Sudden Shortness of Breath or Chest Pain? Understanding Pulmonary Embolism Before It Is Too Late

Have you ever felt a sudden shortness of breath or a sharp pain in your chest that made you feel frightened? You might wonder if you are having a heart attack. But did you know that those signs can point to another very serious condition? That condition is when a blood clot blocks a blood vessel in your lungs, known medically as a pulmonary embolism, or PE. This is not as rare as you might think. Let us talk about this condition in clear, simple detail today so you know what to look for.

When you understand how a lung blood clot happens, you can protect yourself and your loved ones. Doctors and health experts want you to know the warning signs so you can act right away. Let us break down everything you need to know about pulmonary embolism in plain, easy-to-read English.

What Is a Pulmonary Embolism?

Simply put, a pulmonary embolism is a blocked blood vessel in your lungs. How does this happen? A blood clot usually forms in a vein in another part of your body, most often in your leg or your arm. That clot breaks free, travels through your bloodstream, and finally gets stuck in your lungs. Think of it like a roadblock stopping traffic on a busy water stream.

When a blood clot gets stuck in your lungs like this, several things happen:

• Blood flow to your lungs becomes very limited.
• The oxygen level in your lungs drops down.
• Blood pressure in the lung blood vessels, known as the pulmonary arteries, goes up.

This is a medical emergency. If you do not get treatment fast, a pulmonary embolism can damage your heart or your lungs, and sometimes even cause death. In fact, about 33% of people with a pulmonary embolism pass away before doctors can diagnose and treat them. That shows you just how serious this condition can be.

However, if you get a correct and fast diagnosis and prompt treatment, this condition rarely turns fatal.

How Common Is This Condition?

You might wonder how common a pulmonary embolism really is. In truth, it is one of the most common heart and blood vessel disorders seen across the world. To be exact, it is the third most common vascular disease after heart attacks and strokes. Think about it: in the United States alone, about 900,000 people get a PE each year. So this is definitely not something you should ignore.

What Are the Symptoms?

The earliest signs of a pulmonary embolism are usually trouble breathing and chest pain. This pain can get worse when you exert yourself or take a deep breath.

If you have these kinds of symptoms, you must seek medical help right away. Even though a pulmonary embolism is serious, doctors can treat it very well. Quick treatment cuts down the risk of death by a large margin.

The symptoms of a pulmonary embolism can vary depending on how big the clot is. While many people have clear symptoms, some people might show no signs at all.

The main symptoms you might see include:

• A sudden shortness of breath - this can happen whether you are active or resting.
• Breathing very fast.
• A wheezing sound when you breathe in and out.
• An unexplained, sharp pain in your chest, arm, back, shoulder, neck, or jaw. This pain can feel like a heart attack and might get worse when you breathe.
• A cough - sometimes bringing up pink or bloody mucus.
• Pale skin, sweating, or a bluish tint to your skin or lips.
• A fast heart rate or pulse.
• Heavy sweating all over your body.
• In some cases, feeling restless, dizzy, lightheaded, or even fainting and losing consciousness.

How Long Can Someone Have This Without Symptoms?

Some people start with very mild signs. These mild signs might linger for days or even weeks. Over time, the symptoms slowly get worse until they finally catch your attention. Yet, other people might get sudden symptoms within minutes, or even seconds, of the clot forming. That is why you must always stay alert and pay attention to your body.

What Causes It?

Now let us look at how a pulmonary embolism happens and what causes it. The main cause is a blood clot that forms in a vein in another part of your body, especially in your legs or arms, and then breaks loose to travel to your lungs. Doctors call blood clots that form in places like your legs deep vein thrombosis, or DVT.

Several main factors can cause these clots to form:

• Blood pooling or slowing down in one part of your body, usually an arm or a leg. This usually happens after surgery when you stay in bed for a long time, or when you stay still for a long trip in a car, train, or plane. Think about it: when you sit in the exact same position for hours, blood flow in your legs slows down. That raises your risk of forming a clot.
• Damage to a blood vessel. This can happen because of a broken bone or surgery, especially around your hip, knee, or leg.
• Other medical conditions. Examples include cardiovascular disease, congestive heart failure, atrial fibrillation, a past heart attack, or a stroke.
• Changes in your blood clotting factors. Certain types of cancer, hormone replacement therapy, or birth control pills can make your blood more likely to clot. People who have inherited blood clotting disorders also face this risk.

