Are you currently experiencing chest pain? Head to the nearest emergency room.
You have probably had an episode of chest pain at some point in your life. Most of the time it is nothing serious. The cause of your chest pain can range from a temporary muscle strain, to esophageal reflux or to a life-threatening lung or heart conditions.
We do not recommend that you go through a checklist or an online search for self-diagnosis if you are experiencing chest pain right now. However, knowing the signs of a serious condition can help you take quick action and save you or a loved one’s life.
Do you or a loved one have a history of venous disease or blood clots? We want you to know the signs of a pulmonary embolism (PE). Caused by a blood clot in the lungs, PE is a life threatening emergency. Head to the nearest emergency room or dial 911 if you think you or someone you love has a PE.
More Than Chest Pain: Symptoms of a Pulmonary Embolism
In addition to sharp chest pain, PE presents suddenly, other common symptoms include:
- rapid heartbeat,
- shortness of breath,
- a cough which expels pink, frothy mucus.or makes the chest pain worse.
Less common symptoms that may alert you to the presence of a PE include:
- anxiety, or sense of impending doom,
- excessive sweating,
- lightheaded sensations or fainting, and
- heart palpitations.
What Causes a Pulmonary Embolism?
Long before you have a PE with chest pain and shortness of breath, a blood clot has formed somewhere in a vein. The most likely site is in the deep veins of the legs. These clots are known as Deep Vein Thrombosis (DVT).
The exact number of DVTs per year is unknown since many are never diagnosed. The CDC suggests that DVT affects as many as 900,000 Americans per year. Based on these numbers, DVT is one of the most under-diagnosed conditions in the United States.
Symptoms of a Deep Vein Thrombosis:
If you have a DVT, 50% of the time you may have ‘no symptoms.’ When symptoms do occur, they may include one or more of the following:
- sudden, unexplained leg pain
- difficulty walking
- reddened skin which is tender and/or hot to the touch
If you suspect you may have a DVT, you should seek immediate medical attention. Early diagnosis and treatment may prevent a life threatening PE and other long term leg complications in your legs known as Post Thrombotic Syndrome.
What Happens in the Emergency Room?
When you present to the ER with symptoms such as shortness of breath and chest pain, the most important thing you can do is ask the doctor, “How do you know I do not have a PE?” As PE symptoms are often similar to other medical incidents, such as panic attacks and heart attacks, doctors must act quickly to determine the cause and correct course of action.
Blood tests, CT scans, EKG/ECG, ultrasound, and/or MRIs may be performed in addition to a physical exam and patient intake questions.
If you are diagnosed with a PE, the outcome depends on the expertise of the treatment team activated to provide your care. Depending on the severity of the PE, the team will determine the best treatment option. If you are clinically stable, you may do well with hospitalization and blood thinners. If you are not stable, other treatments may be needed. When indicated, thrombolytics may be administered to dissolve the clots quickly. For some patients, surgery is required to remove the clot. If diagnosed and treated in a timely manner, lives can be saved.
If you are diagnosed with a DVT, depending on the vein that is thrombosed and your symptoms, additional treatments may be needed. Most DVT are treated with a blood thinner. In more serious DVT that may threaten the limb thrombolytic is used.
If you cannot take blood thinners or do not respond well to them, a temporary filter may be placed (into the vena cava) known as vena cava filters. The filter allows healthy venous blood flow while preventing clots from traveling to the lungs. It is important to remove these temporary filters once you are better to avoid long term filter complications.
Who is at Risk for Pulmonary Embolism?
DVT and PE can happen to anyone, but there are circumstances which put you at a higher risk. These include:
- Long Periods of Inactivity: If you were injured, had surgery, are put on bed rest, or simply have a desk job which keeps you inactive for long periods of time, your risk of DVT and PE increases.
- Diseases: Cancer, heart failure, stroke, and severe infections have all been linked to DVT and PE.
- Motherhood: Pregnancy and childbirth both contribute to blood clots. Hormonal changes and weight gain affect circulation, putting you at greater risk. Additionally, if you are on bed rest or have a c-section, your risk goes up.
- Hormones: In addition to pregnancy hormones, hormone therapy and birth control also affect healthy circulation and are linked to DVT.
- Age: DVT can happen at any age but it is more common in adults 70 and older.
- Weight Gain: If you are overweight/obese, your risk of blood clots is very high.
- Smoking: If you are a smoker, it’s not just your lungs you should worry about. Circulation is negatively affected by smoking, increasing blood clot risks.
- Previous PE Diagnosis: If you have had a PE before, you’re more likely to have one again. Preventative measures should be taken and followed to avoid future episodes.
- History of DVT: If you have had blood clots in the deep vein, you are at a higher risk of PE. It is important to have your legs checked regularly by a specialist to catch and treat blood clots as well as prevent them.
The Link Between Varicose Veins and DVT/PE
We have long suspected a link between varicose veins and DVT/PE. This suspicion was confirmed during a recent JAMA study which showed a connection between venous disease and blood clots. While it is still unclear if varicose veins contribute to DVT or if they are simply more likely to occur under the same circumstances, we recommend routine DVT screening for patients who have venous disease.
If you have visible varicose veins, even if they do not bother you, please see us for an evaluation to protect yourself against more advanced venous disease, DVT, and PE.