causing potential heart failure, but surgical interventions (like pulmonary thrombo-endarterectomy) can significantly improve outcomes.	Progressive shortness of breath Fatigue Exercise intolerance Syncope Swelling in the legs or ankle edema

When to See a Doctor

Pulmonary embolism can result in serious complications, including persistent pulmonary hypertension, right heart strain or failure, and recurrent embolic events. In severe cases, it may cause sudden cardiovascular collapse or death. Prompt diagnosis and treatment are crucial to reducing mortality and preventing long-term complications such as chronic thromboembolic pulmonary hypertension (CTEPH).

Emergency Situations

If you suspect you or someone else has a pulmonary embolism, it is crucial to seek medical help immediately, as this is a medical emergency. Call emergency services or go to the nearest emergency room. Signs and symptoms of a pulmonary embolism include:

Sudden shortness of breath
Chest pain that may become worse when breathing in
Cough that may produce bloody or blood-streaked sputum
Rapid heart rate
Lightheadedness or dizziness
Excessive sweating

Routines for Pre-existing Conditions

If you have a preexisting condition that increases your risk of a pulmonary embolism, such as a history of deep vein thrombosis (DVT), it’s important to have regular checkups with your doctor. Recommended frequency of visits may include:

Every 6 months: If your condition is stable and well-managed.
Every 3 months: If you are undergoing treatment or have changes in your condition.

Preventative Checkups Based on Family History or Lifestyle Factors

If you have a family history of blood clots or lifestyle factors that increase your risk (such as smoking, prolonged periods of inactivity, or recent surgeries), consider preventative checkups:

Annually: For individuals with a family history of clotting disorders or other related risk factors.
Every 1 to 2 years: For individuals with moderate risk factors and no symptoms.

Doctors to Consult

The following healthcare professionals can assist with the management and prevention of pulmonary embolism:

General Physicians: for initial assessment and management of risk factors.
Cardiologist: for heart-related evaluation and if there are any cardiovascular issues.
Pulmonologist: for specialized care of lung-related symptoms and conditions.
Hematologist: If there is a concern regarding blood clotting disorders, a hematologist can be consulted for evaluation and specialized treatment of blood disorders.
Vascular Specialist: A doctor specializing in blood vessel disorders. They may offer a more in-depth examination and targeted treatments.

Risk Factors/Causes

Family History & Genetics

Family history of DVT or pulmonary embolism
Genetic clotting disorders (e.g., Factor V Leiden mutation, Prothrombin gene mutation)
Deficiencies in proteins that help prevent clotting (e.g., Protein C, Protein S, Antithrombin III deficiencies)

Age & Sex

Increasing age (higher risk with advancing age)
Sex
- Hormonal factors in women, including pregnancy and the postpartum period, can increase the risk for DVT/PE.
- Males may have a slightly higher risk compared to females in certain age groups.

Lifestyle Habits

Health-related immobility (e.g., Post-surgery, confined to bed, disability)
Sitting still for prolonged periods (e.g., long flights or car rides >3 hours, desk job)
Smoking
Obesity
Sedentary lifestyle

Pre-existing Medical Conditions

Cancer and cancer treatments (e.g. Chemotherapy)
Heart disease and related conditions
Previous history of DVT or pulmonary embolism
Surgery, especially pelvic, abdominal, or orthopedic surgery
Injury or trauma
Chronic medical illnesses such as Inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis)
Varicose veins
Autoimmune disorders
Presence of central venous catheters
Extended use of Hormonal therapy (e.g., birth control pills, hormone replacement therapy)

Prevention of Pulmonary Embolism

Stay Active:
Regular physical activity helps maintain healthy blood circulation. Aim to include both aerobic and strength exercises in your routine.
Maintain a Healthy Weight:
Reducing excess body weight can lower the risk of blood clot formation.
Manage Chronic Conditions:
Proper management of conditions such as hypertension and diabetes can reduce risk factors associated with blood clotting.
Hydrate Adequately:
Staying well-hydrated can help prevent blood clots, especially when traveling or in situations where you’re immobile for long periods.
Wear Compression Stockings:
These can help improve blood flow in your legs during long periods of immobility, such as long flights or bed rest.