Who Has a Higher Risk?

Let us look at who has a higher chance or risk of getting a pulmonary embolism. Certain habits, medical conditions, and life situations raise this risk.

• People who already have a blood clot in the leg, known as deep vein thrombosis or DVT.
• People who stay still for a long time while traveling in a car, train, or airplane, such as on a long road trip across the country.
• People who recently had surgery, a broken bone, or a condition like varicose veins that injured a blood vessel.
• People who use hormone-based birth control methods like pills, patches, or rings, or who take hormone replacement therapy.
• People who have a diagnosed blood clotting disorder.
• People who have a family history of blood clots.
• People who currently smoke cigarettes.
• People who have diabetes mellitus.
• People who suffer from cancer.
• Adults who are over the age of 60.
• People with a past history of heart failure, heart attack, or stroke.
• People with a body mass index, or BMI, over 25, meaning they are overweight, or over 30, meaning they have obesity.
• Pregnant women or women within six weeks after giving birth.
• People who have a central venous catheter placed inside a vein in their arm or leg.

If you have one or more of these risk factors, and especially if you have had a blood clot before, talk with your doctor to take steps to lower your PE risk.

What Complications Can Happen?

A pulmonary embolism can lead to serious health complications:

• Cyanosis - a bluish color on your skin because of low oxygen levels.
• Heart attack.
• Stroke.
• Pulmonary hypertension - high blood pressure inside the blood vessels of your lungs.
• Shock.
• Pulmonary infarction - the death of lung tissue due to a lack of blood flow.

Because these are severe conditions, quick medical care for a PE is vital.

How Do Doctors Diagnose It?

If you have these symptoms, how does a doctor figure out if you have a pulmonary embolism? They will check your symptoms and your risk factors, and then run several tests.

• Blood tests - one key test is the D-dimer test, which checks for clot fragments in your blood.
• CT angiogram - a specialized CT scan that looks closely at the blood vessels in your lungs for clots.
• Leg ultrasound - an imaging test to check your legs for deep vein thrombosis, since a clot there can travel to your lungs.
• V/Q scan - a ventilation-perfusion scan used to find blood clots in your lungs if you cannot take the contrast dye for a CT scan.
• Pulse oximeter - a small clip placed on your finger to check your blood oxygen level quickly.
• Echocardiogram - an ultrasound picture of your heart to see how well it is pumping.

Doctors may also use other tests:

• Pulmonary angiogram.
• Chest X-ray.

How Do Doctors Treat It?

A pulmonary embolism is a medical emergency that requires fast treatment. Doctors usually treat this condition by admitting you to a hospital. This lets your medical team monitor your health closely. How long you stay in the hospital depends on how severe your clot is. In some mild cases, patients might not need an overnight hospital stay.

The main treatment for a pulmonary embolism is anticoagulant medicine, which helps thin your blood.

Depending on how serious your clot is and how much it affects your heart and other organs, doctors might also use thrombolytic therapy (clot-dissolving treatment), surgery, or other interventional procedures to restore normal blood flow in your lungs.

Anticoagulant Medicines.

In most cases, doctors prescribe anticoagulants, commonly known as blood thinners. These drugs lower your blood's ability to clot. This stops new clots from forming and keeps existing clots from getting bigger.

Like any medicine, you must follow your doctor's instructions carefully on how and when to take your blood thinners. The type of medicine you get, how long you take it, and what follow-up tests you need will depend on your specific diagnosis. Make sure to keep every appointment your doctor and lab give you. This lets them check how well your body responds to the medicine. While taking anticoagulants, you may need regular blood tests, such as a prothrombin time test, to check how fast your blood clots.

Compression Stockings.

These are special elastic stockings. They improve blood flow in your legs. You may have seen people with deep vein thrombosis wearing them. You should use these stockings exactly as your doctor tells you. They usually reach up to your knee. They squeeze your legs gently to stop blood from pooling in one spot. Ask your doctor how to wear them, how long you need them, and how to wash and care for them.

Other Treatment Procedures.

If a pulmonary embolism threatens your life, or if other treatments do not work well enough, your doctor may recommend surgery or a catheter procedure to remove the blood clot from your pulmonary artery. Thrombolytic therapy is another option. This uses clot busters, such as a medicine called tissue plasminogen activator or TPA. Doctors give these strong drugs in a hospital emergency department or intensive care unit (ICU) while monitoring you very closely. If your blood pressure is low or your condition is unstable due to a PE, doctors may use these advanced treatments.

