Pulmonary embolism in the context of Shock (circulatory)

Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, chronic obstructive pulmonary disease and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.

The study of respiratory disease is known as pulmonology. A physician who specializes in respiratory disease is known as a pulmonologist, a chest medicine specialist, a respiratory medicine specialist, a respirologist or a thoracic medicine specialist.

Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath. It can be divided into heart-related and non-heart-related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or the elderly may have less clear symptoms.

Serious and relatively common causes include acute coronary syndrome such as a heart attack (31%), pulmonary embolism (2%), pneumothorax, pericarditis (4%), aortic dissection (1%) and esophageal rupture. Other common causes include gastroesophageal reflux disease (30%), muscle or skeletal pain (28%), pneumonia (2%), shingles (0.5%), pleuritis, traumatic and anxiety disorders. Determining the cause of chest pain is based on a person's medical history, a physical exam and other medical tests. About 3% of heart attacks, however, are initially missed.

Coumarin (/ˈkuːmərɪn/) or 2H-chromen-2-one is an aromatic organic chemical compound with formula C₉H₆O₂. Its molecule can be described as a benzene molecule with two adjacent hydrogen atoms replaced by an unsaturated lactone ring −(CH)=(CH)−(C=O)−O−, forming a second six-membered heterocycle that shares two carbons with the benzene ring. It belongs to the benzopyrone chemical class and is considered a lactone.

Coumarin is a colorless crystalline solid with a sweet odor resembling the scent of vanilla and a bitter taste. It is found in many plants, where it may serve as a chemical defense against predators. While coumarin is not an anticoagulant, its 3-alkyl-4-hydroxy derivatives, such as the fungal metabolite dicoumarol, inhibit synthesis of vitamin K, a key component in blood clotting. A related compound, the prescription drug anticoagulant warfarin, is used to inhibit formation of blood clots, deep vein thrombosis, and pulmonary embolism.

Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blood. The body normally attempts to compensate for this homeostatically, but if this fails or is overridden, the blood pH will rise, leading to respiratory alkalosis. This increases the affinity of oxygen to hemoglobin and makes it harder for oxygen to be released into body tissues from the blood. The symptoms of respiratory alkalosis include dizziness, tingling in the lips, hands, or feet, headache, weakness, fainting, and seizures. In extreme cases, it may cause carpopedal spasms, a flapping and contraction of the hands and feet.

Factors that may induce or sustain hyperventilation include: physiological stress, anxiety or panic disorder, high altitude, head injury, stroke, respiratory disorders such as asthma, pneumonia, or hyperventilation syndrome, cardiovascular problems such as pulmonary embolisms, anemia, an incorrectly calibrated medical respirator, and adverse reactions to certain drugs. Hyperventilation can also be induced intentionally to achieve an altered state of consciousness such as in the choking game, during breathwork, or in an attempt to extend a breath-hold dive.

Pleurisy, also known as pleuritis, is inflammation of the membranes that surround the lungs and line the chest cavity (pleurae). This can result in a sharp chest pain while breathing. Occasionally the pain may be a constant dull ache. Other symptoms may include shortness of breath, cough, fever, and weight loss, depending on the underlying cause.

Pleurisy can be caused by a variety of conditions, including viral or bacterial infections, autoimmune disorders, and pulmonary embolism. The most common cause is a viral infection. Other causes include bacterial infection, pneumonia, pulmonary embolism, autoimmune disorders, lung cancer, following heart surgery, pancreatitis and asbestosis. Occasionally the cause remains unknown. The underlying mechanism involves the rubbing together of the pleurae instead of smooth gliding. Other conditions that can produce similar symptoms include pericarditis, heart attack, cholecystitis, pulmonary embolism, and pneumothorax. Diagnostic testing may include a chest X-ray, electrocardiogram (ECG), and blood tests.

Idiopathic pulmonary fibrosis (IPF), formerly known as cryptogenic fibrosing alveolitis, is a rare, progressive illness of the respiratory system, characterized by the thickening and stiffening of lung tissue, that surrounds the air sacs, and is associated with the formation of scar tissue. It is a type of chronic pulmonary fibrosis characterized by a progressive and irreversible decline in lung function.