Elevate Legs:
If you’re sedentary for long periods, elevate your legs periodically to promote blood flow.

Avoid Long Periods of Immobility:
If you’re sitting for long periods, be sure to get up and walk around every now and then.

Exercise your legs when sitting:
If moving around is not an option, perform simple leg exercises like flexing & stretching your feet or rotating your ankles regularly to encourage circulation.
Consult Your Doctor:
Especially if you have risk factors for DVT/PE, consult your healthcare provider for personalized preventive advice.
Consider Anticoagulant Medications:
Under the advice of a healthcare provider, blood-thinning medications might be prescribed, particularly after surgery or in high-risk individuals.
Avoid Smoking:
Smoking cessation is crucial as it significantly reduces the risk of clot formation.
Be Mindful of Hormonal Treatments:
If you are using birth control pills or hormone replacement therapy, discuss with your doctor about potential risks and alternatives.
Follow Post-Operative Guidelines:
After surgery, adhere to recommended practices such as early mobilization and use of any prescribed medications to minimize clot risks.

Diagnosis

The diagnosis of pulmonary embolism (PE) process is typically initiated based on clinical suspicion and risk factors, followed by confirming or excluding the diagnosis through a combination of risk assessment, laboratory tests, and imaging studies. Each step adds progressively more information to either confirm or exclude the presence of a pulmonary embolism. Here are the steps commonly taken in the diagnosis of pulmonary embolism:

Medical History and Physical Examination

Initial evaluation involves assessing the patient’s clinical symptoms and history, including:

Sudden shortness of breath
Chest pain worsened by breathing deeply (pleuritic pain)
Tachycardia (increased heart rate)
Hypoxemia (low blood oxygen levels)
Risk factors such as recent surgery, immobility, or history of deep vein thrombosis (DVT)

Risk Stratification

Using clinical prediction rules to estimate the probability of PE:

Wells Score
Revised Geneva Score

Laboratory Tests and Results Interpretation

Key laboratory tests include:

D-dimer Test:
Used primarily to rule out PE in patients with a low clinical pretest probability. A blood test that measures D-dimer, a substance released when blood clots break down. Blood is drawn and tested for D-dimer levels; elevated levels may indicate clotting but are non-specific, so further imaging is required for PE confirmation. A negative D-dimer test, along with low probability, can exclude PE.

Additional tests that might be considered include:

Arterial Blood Gases (ABG): May reveal hypoxemia (low oxygen levels) and hypocapnia (low carbon dioxide levels), indicating impaired gas exchange due to PE.
- PaO2: Evaluates oxygenation
- PaCO2: Evaluates CO2 levels & ventilation
- pH: Evaluates acid-base balance
- HCO3: Evaluates metabolic component
Complete Blood Count (CBC): Used to assess for anemia or other underlying conditions that may influence oxygen transport and overall health, potentially affecting PE risk.
Coagulation Profile: Evaluates for inherent clotting disorders, which could predispose a patient to clot formation, contributing to PE risk.
Cardiac Biomarkers: Elevated troponins or brain natriuretic peptide (BNP) may indicate right heart strain or pressure overload due to a blocked pulmonary artery, which is common in larger PEs.

Note: Test results may vary if you are taking anticoagulants or other medications. Consult your doctor before interpreting the results.

