Pulmonary Embolism Warning Signs: When to Call 911 and Who Is at Risk

What it involves

MedlinePlus explains that a pulmonary embolism, or PE, is a sudden blockage in a lung artery, usually when a blood clot breaks loose and travels through the bloodstream to the lungs. The clot most often starts as a deep vein thrombosis, or DVT, in the leg. PE can cause permanent lung damage and low oxygen levels, and it can be life-threatening.

Who this is for

• Adults who have had a blood clot in the leg and want to understand their risk of a clot in the lung
• Patients recovering from surgery, a broken hip or leg bone, or long periods of bed rest
• People who take hormone-based medicines or who have cancer, heart or lung disease, obesity or a family history of clots
• Family members who want to know the warning signs before they are needed

What to expect

• A review of your clot risks, including surgery, long travel, hormone medicines, family history and past clots
• An exam of the legs for pain, redness and swelling, plus your heart rate and breathing
• Blood work and, at the Loxahatchee and West Palm Beach offices, an EKG when your provider thinks it is useful
• A same-day plan: emergency care if clot symptoms are present, or a referral for an ultrasound or other testing

The signs that mean call 911

MedlinePlus lists shortness of breath, rapid breathing, chest pain or discomfort that usually gets worse when you cough or take a deep breath, a fast heart rate, coughing up blood, and very low blood pressure, lightheadedness or fainting. The encyclopedia adds that the pain can be sharp, stabbing, burning, aching or heavy, and can be eased by bending over. It says to go to the emergency room or call 911 if you have symptoms of a pulmonary embolus. The chest pain guide and the shortness of breath guide cover the non-emergency versions.

Why this is not an office visit

MedlinePlus says a PE needs treatment right away, often in the hospital, with medicines that thin the blood and, in severe cases, medicines or procedures that dissolve or remove the clot. Diagnosis is difficult and usually involves imaging, such as a CT angiogram of the chest or a ventilation-perfusion scan, and blood tests such as a D-dimer. Those are hospital tests. The sick visit, urgent care or ER guide helps you choose the right place when the symptoms are not clear-cut.

Where the clot comes from

The encyclopedia says the most common source is a deep vein thrombosis in the thigh or pelvis, a clot that breaks off and travels to the lungs. Less common causes include air bubbles, fat droplets, amniotic fluid and clumps of tumor cells. Leg pain, redness or swelling can be the first sign of a DVT, and the leg blood clot warning signs guide and the leg swelling guide explain what a provider looks for before a clot ever reaches the lungs.

Who is at higher risk

MedlinePlus names surgery, especially joint replacement; cancer, heart disease and lung disease; a broken hip or leg bone; hormone-based medicines such as birth control pills or menopause hormone therapy; pregnancy and the weeks after childbirth; and not moving for long periods, such as bed rest, a cast or a long flight. Risk also rises with age after 40, with a family history or genetic clotting changes, and with obesity, which the obesity and BMI guide explains. Knowing your own list lets you act on early signs.

After a clot: follow-up

MedlinePlus says anticoagulants, or blood thinners, keep clots from getting larger and stop new ones from forming, and that they can cause bleeding, especially when taken with other medicines that thin the blood, such as aspirin. The encyclopedia says how long they are needed depends mostly on the cause, and that some people develop long-term heart and lung problems. Tell every provider which medicines you take. The easy bruising guide describes how unexplained bruising is evaluated. Clots in the lungs are also listed as a cause of high pressure in the lung arteries, which the pulmonary hypertension symptoms guide describes.

Prevention to discuss at a visit

The encyclopedia says blood thinners may be prescribed to help prevent DVT in people at high risk or having high-risk surgery, that pressure stockings may help with long-term swelling after a DVT, and that moving your legs often on long plane or car trips helps. It advises people who smoke to quit, and the quitting smoking guide explains where to start. Ask your provider about your own risk before surgery or a long trip, and keep leg pain or swelling on your list for the next visit. Coughing up blood is one of the warning signs of a clot in the lung, and the hemoptysis guide lists the other causes and when an emergency visit cannot wait.

Sources

• MedlinePlus: Pulmonary Embolism (health topic)
• MedlinePlus: Pulmonary embolus (medical encyclopedia)