I don‘t actually know what happened to my friend. I saw her at the hockey rink one Saturday night. Our boys played on the same team more than five years ago but had moved on to different high schools playing at different levels. Still, I was happy to see her and all the other hockey parents in that first weekend of the season. She said she was doing well, and she looked great.
Another hockey parent texted me 10 days later that she died.
I couldn’t believe it. Pulmonary embolism in a middle-aged woman who was cheering her son on one day and abruptly gone the next.
I’m not her doctor and never have been. But, because of her, I want to tell you what it feels like to have a blood clot in your lungs and how to know if you are at risk — so you will seek the type of care that you need if it should happen to you.
What is deep venous thrombosis and pulmonary embolism?
Pulmonary embolism (often called PE) is actually pretty common. Most often, PE starts with a blood clot in the deep vein system of one of your legs, called deep vein thrombosis (DVT). The leg clot might be silent or can cause swelling or muscle pain in one leg.
A DVT can travel up to your lung where it becomes known as PE. A PE blocks blood flow in an artery in the lung and can be life-threatening. According to the Centers for Disease Control and Prevention, 900,000 Americans will have DVT/PE each year.
If you catch the clot when it is still only in your leg, treatment is pretty straightforward. Therapy focuses on limiting clot extension, or growth. Treatment will reduce the likelihood that your leg clot will travel to your lungs and become potentially life-threatening.
Tip 1: If you have unexplained swelling in one leg — that is, you didn’t have a sports injury or have no other reason for swelling — contact your healthcare team.
What are symptoms of pulmonary embolism?
Symptoms of PE can be tricky. Depending on how big the clot is in your lungs, your symptom severity will vary. Most people, however, have difficulty breathing, trouble breathing with activity (exertion), shortness of breath or some alteration in their normal breathing pattern.
Tip 2: If your breathing feels suddenly different, get emergency care or call 911.
Tip 3: If your breathing more gradually changes and you have a swollen leg, get emergency care right away.
Once the clot gets to your lungs, it will get bigger without treatment and continue to cause problems. Some people need to be extra cautious because they are at higher risk for DVT/PE.
What are the causes and risks of pulmonary embolism?
Anybody can get a DVT or PE. In fact, most people at high risk are not even aware of their increased risk.
However, there are some clear risk factors that, if present, should urge you to take symptoms of DVT/PE more seriously. These include:
- A prior blood clot.
- Family history of blood clots. If your sibling, parent or child has had a blood clot, you could also be at risk.
- Inherited clotting disorder. If you know that you have Factor V Leiden, Protein C deficiency or another condition that increases clot susceptibility, your risk is higher.
- Immobility. Travel or a health issue that has kept you in one place without moving your legs for several hours can cause blood to pool and potentially clot.
- Cancer history or current cancer.
- Certain medications. People who take birth control pills or other hormones are at higher risk of blood clots.
- Recent leg fracture.
- Recent surgery.
- Certain health conditions. This includes chronic lung or heart disease, as well as inflammatory bowel disease.
- Older age.
- Certain medical devices. These include a catheter or medical device in one of your blood vessels, such as a PICC line or dialysis catheter.
The more boxes you check, the higher your risk.
Tip 4: If you have breathing symptoms and one or more risk factors applies to you, seek emergency care.
What about acute pulmonary embolism?
Sometimes, PE happens without warning symptoms and is deadly. In that case, emergency services should be contacted immediately. Unfortunately, it is often too late at that point.
For that reason, it’s imperative to seek care if you have any of the warning symptoms. Diagnosing a DVT/PE is something any hospital can do.
How is pulmonary embolism diagnosed?
If you seek care concerning DVT/PE and are stable, most healthcare teams will start with vital signs and a physical exam. In addition, you will likely have an ECG and a heart monitor may be placed on your chest.
DVT is seen by ultrasound. If you need an ultrasound to assess for a clot in your leg, it should happen immediately.
Tip 5: Testing by ultrasound for a DVT should not be delayed — even to the next day if at all possible.
Signs of PE can be seen on your ECG, however, a diagnosis can only be made with an imaging study. Most commonly, this will involve a CT scan. Sometimes, the best diagnostic test is a Ventilation/Perfusion Scan (VQ scan).
In a critically ill person, other tests can be done in the ICU setting to give your team an idea of whether or not a blood clot is present in your lungs.
How is pulmonary embolism treated?
Treatment for PE has a simple strategy: Stop the clotting. Typically, blood thinners, also called anticoagulation, are given as soon as possible to someone with DVT or PE.
In the past, this meant IV drips and tricky medications that could be hard to get into the optimal therapeutic range. Now, there are several oral options that can be used to thin blood and give the body time to reabsorb the clot(s) that have formed without producing more. There also are shots that can be used once or twice daily to treat and to prevent blood clot formation.
Tip 6: Blood clot treatment is available, but only if you seek care. For this reason, do not delay.
If you or someone you care about has symptoms of a blood clot in their legs or in their lungs, get evaluated and treated as soon as possible. It just might save your life.
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