Lab Test	Optimal	Acceptable	Borderline	High	Critical
D-Dimer	< 0.5 μg/mL < 450 ng/ml	0.5 – 1.0 μg/mL 450-500 ng/ml	N/A	> 1.0 μg/mL > 1000 ng/ml	Significantly elevated levels
Arterial Blood Gas (ABG)	PaO2: 75-100mmHg PaCO2: 35-45mmHg pH: 7.35-7.45 HCO3: 22-26 mEq/L	N/A	Decreased PaO2	Significantly decreased PaO2	Severe respiratory compromise concerns
BNP/ NT-proBNP	BNP: < 100 pg/ml NT-proBNP: < 125 pg/ml	N/A	N/A	BNP: >100 pg/ml NT-proBNP: >125 pg/ml	BNP: >400 pg/ml NT-proBNP: >450 pg/ml
Troponin (Tnl & TnT)	Tnl: <.04 ng/ml Tnt: <.01ng/ml	TnI : 0-0.04 ng/ml TnT: 0-0.01 ng/ml	Rises 2-3 hrs after heart attack Max level in 12-48 hrs Elevated levels up to 2 weeks		Tnl: >.04 ng/ml Tnt: >.01 ng/ml
Prothrombin Time (PT)	10-13.5 seconds	13-15 seconds	15-18 seconds	18-20 seconds	Greater than 25 seconds
International Normalized Ratio (INR)	0.8-1.1	1.2-1.5	1.5-2.0	2.0-3.0	Greater than 3.0
Partial Thromboplastin Time (PTT)	25-35 seconds	N/A	35-45 seconds	45-70 seconds	Greater than 70 seconds

CBC Test Results

Component	Normal Range	Critical Range	Interpretration
White Blood Cells (WBC)	4,500–11,000 cells/μL	< 1,000 (or) > 25,000 cells/μL	Elevated WBCs may indicate infection, inflammation, or stress; very high or low values can suggest severe infection, immune disorder, or bone marrow issues.
Red Blood Cells (RBC)	Men: 4.7–6.1 million cells/μL Women: 4.2–5.4 million cells/μL	< 3.0 million cells/μL	High RBCs can suggest dehydration or polycythemia; low values can indicate anemia or bone marrow suppression.
Hemoglobin (Hgb)	Men: 13.8–17.2 g/dL Women: 12.1–15.1 g/dL	< 7.0 g/dL (or) > 20 g/dL	Elevated hemoglobin may be due to polycythemia or dehydration; low values can indicate anemia. Critical values indicate severe anemia, clotting risk, or low oxygen-carrying capacity.
Hematocrit (Hct)	Men: 40–52% Women: 36–48%	< 21% (or) > 60%	High hematocrit may indicate dehydration or polycythemia; low levels suggest anemia. Critical levels indicate severe anemia or high blood viscosity.
Mean Corpuscular Volume (MCV)	80–100 fL	< 70 fL	High MCV suggests macrocytic anemia (e.g., B12/folate deficiency); low MCV suggests microcytic anemia (e.g., iron deficiency).
Mean Corpuscular Hemoglobin (MCH)	27–33 pg/cell	< 20 pg/cell	High MCH suggests macrocytic anemia; low MCH suggests microcytic anemia.
Mean Corpuscular Hemoglobin Concentration (MCHC)	32–36 g/dL	< 28 g/dL	Elevated MCHC may indicate spherocytosis or hemolysis; low MCHC suggests iron deficiency anemia or thalassemia.
Red Cell Distribution Width (RDW)	11.5–14.5%	> 20%	High RDW indicates variability in RBC size, often associated with anemia. Very high RDW suggests mixed anemia types or significant hematologic abnormalities.
Platelet Count (PLT)	150,000–400,000 cells/μL	< 20,000 (or) > 1,000,000 cells/μL	Elevated platelets may indicate inflammation or thrombocytosis; low platelets suggest bleeding risk or bone marrow suppression.

Imaging and Functional Tests

If clinical suspicion remains after initial testing, imaging is performed to confirm PE and assess other risks:

Computed Tomography(CT) Pulmonary Angiography (CTPA):
The gold standard for PE diagnosis; a CT scan with contrast dye is used to directly visualize clots in the pulmonary arteries. A contrast agent is injected, allowing clear imaging of blood flow in the pulmonary arteries. High sensitivity and specificity for detecting PE directly in the lungs.

Ventilation-Perfusion (V/Q) Scan:
Used if CTPA is contraindicated, such as in patients with contrast allergies or renal impairment. A nuclear medicine scan that assesses airflow (ventilation) and blood flow (perfusion) in the lungs. Two scans are performed – one with a radioactive gas for ventilation and one with a radioactive tracer injected into the blood for perfusion. Mismatches between ventilation and perfusion suggest PE.
CT Venography (CTV):
CT imaging and contrast dye are used to detect the source of clots in deep veins, and they are often used when pulmonary embolism(PE) is suspected. It is not used to detect PE directly; instead, it confirms DVT as a PE source.
Compression Ultrasound:
The primary imaging modality used to diagnose DVT, which may indicate a risk of PE if clots are found in leg veins. Uses transducer pressure to compress veins, helping identify DVT by detecting non-compressible, clot-filled veins. Does not detect PE directly; it only assesses for DVT.
Chest X-ray:
Primarily used to rule out other conditions. While it cannot diagnose PE, it can provide insight into other possible causes of symptoms. A standard X-ray of the chest is used to visualize lung fields and rule out other abnormalities.
Echocardiography:
Used to assess for right heart strain and assess heart function, which can indicate a large or hemodynamically significant high-risk PE case. A transducer placed on the chest captures images of the heart; a transesophageal approach may be used for clearer images in some cases.
Pulmonary Angiography:
An invasive procedure involving catheter insertion into the pulmonary arteries to detect blockages; rarely used today due to the availability of CTPA. A catheter is inserted, typically via the groin, and dye is injected directly into the pulmonary arteries to visualize clots on X-ray images.

Allopathic Treatment

Pulmonary embolism (PE) is a serious condition where one or more arteries in the lungs become blocked by a blood clot. The allopathic treatment of pulmonary embolism focuses on preventing further clot formation and dissolving existing clots.

Anticoagulation Therapy

Anticoagulants, also known as blood thinners, are the primary treatment for pulmonary embolism. They reduce the blood’s ability to clot and help prevent new clots from forming. Common anticoagulants include:

Heparin:
Initially administered via injection or intravenous infusion in a hospital setting. It acts quickly to prevent clot propagation.
Low Molecular Weight Heparin (LMWH):
Administered via subcutaneous injection, it is often used for outpatient treatment due to its ease of use.
Warfarin (Coumadin):
An oral anticoagulant typically started soon after heparin therapy. Regular blood tests (INR) are required to monitor dosage.
Direct Oral Anticoagulants (DOACs):
Options include rivaroxaban, apixaban, edoxaban, and dabigatran, which do not require regular monitoring and are becoming more popular for treatment.

Thrombolytic Therapy

Thrombolytics, also known as clot-busters, are used in more severe cases of PE where rapid clot dissolution is necessary. They are administered intravenously and include drugs such as tissue plasminogen activator (tPA). This treatment is reserved for critical cases due to the potential risk of severe bleeding.

Surgical and Interventional Procedures

In certain life-threatening cases, surgery or other interventions might be necessary:

Catheter-directed Thrombolysis:
A catheter is used to deliver thrombolytic drugs directly to the site of the clot. This can be more targeted than systemic thrombolysis.
Surgical Embolectomy:
A surgical procedure to remove the clot manually, typically used when other treatments are ineffective or contraindicated.
Inferior Vena Cava (IVC) Filter:
A filter is placed in the inferior vena cava to prevent large clots from reaching the lungs. This may be considered if anticoagulation is contraindicated or fails.

Inferior Vena Cava (IVC) Filter

Used when anticoagulation is contraindicated or ineffective. An IVC filter is a device placed in the inferior vena cava to prevent clots from traveling to the lungs.

Supportive Care

Supportive measures enhance patient comfort and support cardiovascular function, including:

Oxygen Therapy: Administered to alleviate hypoxia and improve oxygenation.
Pain Relief: Analgesics may be prescribed to manage pleuritic chest pain associated with PE.

Long-term Management and Prevention

After initial treatment, ongoing anticoagulation may be necessary to prevent recurrence. Lifestyle changes and addressing risk factors such as smoking cessation, weight management, and staying active are important components of long-term care.

Medication/Drugs

Medication/Drug	Class	Mechanism of Action	Side Effects	Brand Names in India
Heparin	Anticoagulant- Unfractionated Heparins (UFH)	Heparin enhances the activity of antithrombin III, which inhibits clotting enzymes thrombin and factor Xa, preventing new clots from forming and existing clots from growing.	Bleeding Thrombocytopenia Osteoporosis (with long-term use) Hypersensitivity reactions	Heparin, Hepaglan, Caprin Hep Lock
Warfarin	Anticoagulant/ Vitamin K Antagonist	Warfarin works by blocking vitamin K, which is needed to make certain clotting proteins. This slows down the blood’s ability to form clots, helping to prevent new clots and keep existing ones from growing.	Bleeding Teratogenic potential Skin necrosis Interactions with food and drugs.	Warf, Sofarin, Cofarin
Enoxaparin	Anticoagulant/ Low Molecular Weight Heparin (LMWH)	Enoxaparin, a low molecular weight heparin, binds to and enhances the activity of antithrombin III, with a stronger effect on factor Xa than on thrombin. This prevents clots from growing and helps reduce the formation of new clots. Given as a subcutaneous injection, often used in hospital settings or for short-term use.	Bleeding Thrombocytopenia Injection site reactions.	Lonopin, Clexane, Cutenox
Rivaroxaban	Direct Oral Anticoagulant (DOAC) – Factor Xa Inhibitors	Rivaroxaban selectively inhibits factor Xa, preventing thrombin formation and thrombus development. Taken orally.	Bleeding Liver enzyme abnormalities Allergic reactions.	Xarelto, Rivaflo, Rivaxab
Apixaban	Direct Oral Anticoagulant (DOAC) – Factor Xa Inhibitors	Apixaban blocks factor Xa, an enzyme needed for clotting, preventing new clots, and stopping existing ones from growing.	Bleeding Anemia Nausea.	Eliquis, Apigat, Cadiquis
Dabigatran	Direct Oral Anticoagulant (DOAC) – Factor Xa Inhibitors	Dabigatran is a direct inhibitor of thrombin, preventing the conversion of fibrinogen to fibrin.	Bleeding Gastrointestinal symptoms Hypersensitivity.	Pradaxa, Dabigat, Dabifib, Dabitra
Fondaparinux	Synthetic Factor Xa Inhibitor	Fondaparinux selectively binds to antithrombin III, enhancing its ability to inhibit factor Xa.	Bleeding Anemia Thrombocytopenia.	Arixtra, Fondared, Fondum

Lifestyle Changes for Management

Maintain a healthy weight:
Being overweight can increase the strain on your heart and lungs, so aim to maintain a healthy body weight through a balanced diet and regular exercise.
Regular physical activity:
Engage in regular physical activities according to your physician’s advice. Walking, swimming, and cycling can improve cardiovascular health.
Avoid Prolonged Inactivity:
If you have to sit for long periods, such as during travel or desk work, make sure to take breaks and move around at regular intervals. Stand, stretch, and walk every 1-2 hours to promote circulation.
Quit smoking:
Smoking can damage your lungs and increase the risk of blood clots, so it’s crucial to quit smoking to improve overall lung health.
Monitor alcohol intake:
Limit alcohol consumption as excessive drinking may interfere with blood clot prevention and management medications.
Healthy diet:
Consume a diet rich in fruits, vegetables, whole grains, and lean proteins to support overall cardiovascular health. Reducing salt intake can also help manage blood pressure.
Avoid dehydration:
Stay well-hydrated to help maintain good blood circulation. Drink plenty of water and limit the intake of caffeinated and sugary drinks.
Wear compression stockings:
These can help improve circulation in your legs and reduce the risk of deep vein thrombosis (DVT), which could lead to pulmonary embolism.
Regular medical check-ups:
Attend all medical check-ups and follow-ups to monitor your condition and the effectiveness of any prescribed medications.

Allopathic Supplements

Alongside anticoagulants, some allopathic supplements may support blood flow and vascular health in PE patients. While certain dietary supplements are believed to support cardiovascular health, their efficacy in treating or preventing PE is not well-established. Moreover, some supplements can interact with anticoagulant medications, potentially increasing bleeding risk. Always consult your healthcare provider before adding any supplements to your regimen.

Supplements and Their Considerations:

Omega-3 Fatty Acids:
Found in fish oil, omega-3s have anti-inflammatory properties and may support heart health. However, they can have blood-thinning effects, which might enhance the action of anticoagulant drugs. It’s essential to discuss appropriate dosages with your doctor.
Vitamin E:
This antioxidant may have anticoagulant effects. High doses can increase bleeding risk, especially when taken with blood thinners. Consult your healthcare provider before use.
Garlic Supplements:
Garlic is known for its potential to reduce blood clotting. However, it can interact with anticoagulant medications, increasing bleeding risk. Use with caution and under medical supervision.

Important Considerations:

Monitor for Side Effects: Be vigilant about any unusual symptoms and report them promptly.
Adhere to Prescribed Treatments: Supplements should NOT replace conventional PE treatments.

Ayurvedic Treatment

Warm and Easily Digestible Foods:
Ayurveda recommends foods that are easy to digest to reduce strain on the body.
Hydration and Warm Fluids:
Staying hydrated and consuming warm fluids can help improve circulation and digestion.
Avoid Heavy and Oily Foods:
These foods may aggravate “Kapha” dosha, which Ayurveda associates with congestion and sluggish circulation.
Yoga and Pranayama (Breathing Exercises):
Gentle breathing exercises may support lung health and improve oxygenation. However, these should only be practiced with medical approval, especially post-PE.

Ayurvedic Medicines

Herbal Medication	Description	Brands
Brahmi (Bacopa monnieri)	Brahmi supports blood circulation, reduces stress, and improves vascular function, making it beneficial for DVT prevention with its anti-inflammatory and antioxidant properties.	Organic India Brahmi, Kerala Ayurveda Brahmi
Guggulu (Commiphora mukul)	Guggul is an anti-inflammatory Ayurvedic herb that improves blood flow, reduces blood viscosity, and supports vascular health, making it effective for DVT management. It also helps lower cholesterol and prevent clot formation.	Himalaya Shuddha Guggulu
Arjuna (Terminalia arjuna)	Arjuna is an Ayurvedic herb with cardiovascular benefits, strengthening blood vessels, improving circulation, reducing clot formation, aiding in DVT management	Jiva Arjuna, Himalaya Arjuna
Triphala – Amalaki (Indian Gooseberry), Haritaki (Indian Gallnut or Terminalia chebula), & Bibhitaki (Beleric myrobalan or Terminalia bellerica).	Triphala, a blend of 3 fruits, is valued in Ayurveda for its detoxifying and anti-inflammatory properties. It supports vascular health in DVT by enhancing circulation, reducing inflammation, and lowering oxidative stress, helping maintain balanced blood flow and healthy vessels.	Organic India Triphala, Himalaya Triphala
Ashwagandha (Withania Somnifera)	Ashwagandha, an adaptogenic herb, reduces stress, promotes relaxation, and supports vascular health, making it beneficial for DVT prevention.	Himalaya Ashvagandha Kapiva Ashwagandha Gold Capsules
Punarnava (Boerhavia diffusa)	Punarnava is an Ayurvedic herb known for its diuretic and anti-inflammatory properties, helping to reduce edema and improve circulation by balancing Kapha dosha, improving circulation, supporting blood flow, and managing Kapha imbalance associated with DVT.	Zandu Punarnava Capsules, Himalaya Punarnava Tablets
Turmeric (Curcuma longa)	Turmeric is known for its anti-inflammatory and antioxidant properties due to its active compound, curcumin. It is traditionally used to reduce inflammation and may help improve circulation. Turmeric can have mild blood-thinning effects, so medical supervision is advised.	Himalayan Organics Curcumin, Appris Herbs Turmeric Haldicurcumin Extract
Garlic (Allium sativum)	Garlic is used in Ayurveda for its potential to support heart health and circulation. Like turmeric, garlic also has blood-thinning properties, so it should be used carefully if on blood thinners.	Nature’s Bounty OdorFree Garlic, Garlic Pearls Capsule 100’S

Important Considerations

Consultation with an Ayurvedic Practitioner:
Any Ayurvedic treatment should be under the guidance of a qualified Ayurvedic practitioner, who can tailor treatments based on individual dosha constitution.
Medical Supervision:
Always communicate with your healthcare provider before adding Ayurvedic herbs, especially if you are taking anticoagulant medications, as many herbs may have blood-thinning effects.
Combination with Standard Treatment:
Ayurveda can provide supportive care, but it is NOT a replacement for emergency PE treatments, such as anticoagulant or thrombolytic therapy.

In summary, while Ayurveda offers supportive therapies for heart and circulation health, these should only complement, not replace, the standard medical treatment necessary for managing pulmonary embolism.

Siddha Treatment

In Siddha, PE can be addressed by focusing on balancing the body’s energies, specifically “Vatha” (air and movement), which plays a role in blood flow and circulation. Siddha treatments for PE aim to support respiratory health, improve blood flow, and alleviate inflammation in a way that is harmonious with conventional medical treatments. For pulmonary embolism (PE), Siddha remedies should only be complementary to standard medical care, as PE is a life-threatening condition requiring immediate treatment with anticoagulants or thrombolytic agents.

Medication	Purpose
Thalisadi Choornam	Used to support respiratory health and improve lung function.
Aadathodai Manapagu	Used in Siddha to alleviate respiratory conditions, improve lung function, and clear congestion. Contains compounds that may help thin mucus, which can aid breathing.
Thippili Rasayanam	Traditionally used for respiratory ailments and improving circulation.
Nilavembu Kudineer	Famous for its anti-inflammatory properties, supporting overall health.
Seenthil Chooranam	The powdered form of Eclipta prostrata (Guduchi) & Tinospora Cordifolia is used to enhance immunity and respiratory health.
Amukkura Chooranam (Ashwagandha)	Used for stress reduction and cardiovascular support.
Vishamushti Lehyam (Black Pepper-based)	Known for its circulation-enhancing properties.
Kabasura Kudineer	An herbal decoction traditionally used for respiratory conditions believed to help in clearing lung passages and enhancing oxygenation.
Chukku (Dry Ginger / Zingiber officinale)	Dry ginger is known to improve circulation, reduce inflammation, and support heart health. It is believed to possess mild blood-thinning properties, so it should be used cautiously if anticoagulants are prescribed.
Thippili (Piper longum / Long Pepper)	Used in Siddha to support respiratory function and improve blood flow. Often included in treatments for lung congestion and to improve respiratory resilience.

Note: It is essential to consult qualified practitioners before using these medicines, as individual treatment options may vary. Severe conditions may need immediate allopathic care.

Yoga

Here is a list of yoga asanas that can be beneficial for individuals with pulmonary embolism. Consult a healthcare professional before starting any new exercise regimen.

Pranayama (Breathing Exercises)

Improves lung capacity.
Increases Oxygenation.
Promotes Relaxation.

Bhujangasana (Cobra Pose)

Increases the function of the lungs.
Expands the chest, which aids in improving heart health.
Strengthens the spine and increases flexibility.
Improves oxygen and blood circulation.

Tadasana (Mountain Pose)

Improves posture and balance.
Increases awareness and focus, aiding in mental calmness.
Enhances circulation and can help reduce blood pressure.

Setu Bandhasana (Bridge Pose)

Opens the chest, improving heart and lung functioning.
Reduces anxiety, stress, and tension.
Improves blood circulation and helps maintain healthy blood pressure.

Salamba Bhujangasana (Sphinx Pose)

Promotes deep relaxation and stress relief.
Calms the mind and reduces anxiety.
Improves circulation and encourages a healthy heart rate.

Shavasana (Corpse Pose)

Promotes deep relaxation and stress relief.
Calms the mind and reduces anxiety.
Improves circulation and encourages a healthy heart rate.