Symptoms typically include gradual onset of shortness of breath and a dry cough. Other changes may include feeling tired, and clubbing abnormally large and dome shaped finger and toenails. Complications may include pulmonary hypertension, heart failure, pneumonia or pulmonary embolism.

Thrombosis (from Ancient Greek θρόμβωσις (thrómbōsis) 'clotting') is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel around the body is known as an embolus. Thrombosis can cause serious conditions such as stroke and heart attack.

Thrombosis may occur in veins (venous thrombosis) or in arteries (arterial thrombosis). Venous thrombosis (sometimes called DVT, deep vein thrombosis) leads to a blood clot in the affected part of the body, while arterial thrombosis (and, rarely, severe venous thrombosis) affects the blood supply and leads to damage of the tissue supplied by that artery (ischemia and necrosis). A piece of either an arterial or a venous thrombus can break off as an embolus, which could then travel through the circulation and lodge somewhere else as an embolism. This type of embolism is known as a thromboembolism. Complications can arise when a venous thromboembolism (commonly called a VTE) lodges in the lung as a pulmonary embolism. An arterial embolus may travel further down the affected blood vessel, where it can lodge as an embolism.

Venous thrombosis is the blockage of a vein caused by a thrombus (blood clot). A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off (embolizes) and flows to the lungs to lodge there, it becomes a pulmonary embolism (PE), a blood clot in the lungs. The conditions of DVT only, DVT with PE, and PE only, are all captured by the term venous thromboembolism (VTE).

The initial treatment for VTE is typically either low-molecular-weight heparin (LMWH) or unfractionated heparin, or increasingly with direct acting oral anticoagulants (DOAC). Those initially treated with heparins can be switched to other anticoagulants (warfarin, DOACs), although pregnant women and some people with cancer receive ongoing heparin treatment. Superficial venous thrombosis or phlebitis affects the superficial veins of the upper or lower extremity and only require anticoagulation in specific situations, and may be treated with anti-inflammatory pain relief only.

Syncope (syncope), commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from low blood pressure. There are sometimes symptoms before the loss of consciousness such as lightheadedness, sweating, pale skin, blurred vision, nausea, vomiting, or feeling warm. Syncope may also be associated with a short episode of muscle twitching. Psychiatric causes can also be determined when a patient experiences fear, anxiety, or panic; particularly before a stressful event, usually medical in nature. When consciousness and muscle strength are not completely lost, it is called presyncope. It is recommended that presyncope be treated the same as syncope.

Causes range from non-serious to potentially fatal. There are three broad categories of causes: heart or blood vessel related; reflex, also known as neurally mediated; and orthostatic hypotension. Issues with the heart and blood vessels are the cause in about 10% and typically the most serious, while neurally mediated is the most common. Heart-related causes may include an abnormal heart rhythm, problems with the heart valves or heart muscle, and blockages of blood vessels from a pulmonary embolism or aortic dissection, among others. Neurally mediated syncope occurs when blood vessels expand and heart rate decreases inappropriately. This may occur from either a triggering event such as exposure to blood, pain, strong feelings or a specific activity such as urination, vomiting, or coughing. Neurally mediated syncope may also occur when an area in the neck known as the carotid sinus is pressed. The third type of syncope is due to a drop in blood pressure when changing position, such as when standing up. This is often due to medications that a person is taking, but may also be related to dehydration, significant bleeding, or infection. There also seems to be a genetic component to syncope.

A lung cavity or pulmonary cavity is an abnormal, thick-walled, air-filled space within the lung. Cavities in the lung can be caused by infections, cancer, autoimmune conditions, trauma, congenital defects, or pulmonary embolism. The most common cause of a single lung cavity is lung cancer. Bacterial, mycobacterial, and fungal infections are common causes of lung cavities. Globally, tuberculosis is likely the most common infectious cause of lung cavities. Less commonly, parasitic infections can cause cavities. Viral infections almost never cause cavities. The terms cavity and cyst are frequently used interchangeably; however, a cavity is thick walled (at least 5 mm), while a cyst is thin walled (4 mm or less). The distinction is important because cystic lesions are unlikely to be cancer, while cavitary lesions are often caused by cancer.

Diagnosis of a lung cavity is made with a chest X-ray or CT scan of the chest, which helps to exclude mimics like lung cysts, emphysema, bullae, and cystic bronchiectasis. Once an imaging diagnosis has been made, a person’s symptoms can be used to further narrow the differential diagnosis. For example, recent onset of fever and productive cough suggest an infection, while a chronic cough, fatigue, and unintentional weight loss suggest cancer or tuberculosis. Symptoms of a lung cavity due to infection can include fever, chills, and cough. Knowing how long someone has had symptoms for or how long a cavity has been present on imaging can also help to narrow down the diagnosis. If symptoms or imaging findings have been present for less than three months, the cause is most likely an acute infection; if they have been present for more than three months, the cause is most likely a chronic infection, cancer, or an autoimmune disease.

Jack Leon Ruby (born Jacob Leon Rubenstein; c. March 25, 1911 – January 3, 1967) was an American nightclub owner who murdered Lee Harvey Oswald on November 24, 1963, two days after Oswald was arrested for the assassination of President John F. Kennedy.

Born in Chicago, Ruby operated nightclubs in Texas. On November 24, 1963, two days after Kennedy was assassinated in Dallas, Ruby shot and mortally wounded Oswald in Dallas Police Headquarters and was immediately arrested. The shooting happened on live television. Ruby was convicted and sentenced to death. This was overturned on appeal, and he was granted a new trial, but Ruby fell ill, was diagnosed with cancer, and died of a pulmonary embolism on January 3, 1967.

Warfarin, sold under the brand name Coumadin among others, is used as an anticoagulant medication. It is commonly used to prevent deep vein thrombosis and pulmonary embolism, and to protect against stroke in people who have atrial fibrillation, valvular heart disease, or artificial heart valves. Warfarin may sometimes be prescribed following a ST-segment elevation myocardial infarction and orthopedic surgery. It is usually taken by mouth, but may also be administered intravenously.

The common side effect, a natural consequence of reduced clotting, is bleeding. Less common side effects may include areas of tissue damage, and purple toes syndrome. Use is not recommended during pregnancy. The effects of warfarin are typically monitored by checking prothrombin time (INR) every one to four weeks. Many other medications and dietary factors can interact with warfarin, either increasing or decreasing its effectiveness. The effects of warfarin may be reversed with phytomenadione (vitamin K₁), fresh frozen plasma, or prothrombin complex concentrate.

Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms.

The most common life-threatening concern with DVT is the potential for a clot to embolize (detach from the veins), travel as an embolus through the right side of the heart, and become lodged in a pulmonary artery that supplies blood to the lungs. This is called a pulmonary embolism (PE). DVT and PE comprise the cardiovascular disease of venous thromboembolism (VTE).

Free were an English rock band formed in London in 1968 by Paul Rodgers (vocals), Paul Kossoff (guitar), Andy Fraser (bass, piano) and Simon Kirke (drums, percussion). They are best known for their hit songs "All Right Now" and "Wishing Well". Although renowned for their live performances and non-stop touring, their music did not sell well until their third studio album, Fire and Water (1970), which featured the hit "All Right Now". The song helped secure them a performance at the 1970 Isle of Wight Festival, where they played to an audience of 600,000 people. In the early 1970s they became one of the best-selling British blues rock groups; by the time they disbanded, they had sold more than 20 million records worldwide and had played in more than 700 arenas and festival concerts. "All Right Now" remains a staple of R&B and rock, and has entered ASCAP's "One Million" airplay singles club.

Fraser left the band in 1972 and formed Sharks. Free recorded one more album, Heartbreaker, before disbanding in 1973; Rodgers and Kirke went on to co-form the more successful rock supergroup Bad Company. Kossoff formed Back Street Crawler in 1973, but died from a pulmonary embolism at the age of 25 in 1976. Fraser died in 2015 at 62.