Sometimes, your doctor may recommend placing a vena cava filter. This device acts like a tiny net. Doctors place it inside the main vein of your body so it catches any loose blood clots before they can reach your lungs.

Side Effects of Treatment.

The main side effect caused by the medicines used to treat a pulmonary embolism is bleeding. That is why doctors take great care to give you the exact right dose of anticoagulant or thrombolytic drugs. Staying in the hospital during the initial treatment makes it much easier for your care team to monitor your health safely.

How Fast Will You Heal After Treatment?

You may start to feel better about a week after starting treatment. Even so, recovering completely from a pulmonary embolism can take many months, or sometimes even years.

When blood vessels in your lungs get blocked, your heart has to work much harder to pump blood. Think of it like a water motor working harder when a garden hose gets pinched. Because of this extra strain, some people find that one of their heart chambers takes months to return to normal after a PE. This can make it hard for them to do heavy physical work or exercise like they used to.

Can You Prevent It?

Yes, you can take steps to prevent a pulmonary embolism in many cases. To help protect yourself, follow these healthy habits:

• Exercise regularly. If you cannot walk around easily, move your arms, legs, and feet for a few minutes every hour. If you know you must sit or stand still for a long time, wear compression stockings to keep your blood flowing well.
• Drink plenty of water. Keep your body hydrated, but cut back on alcohol and caffeine drinks.
• Avoid tobacco products. Do not smoke or use nicotine products.
• Do not cross your legs when you sit.
• Avoid wearing tight clothes that cut off circulation.
• Maintain a healthy body weight.
• Prop your legs up for about 30 minutes twice a day.
• Talk with your doctor about ways to lower your personal risk factors, especially if you or someone in your family has had a blood clot before.
• Ask your doctor if a vena cava filter is right for you.

What Can You Expect If You Have a PE?

If left untreated, a pulmonary embolism is a very serious condition that can cause permanent disability or death. Some people pass away within hours or even minutes of a pulmonary embolism starting. This can happen before a doctor even gets a chance to diagnose it.

If you have an underlying heart or lung disease, your risk of dying from a PE goes up. However, thanks to modern, advanced imaging methods, only 1% to 3% of people with a pulmonary embolism face fatal outcomes today.

With proper treatment, your outlook depends on the size of the blood clot, the extent of the blockage, your overall health, and how well your heart can pump blood.

Does a PE Go Away Completely?

A pulmonary embolism can take months, and sometimes years, to clear up entirely. In some cases, repeated blood clots can lead to a long-term condition called chronic thromboembolic pulmonary hypertension, or CTEPH.

How Can You Care for Yourself?

You may need to take blood-thinning medicine for three to six months, or sometimes even longer. Never stop taking your medicine until your doctor tells you it is safe. While taking blood thinners, try to stay safe and avoid activities where you might get hurt or bleed easily.

Talk with your doctor to understand your follow-up care plan completely. Follow their advice to lower your chances of getting another PE. They may suggest quitting smoking, exercising more often, or changing your diet.

Always go to every follow-up appointment and lab visit so your doctor can check how well you respond to your prescribed treatment.

If you feel anxious, scared, or nervous after your PE, ask your doctor about talking with a counselor. Getting professional support can help you cope.

When Should You See a Doctor?

Keep all of your scheduled follow-up appointments with your doctor. While taking blood thinners, call your doctor right away if you notice black stools, severe headaches, or bruises that grow larger. These can be warning signs of bleeding inside your body.

What Questions Should You Ask Your Doctor?

Here are some helpful questions you can ask your doctor during your visit:

• What is the best treatment choice for my specific condition?
• How long do I need to take the medicine you prescribed?
• When is my next follow-up appointment?

After a pulmonary embolism, you may realize that your daily life will not go right back to how it was before. Accepting this change takes time. Having fears about getting another clot is normal, but friends or family members may not always understand how you feel. Because of this, talking about your fears with a support group or a counselor can help. Fight your fears by following your doctor's instructions closely, including taking your prescribed medicines every single day.

References: Cleveland Clinic, Mayo Clinic, National Health Service (NHS), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH).