What is a Pulmonary Embolism?
A pulmonary embolism is the term for a clot trapped in the lung. It is often referred to simply as PE, which of course is short for pulmonary embolism. The clot that is trapped in the lung leads to blockage of blood flow and can be extremely dangerous if not treated appropriately.
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This picture demonstrates a clot being extracted surgically from the lung artery of a patient with a massive pulmonary embolism.
Pulmonary Embolism – A Big Deal
Pulmonary embolism is a big deal, being both common and dangerous. It’s common with almost a million cases a year in the US alone. It is dangerous because almost a quarter of pulmonary embolism cases present as sudden death and up to a third of pulmonary embolism will ultimately be fatal. For those that survive the pulmonary embolism there is the possibility of decreased life expectancy and the development of complications that can impair quality of life. For this reason it’s critical to make sure that pulmonary embolism is correctly diagnosed and properly managed as that can make all the difference.
These specimens are clot that have been surgically removed from the lung arteries in a patient with massive pulmonary embolism.
How Does Pulmonary Embolism Start? – It All Starts With A DVT, a Clot That Forms In the Veins of the Leg
Really where it all starts is that clots form in the veins of the leg known as a DVT, short for deep venous thrombosis. Let’s take a little time to explain this in a simple manner so we can understand pulmonary embolism better.
Every time the heart beats it pumps blood to the body through arteries. The blood is pumped with force and the flow in these arteries is fast. For that reason if you were to cut your artery, blood would spurt out fast and furiously because of the high pressures in arteries. Once the blood has reached the target organ, it must return to the heart, and it does this through the veins. Flow in the veins is much slower with a much lower pressure. If you were to cut one of your veins then blood would certainly pour out, but since the pressure is low it would be nowhere near as fast or forceful as an arterial bleed. In fact with a venous bleed you could easily stem the flow of blood with gentle pressure over the skin. With an arterial bleed some serious pressure would need to be applied.
So why do clots occur? Three things are thought to be critical in clot formation. Firstly is something called hypercoagulability, second is flow pattern and third is injury to the vessel. These three things are known as Virchow’s triad. Don’t worry, its not that complicated, I’ll explain below.
First in the triad was hypercoagulability, this basically means that for some reason the blood is more likely to form clots because of the changes in the chemicals within it. These chemicals known as clotting factors influence the whole process of clot formation. Simply put, these can make the blood super thick or super thin. Of course if the blood is super thick then clots will be more likely to form. Certain medicines, diseases or genetic abnormalities, can influence the clotting factors and make the blood more likely to be thick. A good example of this is birth control pills. These pills are therefore well-recognized risk factors for clot formation and pulmonary embolism.
Secondly in the triad was flow pattern. If you were to take some blood and pour it into a cup and wait a minute, the blood would form a clot because it’s not flowing. If you were to take the same blood and pour it down a steep hill it wouldn’t clot because it’s moving fast. The clotting factors in the blood need time to work and if the blood is flowing fast they don’t really have time. For this reason clot is much less likely to form in the high pressure arteries and much more likely to form in the low pressure veins. Every time you stand up or walk, you pump blood through the veins. If you sit still for a long time, blood flow is much slower and of course clots are more likely to form. Good examples are really long plane flights, or patients that have had surgery and are unable to be active for a while. These patients are at risk of developing blood clots in their veins and are therefore at risk of pulmonary embolism.
Third and finally is vessel injury. The arteries and veins of the body are not just lifeless tubes for blood to flow through; they are made of cells that are smart and always active known as the endothelium. These cells can sense everything from patterns of blood flow to the composition of the blood. These cells can secrete chemicals and send signals if they want certain things to happen. A good example is if there is injury to the vessel that causes bleeding. The cells will release chemicals that attract cells that can form clot in an attempt to stop the bleeding. When the cells are injured they are more likely to do that. For this reason, if there has been damage to the vessels through surgery, or if someone has fallen or been hit on the leg, a clot would be more likely to form.
You should now have a good understanding of what causes clots to form in the veins known as DVT’s. Pulmonary embolism usually starts with a DVT. We just talked about the triad that consists of blood more likely to clot, slow flow, and injury to the vein. So as you can imagine, the perfect candidate for developing a clot would be a person that is in bed after a leg injury, unable to do much activity, with a disease such as cancer leading to thicker blood, also taking medicine that leads to a higher likelihood of clot forming. That would be almost a perfect storm.
The Pulmonary Embolism Occurs – The Blood Clot Travels From the Leg Veins to the Lung Where It Is Trapped
We have now talked about a clot that forms in the veins of the leg. That clot is called a DVT, or deep venous thrombosis. The veins are like the highway used by the blood to get back to the lungs. In order to get to the lungs the blood has to travel through the right side of the heart. Now lets imagine the nice big blood clot that has formed in the leg gets loose. It slowly makes its way back up through the veins of the body, through the right side of the heart, and in to the lungs. Usually when blood reaches the lungs it is a thin fluid that can pass through the lung vessels easily. When a clot reaches the lungs however it is a large structure that basically just gets stuck, and is known as a pulmonary embolism. The larger the clot the bigger the amount of blockage caused. Sometimes the clot can be so large that it gets trapped in the main artery that leaves the right side of the heart known as the main pulmonary artery. If that happens no blood can leave the heart at all due to the obstruction, and this will almost inevitably result in sudden death. This is known as a massive pulmonary embolism.
The Seriousness of a Pulmonary Embolism Depends on the Strain Placed on the Right Side of the Heart
The pulmonary artery leaves the right side of the heart and supplies the lungs with blood. The main pulmonary artery is a large fast flowing vessel that leaves the heart. This branches into a left and right artery that that are medium sized, then these in turn branch into smaller and smaller pulmonary arteries. So basically the pulmonary arteries get smaller and smaller the further away from the heart they are. The larger the artery blocked by the pulmonary embolism, the more strain placed on the right side of the heart. The more strain placed on the right side of the heart the worse the outcome.
Why is this? The right side of the heart usually gets to pump in to a large artery, the pulmonary artery. Imagine a large pulmonary embolism where a clot was blocking that artery. The heart would have to pump the same amount of blood, but through a smaller hole. This means the heart would have to generate a higher pressure. If the blockage were large enough then the pressure generated would be so high that it overwhelms the right side of the heart. This leads to failure of the right-sided heart-pumping chamber, the right ventricle. This is known as right ventricular dysfunction. The consequences of right ventricular dysfunction can include fatal heart rhythms and development of shock.
It’s also important to note that the blood supply to the lung is also shut off. This can lead to less oxygen content of the blood and also to areas of the lung dying due to lack of blood supply known as pulmonary infarction.
Signs and Symptoms of a Pulmonary Embolism
The most common presenting symptom of a pulmonary embolism is shortness of breath, that occurs fairly rapidly, either at rest, or when performing activity. Other symptoms may include chest pain, dizziness, or passing out. Patients may have had recent leg swelling or leg pain from the clot that started in the leg.
Diagnosis of Pulmonary Embolism
Once a patient comes in with signs and symptoms suggestive of a pulmonary embolism, a number of tests can be performed to confirm the diagnosis.
- Blood tests – A test called a D-dimer may be performed, levels of which will be elevated in the presence of a clot in the body. Blood tests suggestive of heart strain, troponin levels and BNP levels may be elevated in pulmonary embolism
- CT Scan – A CT scan known as a CT angiogram is really the best way to diagnose pulmonary embolism. It can provide information on the size, extent and location of the clot. It can also provide information regarding heart strain.
- Ultrasound Scan – An ultrasound scan of the legs may be performed to look for evidence of clot in the veins of the leg.
- Echocardiogram – This is an ultrasound scan of the heart that may demonstrate evidence of heart strain. An enlarged or dysfunctional right side of the heart is suggestive of pulmonary embolism.
- EKG heart tracing – An EKG tracing shows the electrical activity of the heart and may demonstrate a fast heart rate and can also show evidence of right-sided heart strain. There are also some specific patterns on the EKG that may suggest pulmonary embolism.
- V/Q scan – This is a nuclear medicine scan that looks for areas of the lung that aren’t receiving appropriate blood supply and may therefore be affected by pulmonary embolism.
- Pulmonary Angiogram – This is the gold standard test, where contrast dye is injected directly in to the pulmonary arteries. This may be done at the time of a therapeutic procedure, however it is not typically done as an initial test because CT scanning is now so accurate.
This is an echocardiogram that demonstrates a large amount of clot seen floating in the right side of the heart as it passes through on its way to the lung where is will result in a pulmonary embolism.
A pulmonary angiogram demonstrating a huge clot that has lodged in the artery of the lung. This clot was so large that it caused the heart to stop and required urgent aggressive treatment.
Another pulmonary angiogram in a patient with a large pulmonary embolism. Contrast dye is injected in to the lung where large areas of clot are seen throughout the arteries of the lung.
How Do We Determine The Seriousness of a Pulmonary Embolism?
Surprisingly it’s not necessarily the amount of clot that it is important. Determining the seriousness of a pulmonary embolism really comes down to one thing, how much strain is placed on the right side of the heart. The terminology we use for pulmonary embolisms is Massive, Submassive, or lower risk.
Massive Pulmonary Embolism
Massive Pulmonary Embolisms are extremely high-risk events and as serious as you can get. Massive pulmonary embolism patients are unstable and may often present with sudden cardiac death. The right side of the heart will be severely dysfunctional and it will be difficult to maintain a blood pressure. Patients will be in shock. Patients in this category are often so unstable that they will require medicines to support their heart and may need insertion of a breathing tube. These massive pulmonary embolism patients are at high risk for sudden death. The official definition of massive pulmonary embolism is a pulmonary embolism directly causing cardiogenic shock with blood pressure <90mmHg or drop in blood pressure of over 40 points. Patients with massive pulmonary embolism are at high risk of death. Treatment of massive pulmonary embolism needs to be aggressive and emergent.
Submassive Pulmonary Embolism
Submassive pulmonary embolism means that while criteria for massive pulmonary embolism is not met, and the patient may appear to be relatively stable; there is still evidence for right-sided heart dysfunction. Although not as high risk as those with a massive pulmonary embolism, this is still considered a high-risk group at risk of poor outcomes. To be designated a submassive pulmonary embolism, there has to be evidence of right-sided heart dysfunction. This can include, blood tests suggesting right-sided heart strain (BNP, troponin), heart tracing changes suggestive of right-sided heart strain (EKG) and imaging suggesting enlarged and weak right heart (CT scan, echocardiogram). Typically these patients will have a large amount of clot in the lungs. Although submassive pulmonary embolism needs to be taken very seriously, there is a wide range of severity with some submassive pulmonary embolisms more serious than others. Not everyone with a submassive pulmonary embolism will require aggressive treatment although its important to identify those that are at high risk and treat them appropriately.
Other Pulmonary Embolism
Most pulmonary embolisms will fall in this group. Although a diagnosis of pulmonary embolism is made, there is no evidence of right-sided heart dysfunction and the patients are considered stable. For those treated appropriately the likelihood of a good outcome is high. There is generally no role for overly aggressive treatment in these patients and the mainstay of treatment is to start blood-thinning medications.
Treatment of Pulmonary Embolism
Treatment of Massive Pulmonary or High Risk Submassive Pulmonary Embolism
These are a medical emergency and immediate treatment is needed there are a few different treatment options. Often the treatment chosen will depend on what is available at that facility.
- Clot Busting Medications – The most traditional option is the use of clot busting medications known as thrombolytics, or lytics for short. These medications are typically given through an IV and they travel to the clot where they can try to dissolve the clot. The major drawback of these medications is that there is a significant risk of bleeding that can be life threatening such as a bleed in the brain. In general however the risk of treatment is seen to be less than the risk of doing nothing. Unfortunately there are often situations where the risk of these clot-busting medications are seen to be too high, such as in those patients with known bleeding issues or recent surgery.
- Open Heart Surgery – Sometimes, particularly when there is a very large clot burden or clot known to be floating inside the heart, open-heart surgery may be the preferred treatment option. The chest is opened and the clot is extracted. The downside to this approach is of course the risks of open-heart surgery. In most situations where it is considered, however, the risks of surgery are less than the risk of not treating the pulmonary embolism. The advantage of open-heart surgery is that it can allow for immediate stabilization of the situation in cases where patients are very unstable.
- Catheter Based Treatment – This is the most cutting edge of the treatment options. The pulmonary embolism is treated through small tubes that are typically inserted through the veins of the leg. Different techniques can be used to treat the clot and often injections of clot busting medicines are given directly in to the lungs. An exciting recent development is the use of ultrasound tubes that are inserted into the lung through which micro-doses of clot busting medicines are used. The advantage of this being a much lower risk of bleeding as compared to the traditional doses of the clot busting medications.
- ECMO – This is short for extra-corporeal membrane oxygenation. This is like a heart lung machine that can be used in the treatment of unstable pulmonary embolism. This allows restoration of the circulation if the heart stops or is severely dysfunctional and ensures the organs receive the blood they need. Also the machine allows the blood to be oxygenated in those cases where the lungs aren’t able to function properly. In short ECMO can allow stabilization of an unstable situation and also give time for the situation to recover.
This is a fluoroscope video of 2 special tubes known as catheters that are passed through the veins of the leg into the arteries of the lung. These EKOS catheters emit ultrasound waves that make clot-busting medicines very effective at small doses. Clot busting medicines are slowly dripped through these catheters that will dissolve the lung clot.
A large pulmonary embolus lung clot being surgically taken out of a lung artery from a patient with a massive pulmonary embolism.
Treatment of Pulmonary Embolism That is not High Risk – Blood Thinning Medication
Most pulmonary embolisms that present to hospital are not massive or submassive and fall in to a category that is generally lower risk. The mainstay of treatment for these is blood-thinning medications. Blood thinning medications prevent the clot from enlarging and allow the body to naturally break down the clots. Patients will have to stay on blood thinning medication from 6 months to life long depending on the circumstance.
- Heparin – Initially heparin used. This is a commonly used blood thinner and typically given in the form of a drip. The dose of heparin can be adjusted as necessary to ensure adequately thin blood. This may be transitioned to an injectable form of heparin such as lovenox.
- Warfarin – This is the longest standing medication used for blood thinning. This is taken as a tablet and it takes a few days to get the blood thin. Its levels are monitored with a blood test. The downside is that the blood needs periodic monitoring to ensure levels are in the desired range, and there are some dietary restrictions.
- NOACs – Short for novel anticoagulant agents. These include Rivaroxaban, Eliquis, Pradaxa, Savasya and others. These are given in tablet forms and the advantage is that monitoring of blood levels is not required.
Risk Factors for Developing Vein Clots
Age is a well-known risk factor. The older someone is, the higher the chance of developing a clot. Simply being in hospital is a well-established risk factor. Other risk factors include use of medicines such as oral contraceptive pills, periods of immobilization, pregnancy, surgery and cancer.
Inherited Clotting Disorders
Inherited clotting disorders are a common cause of development of vein clot (venous thrombosis) that can lead to pulmonary embolism. In patients with a family history of clot development, almost half of patients will be found to have an inherited clotting disorder. These are often due to malfunction or mutations of certain clotting factors. These include, deficiency of antithrombin, protein C, and its cofactor protein S. Another relatively common one is resistance against activated protein C caused by factor V Leiden. The presence of these disorders, in combination with other risk factors such as immobility or injury is a particularly dangerous combination.
Blood Disorders
Development of certain conditions can also predispose to clot development and therefore development of a pulmonary embolism. These can include antiphospholipid syndrome. Other conditions include polycythemia, paroxysmal nocturnal hemoglobinuria and essential thrombocytosis amongst others. The presence of these disorders, in combination with other risk factors such as immobility or injury is a particularly dangerous combination for causing vein clot and a pulmonary embolism.
Loved the information. The best I’ve seen so far. I would love to have seen the morbidity results.
What is the longevity of people who have these conditions.
If clots are removed is it like having your appendix removed? They remove the clots in you just go on with your life after healing from the surgery.
I was just diagnosed with multiple clots in both of my lungs I’m on xaelto now my question is how and when do I find out if the clots are gone and will they eventually marry be maybe to the heart? I am 52 they also did ultra sounds of both legs and did t find no clotting there so my other question is where did it come from then?
It would have started in the legs then moved to the lungs. Its now no longer in the legs and thats why the scan was negative. The clots should ‘auto-dissolve over the few weeks after the event’ while on blood thinner.
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interested in article however my friend had severe left ventricle dysfunction which was found after admission to hospital having collapsed due to pulmonary embolysm. The article/information only addresses the connection with right ventricle dysfunction… ?
Does left ventricle dysfunction have a different outcome and is it less serious?
https://myheart.net/articles/heart-function-including-ejection-fraction-ef/
See if this article is helpful.
you can follow my twitter at @MustafaAhmedMD
That is the same as me i dont know what is going to happen now as the clot has gone and i am seeing a cardiologist now if you no any information could you please share
When I had my Massive Pulmonary Embolism in August 2016, it didn’t come from my legs. It’s listed as UnProvoked
It almost certainly started in the legs but had migrated by the time the scan was done.
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Having read your article I now know that my 2 small PEs in my R. lung started in a leg. But I am active. I have had no pain or redness or swelling in either leg. I now know I have Factor V Leiden and an extended family history of DVTs and PEs. My sister and 2 nephews are on Xarelto 10 mg for life. My sister does not have Leiden but my nephews do. I have been on Xarelto 20mg for a year. My doctor wants to stop it but I am very frightened of having another PE, My older sister died from PE at the age of 64. I am almost 71. What can I do?
In many patients lifelong anticoagulation is recommended. Maybe discuss your history and risk factors and potentially seek a second opinion.
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Mine didn’t come from my legs either. They said it actually formed in the lungs! Good luck
Sir, my mother is hospitalized day before two days, we had CT where we saw pulmonary thrombosis. Now I want to know is that massive, submissive or third third category.. She’s complaining chest pain.. Doctors prescribed warfin and heparin… Please guide me is it worrying case for me…
Hi Dr. Ahmed,
I passed out at home, had a Massive PE, admitted to ICU for 9 days. Hospitalized for 16 days, I recovered rapidly. I had Breathing Tx q 6 hrs. I believe that helped me tremendously to gain my O2 ability to function in lungs. Also, I was given Lasix to reduce the swelling in my Left leg, it worked good, because it was huge!
You did not mention how SCD can cause clotting as well? Sickle Cell Disease is a factor for clotting, also my spleen was removed age 22, now 48. My Dr. says I produce many platelets. Recent blood test is still very High, also Lymphocytes High as well. My Left Foot is swollen and painful. Its been almost 2 months. I am on Eliquis, I preferred Xarelto better, but my Dr says Eliquis is better for me for high platelets. I’m pretty active and I’m a LVN, I’m ready to get back to life.
I know this is an old post .I was diagnosed with a upper extremity dvt from a pics line insertion .The dvt is in the brachial vein..I couldn’t tolerate blood thinners I lasted 3 weeks on eliquis and had to stop due to side effects. I am 10 weeks post dvt and now have shortness of breath and chest pain..I did have a ct pe scan 6 weeks post dvt and lungs were clear..My doc told me he doesn’t think it’s a pe causing my issues now.He stated most pes occur within a few days up to a month after the dvt. He stated the dvt is mostly likely adhered to the vein vessel..Your thoughts?
If the CT was done and saw no PE that is reassuring as that is the primary test.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
What were your side effects from Eliquis?
My husband has PE with infarction (which is not discussed) and was put on Eliquis in the hospital within 24 hrs of being admitted following heparin drip because they were going to discharge him but they did not have his pain managed. 48 hrs after Eliquis started he has a rash over back, arms and stomach.
Please refer me to information on what to expect with infarction. After 2 days in hospital, a pulmonary specialist stopped and validated pain, but then experienced fever (had to wait for infectious disease to say fevers come with infarction and stopped antibiotic hospitalist started), then got a rash and pulse ox dropped below 90 so on supplemental oxygen. Please help me understand what to expect.
I also was diagnosed with lots of pes in both lungs, after 6 months my lung doctor told me I was clear because I had had treatment (same as yours) and he took me off the blood thinners. I asked him how he could be sure they were gone and if I could have another test to confirm this. To cut a long story short he finally allowed me to get the test against his better judgement. The test showed I still have lots of PSs in both lungs. Insist on checking don’t just take their word.
i have the same medical problem. I’m having genetic testing done.
Hi Dr Ahmed
I would be most grateful if you could give me a general comment about Direct Acting Oral Anticoagulants. I have been on Warfarin @7.5mg per day since May 2017. I was also taking Carbamazepine for control of Trigeminal Neuralgia. An operation sorted that out and I stopped this drug in Dec 2017. This meant that I did not have any drug interaction contraindications for taking a DAOA: and I have been on 60mg daily of Edoxaban.
There is no monitoring now of course whereas I used to get quite a lot of feedback on INR while on Warfarin. This was not “so convenient” as Edoxaban but at least I knew what my levels were (trying to achieve 2.5, but in fact was rather unstable and often jumped up to 6.0 and when I was told to stop Warfarin, it undershot to about 1.5.
Now I have no idea if my anticoagulation is working effectively or if my old clots have “gone” or new ones prevented from forming.
Seems to be that I’d only know if things were not effective if I had more severe clots or even a PE!! Wow! So I am rather worried about this.
Are DAOAs as effective as Warfarin and how can I monitor this? There must be many thousands of people who’ve been on these drugs for many years. My general practitioner had not supplied further info about this for me, but I feel sure you will have a view on this in relation to preventing new clots and PE.
I am sorry this has turned out to be such a long message for you!
Yours
Duncan
For PE the evidence for DOA is excellent and are now essentially the preferred treatment in the current era.
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Maybe not relevant now but I have trigeminal neuralgia and PE. Tests found antiphospholipid syndrome with may underlie both conditions
What If you’re diagnosed with a large clot in your aorta vein
Thank you for breaking things down so that I can finally understand what I am dealing with. My particular case, was that the PE developed two weeks after surgery. Both lungs were affected. They found another clot in my groin, but thankfully I fall into the ‘other’ category. My question is that if I have a family history of stroke and heart disease (my mother and father) will this be a factor on how long I am on blood thinners?
Depends on many different factors. In your case the surgery was the precipitating event. I would suspect you would need blood thinners for at least 6 months, if not a year.
Hey. I’ve been having shortness of breath all day long for about a month now, even when I’m at rest Im still out of breath. I also get a matelliac taste in my mouth.I also sometimes get chest pains, and fever-like chills at night.I feel like I have the above but haven’t gone to doctor yet.
The fever aspect makes it sound potentially like an infectious process as opposed to pulmonary embolism. You need to go and see a doctor when you can.
I was recently discharged from the hospital with 11 ailments all of them due to bad medical advice and medical procedures contracted at the hospital. I started out with A-fib, then a pacemaker was implanted. I am 81 yrs. old and too old to be on pradaxa (300) . When I got the pacemaker the doctor told me to stop padaxa for 30 days. When I stopped the pradaxa I developed blood clots. fluid on the lungs, and couldn’t breathe. Pulmonay embolism. Then I got pneumonia and a UTI from catherization. Everyday it seems I had contracted something new. The worst part of it all is that I was put on heparin IV for 10 days and my platelets went down from 200,000 to 43. A blood sample was sent to the Mayo clinic and it was determined that I had contracted Hitt disease from the heparin. I nearly died, This was a horrible experience. I hope I never have to go back to that place ever again.
I sincerely hope you are OK. I read everything they had here and it helped me alot but scared me also. I am 63 bilateral pulmonary Embuli. I feel I am good but should be doing my shite list… Can’t think what it’s called. I truly hope to reach your lovely age. God Bless and keep you here with us.
I would like to Ask the doctor a question…I am the above Marilyn….I also diagnosis with alot of blood clots in Left leg then pulmonary Embuli three days hospital ultrasound… Echo and cat scan without and with dye. I felt normal before ER. Am on Eloquis now 5 mg twice a day. Was 20 a day for the first week home. Leg still swells a bit but now on leg stocking. After arrival at home Jan 6 the. 2017 had cough . They exray all was OK. Put on antibiotics. Then this past week fluid in eat. Now antibiotics again. Everyday I am slightly dizzy. Is this normal.
First Hitt is an adverse reaction to heparin , not a something you catch . You are unfortunately in the 1% of people you have HITTS .
Also we all unfortunately get to a time in our health ( and it’s different for everyone ) when treating one problem will cause another medical issue . It’s when our bodies start to break down and can happen at different times for different people depending on their health . For my son , his catch 22 problems happened as a baby and he died at 6 months due to being born with a severe genetic disorder
my daughter fell at the park and hit her head she had emergency brain Sergury and doctors said she was going to die then they found out she had a Pulmonary Embolism that went from the heart to the lung doctor said she couldn’t have Sergury Done but I see this vedeo and if this could be done on my daughter with special needs please contact me at (210) 251-8551 & I well give you my information below…I pray to God that you can help me with my daughter
Im sorry to hear about your daughter. If the pulmonary embolism is not life threatening and she is stable it may well be best to simply watch it and when possible start blood thinners. Use of blood thinners now may be dangerous if it is soon after surgery. Unless she is truly unstable from the clot, it may be best to treat it conservatively.
I am just 17 when I got acute pe when will the clott get removed or if it can be permanent plsss tell does eating oily will increase my pe threat more plss tell
Most clots will dissolve over the days to weeks after is occurs. Its important to be on blood thinner to allow that process to occur.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I am just 17 when I got acute pe when will the clott get removed or if it can be permanent plsss tell does eating oily will increase my pe threat more plss tell how long will I survive what are the chances of getting it again can clot be permanent
My Dad has just died following a PE. He had just had surgery for a burst appendix and blocked bowel and they gave him blood thinners. Should they have done this as it says they shouldn’t in your article. They said he also had a heart attack which they brought him back from but they also said if he had another heart attack it wouldn’t be my Dad. What would happen and what would he be like. Thank you
Hi I am a male 28 years old I have been smoking for 15 years I have been a functioning addict for 10 years (crack,coke,marijuana) I just had my first pulmonary embolism in my lung I have a hereditary disease called an antithrombrin 3 deficiency with a mutant factor. I have been clean from any drugs or alcohol for the last two months since my PE and I do not plan to ever return to any narcotics as the pain I went threw scared me very much and I realized how much I want to live. My question is how long roughly is the recovery of pain in the chest. Roughly what is the comman age of death in people who have PE at aroumd my age and stay on stop of taking there medication. What is the best thing I can do to ensure a good quality and long life. And also I climb and build cellphone towers for a living should I find a new profession.
You can do well, staying on the blood thinner is the key here. The chest pain should fully resolve within weeks. I tell my patients to refrain from things with more than an ordinary risk of bleeding (motorcycle, diving etc).
I had a large pulmonary embolism in each lung and had been feeling ill and breathless with chestpains for 3 months before they found them. By the time they did I was 6 weeks pregnant as it got misdiagnosed at first. d-dimer was 1700 and there was right side heart strain all though pregnancy I was told don’t do anything complete rest. I want to know what’s the likely hood of heart damage after being ill all though pregnancy. My clot didn’t go very quickly by the end of pregnancy it was still quite big.i am left with chestpains and breathlessness each day and since the pe a balance disorder and night seizures.
You need a repeat echocardiogram to see if your right side of the heart is back to normal and to monitor the pressures in the lung. Were you able to go on blood thinning medication?
Also I’m on warfarin for life as they didn’t want to risk me not on thinners I was on clexsane injections through out pregnancy and for a good five ,on the after while hy hemotologist watched me a d ran loads of tests as he was studying me and wanted to test for every reason possible that could of made me clot I don’t drink, smoke, wasn’t over weight I used to cycle and horse ride .
It has been almost six years since my pes now I have been discharged from the pulmonary doctor I had a echo done while I was still pregnant and she said it was fine. I went to the gynaecologist at the near end of pregnancy after the echo and was explaining that my lung doctor all though pregnancy had told don’t do anything to exsurt myself and I wasn’t told why he said its because of the echo.I replied she said it’s fine he shook his head no its not you have strain on the right side of your heart.. I still some days get chestpains it hurts to breathe and I still get night seizures and the balance disorder is still there .Along with the breathlessness if I over exsert myself and days where I wake up just breathless all day I don’t feel right it’s on these days my oxygen levels drop a bit to 92% it makes a difference when there usally 99% until a bad day.I had my disc removed at c5 c6 last year and woke up from surgery struggling to breathe and put on oxygen and i remained on it until I was discharged. I have a gallstone that’s been waiting for surgery for over three years as I waited 2 years for the spinal surgery which they wanted to do before the gallbladder my question is do you think I’m going to have a drop in oxygen levels again as waking up struggling to breath was not nice . I still have some calcified clot in the doorway of my left lung the doctor said it might give me trouble later on.
Good evening
I was diagnosed yesterday in the ER yesterday with PE. The doc said very small one(s). They were treating me for heart attack symptoms. After blood, x-rays and a CT w/ contrast they told me I had small ones that were not “compromising”. They started me on the injections. Gave me one in ER and sent me home with a prescription for ten days. Seeing my doc three days after discharge. I am 43 and a long distance runner. My BP in the hospital was 117/74 and pulse was 59-64. I am kind of worried they didn’t keep me…. my leg has started to hurt after the meds and my symptoms are “there” just not as strong and hard. But could all be in my head – they seem to come and go. I am taking three days off of work and I walked the dog for 30 mins with only minor pain. Is this normal? Should I insist on more test? It is a get ER and hospital. I guess I should feel good they let me go after 6 hours but after reading on line – nervous again! Thanks
Sorry I meant it’s a GREAT hospital.
Did you have an ultrasound of your legs to rule out DVT?
Were you started with blood thinner?
A small PE doesn’t necessarily require hospitalization and outpatient treatment can be acceptable if low risk. If the PE was confirmed then at least a intermediate to long term blood thinner and investigations to understand possible underlying causes.
I’m being treated for a saddle embolism across my lungs with Pradaxa. I know how scared you are; so was I. I just want you to know that you need to hydrate. Drink water. I noticed you are a runner. In my research, I found that dehydration is one of the causes of clot formation. And, I read runners had high incidence of this. Please drink plenty of water.
My mother died of a massive pulmonary embolism. She had suffered with phlebitis in the summer. Is it likely that this was the cause of the clot?
Phlebitis can occur with or without a clot. A DVT, a clot in the leg deep veins can lead to swelling and thrombophlebitis. However the presence of phlebitis doesn’t necessarily mean a DVT. In your mothers case it would be difficult at this point to know whether there was a clot in the leg. Part of the work up for phlebitis is ultrasound of the legs looking for clot.
I have been to the Emergency room twice now, once for a sharp pain in my groin that extended down to my knee. It was treated as staphylococcus. Second time, my leg began to swell in different areas and i was in pain, i had a deep vein scan and blood work done but it came back clear. At the moment i am on my third day of experiencing deep throbbing pain in my calf and inner thigh along with warm sensation. Today the sharp pain has subsided but the heavy achy feeling is still lingering rom calf to inner thigh. Im worried but dont know if i should see a doctor.
Yes you should if there is uncertainty or you are worried.
Thank you. I woke up today with vein in my thigh swollen and a burning sensation.
That sounds just like when I had blood clots in superficial veins, superficial thrombophlebitis. I was scanned three times over two weeks and they never found any DVTs. Five months later and in the ER diagnosed with lots of PEs in both lungs.
Hi Dr. Ahmed,
I am a 47 y/o overweight, but highly active and physically fit female in relatively good physical shape. I had a large dvt in rt femoral, politeal, and calf 5 yrs ago. This was attributed to taking OCPs. Since that time, the OCPs were discontinued. On Sept 28, 2016 at 4:45am after letting my dog back in doors. I felt my heart racing really fast, sob, diaphoresis and experienced sudden collapse. When I came to approx 10-15 min later, I was on the floor. It took so much energy to get off floor and get to the phone. I called a family member and they called 911. I was taken to local ED and was diagnosed with a saddle PE with acute for pulmonale with rt sided heart strain. I was admitted to the ICU and was given TPA and heparin. I have done way better than anyone could have imagined. I was really winded and deconditioned for about the first 2-3 weeks. I am not on home oxygen. I am back walking about 2 miles on treadmill 4 days per week, however I am having some rt sided chest pressure with palpitations. Is this normal? I have requested another echo, however the cardiology fellow I was assigned to said I did not need one. My pulmonogist said that sometimes there could be residual clot, and he is planning on doing a follow-up CTA in 1 month. Can you offer any input?
The main issue after a large pulmonary embolism is the development of chronic pulmonary hypertension, read this article here https://myheart.net/articles/chronic-thromboembolic-pulmonary-hypertension/, an echocardiogram would be of use to determine your right ventricle function and pulmonary artery pressures, a repeat CT would be reasonable particularly if the PA pressures were high or the right ventricle dilated.
Hi Dr. Ahmed,
My father, age 57, passed away of a PE in December of 2014. He had been active his entire life and rarely ever even got the flu or a cold. In late November of 2014, he was loading their outdoor wood furnace and the large chunk of wood he was throwing in caught the door and swung the door into his finger and completely smashed and cut his fingertip (to the first knuckle) off except the piece of skin it was hanging by. My mom rushed him to the ER and they surgically replanted his fingertip back on. They told him they were 90% sure it would survive, but if not they would have to remove it. They placed him on an anti-biotic and sent him on his way. A week later he started feeling shortness of breath and assumed he had caught a cold from my brother. Two weeks after the surgery, he went in to have his stitches removed and told the surgeon how he was feeling and the surgeon told him he didn’t handle issues like that and that he would have to go see his family physician. So my dad went to see his physician in the same town and was immediately told he thought it was a blood clot in the lung and sent back to the same hospital for a CT with a vial of blood to have the lab test. The hospital made him walk his vial down to the lab and then to the the waiting room for his CT. After about 15 minutes in the waiting room he began to get very warm, passed out and died right there. The physician refuses to say the blood clot was more than likely caused by the accident and the surgery. What are your thoughts on this?
I forgot to add that his D-dimer was 3380 from the lab results. For years he gave blood doubles for the Red Cross 3 times a year.
Im sorry for your loss. Its honestly very difficult to say. If a pulmonary embolism was suspected a CT sounds like the appropriate confirmatory test. Why was a PE suspected? what was his heart rate and blood pressure when seeing the initial dr?
I have one small blood clot in each lung and one in my leg, what are my chances of survival?
Can you provide the test result information?
Hi, with PE how long is quick in terms of diagnosis? My mum has just phoned to inform me that she is in hospital with PE and has been suffering with a bad chest for around 2 weeks now. Everywhere I’ve read it says that quick diagnosis is very important and I’m worrying that maybe 2 weeks isn’t what they would call quick. She did originally go into hospital but they sent her home saying she had a chest infection despite her recently having DVT and the fact that blood clots and strokes seem fairly common in the family (Careless of them not to do any checks). She will be ok won’t she? Unfortunately I don’t know which or how much of the lung has been affected. I just want to make sure she has begun treatment fairly quickly.
The mainstay of the treatment is blood thinner, I’m sure they would have started that. In terms of the significance of the PE, the key factor is heart strain, this can be determined by an echocardiogram.
Im sure that the main treatment of blood thinners would have been started. Has she had an echocardiogram, was there any evidence of heart strain?
I am 63.. I was disgnosed with a PE in my main artery this past August. I also have many small clots in my lungs. They hospitalized me and gave me heparin drip a d put a filter in. I also was in A fib. I take Eliquis and Metoprolol. Now I’m getting intermittent sharp pains in my right lower lobe. What could it be? I also have rheumatoid arthritis a d take Enbrel
and methotrexate and I have this horrible sore mouth and throat.
I had a clot in one if the 4 chambers if my heart and 2 massive clots on my lungs. Was told I had a PE. Spent 9 days on the cardiology ward. Am home now taking warfarin. Still getting a sharp pain when I take a deep breath on my left hand side. I cannot walk very far. Lost my confidence. Just do not feel myself. Can anyone tell me what recovery time I can expect. My PE was 6 weeks ago. Just feel tired, week and depressed. Just would like some idea of how long I will feel like this?
The pain is likely secondary to pulmonary infarction, this should improve over the next few weeks. Given that you had likely atrial thrombus you did well to get through it all and the recovery may take a little while. Did you have any use of clot busting medication or procedures?
Hi Karen; I had multiple bi-lateral PEs in September 2012, followed by a clot in my r iliac vein and then two more DVTs in September 2014. I also experienced sharp chest pain and was diagnosed with pleurisy; it comes and go but it worse with deep breaths and when it is super cold. Perhaps ask your doc about pleurisy. As for how long it will take you to get back to normal, I’m now 4 years into this and I have good days and bad days. I too had a deep depression, anxiety, fatigue for almost six months after the first incident but I no longer take any anti-anxiety or depression meds. The worst part of having a PE is that every time I have an ache in my leg, a strange twitch or “butterfly” feeling in my chest I’m terrified it’s another PE. I keep a pulse-ox meter around me and test 1-2 times a day to make sure my oxygen is good and if the pain I feel doesn’t dissipate, I don’t hesitate to go to the ER. I tell the doc I feel like an idiot for wasting their time, but he said PEs are nothing to mess with and to never put my life ahead of feeling like I’m wasting their time. And followed that up with “the one time you don’t come, could be the one time you need to be here”. So my advice is, you know your body and when something is wrong, if you don’t feel right, get yourself checked out. Also, don’t get too down on yourself. PEs are difficult to understand; you don’t look hurt, you didn’t have surgery, it’s not a disease, yet you’re still feeling anxious. You and your body have been through a lot; give yourself to heal both mentally and physically. I wish you a happy and healthy 2017!
I appreciate this article. My 84 1/2 year old mother was diagnosed with DVT in AUG 2015 and JUL 2016. Both times she was prescribed Eliquis by vascular doctor. She saw vascular doctor after 3 months on Eliquis and both times was discharged as the clots in her legs had dissolved. However, less than 2 weeks after she was advised to discontinue Eliquis, for the second DVT, which she did, she experienced shortness of breath, chest cough and weakness. A trip to PCP and she was prescribed an anti- biotic to treat possible pneumonia, but later a drop in O2 level, we were sent to ER where she was diagnosed with PE and blood clots in both legs and admitted to ICMU of hospital. She was given 2-3 shots of anti-coagulant while there and prescribed double dose of Eliquis for first week, then resumed normal dose, same as she took to treat previous DVT. She is now on O2, Level 2. Two weeks from diagnosis, she saw pulmonary doctor for post hospitalization followup. Her PCP, pulmonary and hematologist specialist all concur she must remain on Eliquis the rest of her life. My question for you is how unusual is it that she developed PE and DVT within two weeks of discontinuing Eliquis after taking it for 3 months? It is my understanding that no matter the cause of the blood clotting, the treatment is the same. Doctors wanted to do blood test to determine if this is due to blood clotting disorder, specifically genetic. I said no, no more tests or doctor visits than absolutely necessary. I welcome any comments and appreciate your time. My mother is in Stage 5/6 of Alzheimer’s and I am her primary care giver. She resides in a wonderful assisted living facility. My greatest desire is she does not suffer. Thank you.
She is 84 years old and had a DVT then a PE. I would not advise genetic testing. You are correct in that the treatment will stay the same regardless, if this is a big clot then life long blood thinning medication.
Thank you for your reply. My sweet mother will see pulmonologist next month for another ultra sound on legs & cat ? scan of lungs. It is my understanding that after 90 day treatment with Eliquis, the average result is for 73% of clots to be gone. She had multiple clots in both lungs, 1 particularly large. Mom’s Health Care Directive states DNR & that she does not want any “medications, machines or other medical procedures that in reasonable judgment could keep me alive but not cure me”. Now in Stage 6/7 of Alzheimer’s, she cannot speak for herself & my brother & I, as medical powers of attorney, must decide her level of care. Our greatest desire is she NOT SUFFER. If we decided to stop Eliquis we understand the result will most likely be death. Please know I understand you are not God & are not my mother’s doctor, but with the information I have provided, can you tell me if she would suffer from lack of oxygen or experience sudden death. As you know she is “suffering” greatly with Alzheimer’s. I welcome your thoughts and will of course discuss the same w/pulmonologist next month.
Dr.
I am currently hospitalized for significant PE in both lungs near pulmonary artery. Several DVT were found throughout left leg and thigh. I have transitioned today from Lovenox to Xarelto and home tomorrow after a 5 day stay.
Our question is whether or not there is any likelihood of the current PE’s especially or DVT’s from breaking loose AGAIN regarding the PE or more DVT causing an issue now that I am on Xarelto?
My wife is concerned that especially the PE will move and re-block.
Thank you in advance
Eric
Did you have right heart strain on your ct or echo?
In general although there is a theoretical risk of clot breaking off, the standard treatment once past the initial phase of PE is blood thinner. In general patients do well once treated, the clot in the lungs often disappears relatively fast. In my experience, on follow up imaging, the clot is often gone. Blood thinner is a successful treatment.
Is chest pressure a symptom of a PE? I was diagnosed with a PE last week after a month of misdiagnosis. I am now on Xarelto. The chest pains are still there, but they are lessening. The worst part, is the chest pressure. I have immense pressure on my chest and diaphragm, making it difficult to breathe. Is this a normal symptom? How long will these symptoms last? I am extremely uncomfortable.
I would go and seek an urgent medical opinion if you have had a recent PE and are having symptoms that concern you.
I have a history of DVT and UDT from injuries, I believe. I was recently prescribed multiple courses of prednisone by my dermatologist for an id response and rash on lower leg. Shortly thereafter I developed a thrombosis in my calf and PE’s. I have since read that glucocorticoids should not be prescribed to patients with a history of thrombosis.
How dangerous is prednisone for people with such a history, and if so, are the warnings adequate? I have asked four physicians, including a close relative, and none were aware of any precaution.
Thank you for your article. In January of 2015, I had bronchitis, then an ear infection that led to vertigo. I felt ill off and on for two months. I’m typically quite active, going to spin classes daily, but I had not been moving around enough. I had a pulmonary embolism getting my hair washed and styled. I passed out and stopped breathing. An ambulance arrived ten minutes later, but the hairdressers couldn’t get a pulse or twenty beats per minute. It stopped, started again, etc. I started that strained snoring breathing, but stopped breathing again. One of the ladies hit me in the chest very hard, and I came to. I don’t remember anything except feeling hot and nauseated, and then waking up to hysterical yelling. A clot was found in my lung, and then ultrasound found the origin in my left ankle. I had IV blood thinners for several days and not allowed up for four days. I went home with eliquis which I took for six months. Two months after the embolism, I had a mastectomy for DCIS. I did not need further treatment. I continue to take daily aspirin. Here is my problem, it is now late December of 2016, and my energy level has not returned to normal. My heart and lungs are fine. From October of 2015 to May of 2016, it all I could do to get out of bed and teach. I would collapse when getting home, fighting to stay awake until I drove the five minutes to my driveway. Summer arrived, and I could hardly do anything. I am feeling less exhausted, but after any exertion, I have to sleep for two or three hours, or I feel I will fall down from exhaustion. I do one or two spin classes per month for this reason. I’ve been to several doctors, but no one can determine what is causing me to be so sleepy. I eat well, take supplements, and last week begged for and received a vitamin B-twelve injection. I know it isn’t supposed to help, but I’m desperate to resume my life. I was prescribed raloxifene, but my oncologist had me stop it because it gave me severe hives. I also had other hives off and on starting a few months after my health issues began, but I haven’t had any for a few months. Any ideas would be greatly appreciated.
I was also having spin classes 2 or 3 times a week, which might be a risk factor to the PE I had (first DVT, 3 weeks later massive PE). The hematologist told me to keep taking warfarin (as I do 2 years now, from right after the PE) or stop spinning classes. No other cause or risk factor found. I could not find any medical reference that links PE(/DVT) with spin classes, but it makes sense. Doesn’t it?
My father was admitted to the hospital to ight with PE and strain on the right side of the hear that was visible from the CT scan the hospital performed.
Back so try is that this is the 4 case of PE in a 3 year span. First time they didn’t know what caused it. Second time the thought his blood levels were skewed. The third time they had no idea, as blood levels were normal and PET scan was clean. Soon after my father went to a different hematologist and they found out the clotting factors were not right (not sure of the details). Also he has been deemed one of the 3 % of pwople whose bodies do not reobsorb the clots, as they have only shrunk slughtly since the first episode.
Anyway he was recently taken off his eloquis to have a biopsy done. Today he was to start the meds aging but began experiencing shortness of breath.
This bring us to today. With the strain on the heart. They have begun to give the clothes busting meds, but how does this affect him long term? Will this shorten his life span?
Any input would be helpful,
A frustrated daughter looking for answers
Should add that my father is 62 and today his blood oxygen was 92% and heart rate was 78.
It depends on a lot of factors, what is the official read of his ct scan, what is the acute clot burden, what is the chronic clot burden, what is his pulmonary artery pressure, and what is the state of his right ventricle. Also in the setting of recurrent clots, in the future is there a role for ivc filter when he has to stop his blood thinner. These are the key points you need to discuss.
I was diagnosed at the beginning of Dec/2016 with multiple “fair sized clots” in both lungs. They felt sure it was due to my BiEst and Prometrium that I have taken daily for the last 13 yrs; I am 63 yrs old. I had no signs of DVT and they never checked for that. I had signs of pulmonary hypertension and some Rt ventricular enlargement. I was given 2 days of IV Heparin and then put onto Xarelto for 3 mo.I was sent home on oxygen at 3L. I was very sleepy of the first several weeks nd tired easily but am improving but still feel a “fullness” and some SOB without the oxygen (trying to wean) so still on it continuously at home. My GP thinks 3mo of anticoags may not be enough and that 6 mo may be indicated. Could my clots have just formed in the lungs? Is it likely I will need longer on anticoags? Would being on ASA 81mg when off the anticoags, for the rest of my life be advisable?
Interesting questions and should be addressed on a case by case basis, without knowing a lot more about your case its hard to comment. If there was right ventricular strain and no clear cause identified, i personally would never stop anticoagulation prior to 6 months. A full evaluation for underlying causes and recurrent risk needs to be performed. Your pulmonary artery pressures and right heart function needs to be monitored also. Your clots started in your legs and travelled to your lungs. An ultrasound of the legs needs to be done if you never had one.
My husband went to the ER Tuesday morning (today’s Thursday) after two days of excruciating pain he thought to be a kidney stone. After having him here they found multiple clots in both lungs, falling in the “other” category. They are sending him home today on eliquis 10mg twice daily. My concern is that he has had two attacks last night of the very similar under rib pain that brought him in here, very excruciating, to the point he can barely breathe. He is an active 40 year old, healthy, man who hasn’t been to the doctor in our 9 years of marriage because no matter what happens, he deals. But this pain brought him in here – yet the doctors are dismissing this reoccurrence as if it’s just a biproduct of the clots that had stopped and restarted and he’s over exaggerating (ya right, not even possible if you witnessed an attack – confirmed by nurses). He has one doctor. I don’t go to the doctor often and am at a complete loss here for what to do. Because we’re in the “other” category is there no concern? Or is the pain an indicator that something needs to be looked at? I have no idea.
Pleural pain can be common, it is sharp in nature and caused by a process known as pulmonary infarction whereby the damaged lung tissue is responsible for the pain. He is on the blood thinner which is good. I suggest he see a Dr to ensure his vital signs and clinical status is stable. You have nothing to lose by being cautious.
My mother had a very bad knee and her doctor determined a knee replacement was necessary. They send us to our house doctor for testing and medical release. She had EKG and Echo done and all the other important test. she was cleared to go ahead. Shortly before the surgery we went to the doctor who sent her for pre-checking at the hospital next door. On October 24th she had the knee replacement done. The surgery went well and she started rehab in the hospital next day. On the 26th the day she was released she even received first place as best recovered patient by the rehabilitation staff. Two days after she was released, a nurse came by and removed the medical nerve blocker that was still inserted through her vein in the leg. She was taking Pain Killers as needed, muscle relaxer and ASPIRIN EC as BLOOD THINNER. On Saturday 29th, the physical therapist came to the house and started her treatment. We asked her multiple times about the danger of blood clots and she said, yes the swellings are normal on the leg. My mother had no pain in the area of the surgery and where the stitches are but she complained about pain behind the knee and above the knee (front and back of leg). Otherwise she was progressing along. On Monday 31st (Halloween) the physical therapist came again and she said again that the swellings are normal and told us to have her lift the leg when lying down. The leg should be higher than the heart. she said it circulates the swelling part away once it gets to the hip area……… Then came the morning of November 1st. My mother woke up around 6am, went to the bathroom and after she entered the living room she started breathing heavy, she turned white, she felt she had to throw up, etc…. we called 911. they came checked her and said everything looks ok but the blood pressure was low. They then shockingly asked us if we wanted her to go to the hospital. Not take her. they asked us. When they took her with my wife in the front seat, they drove normal. no lights on. no siren. nothing. Then all the sudden my wife realizes they are doing CPR in the back and they put the sirens on. now they are driving fast. When arriving at the hospital … they determined she was already gone for 7 minutes and they brought her back and stabilized her. They said she had a heart attack. … Now they take her via helicopter to Florida Hospital (specialized in heart surgery)… when arriving they had to bring her back to live a 2nd time. They checked her and determined that she didn’t have a heart attack but a BLOOD CLOT. The main doctor came to us and said she is stabilized but critical because she doesn’t have only one clot but multiple small once all over the place. They increased the blood thinner and with time her situation got worse and worse and she started bleeding from the kidneys, lungs and at the end from the mouth. Because her body refused the fluids she started swelling everywhere including the face. At the end the doctors told us to get ready. My mother died on November 2nd at 4:33am. A woman that was healthy all her life who had a successful knee replacement went within hours from healthy to dead.
1. How can this happen?
2. How could this have been prevented?
3. Why did the 911 team question her condition and then drive in regular traffic ?
4. How didn’t the physical therapist not see the signs?
5. Was there a pre-condition the doctors (regular house doctor, knee replacement doctor, etc) didn’t see?
6. Where the medications prescribed the correct ones? In Germany everyone gets shots for preventing of blood clots. Why over here only Aspirin ???? This is the biggest question we have. Is it possible they accidentally forgot to give the shots which many people can’t believe she didn’t get.
Would appreciate a reply.
My moms story is almost identical, but she was very quickly taken from us the morning after her full knee replacement surgery. She had complained of her calf hurting & feeling so extremely heavy and her arm hurting after the surgery too. Her heart rate was being monitored through the night as it was going astronomically High then really low – reading everywhere points to the fact they should not have moved her but ultrasounded or at least looked for clots! We are heartbroken and lost the best mom and Grammie ever. We are at a huge loss and forever will be.
Hi
My husband has prostrate cancer with bone mets! He has just been diagnosed with 2 small blood clots in his lungs after a routine CT scan, he had no symptoms at all
We have a very special family holiday booked which entails a 4 hour flight in 2 and half weeks time! Our consultant has said that the risk is minimal and he has told us to go away and enjoy our holiday, he said he will be fine and the injections he is getting every day willl minimise the risk for him! I would love a second opinion please.
Hi Alison, it would be irresponsible of me to provide you with an opinion not having seen details of the case and not having directly assessed him. In terms of clinical significance, 2 small clots, that are being treated appropriately should not pose a problem. It looks like your consultant feels you can go and as long as you are comfortable with his opinion and understand press and cons a decision can be made. Im assuming the injections are lovenox, which will serve to treat the clots and prevent recurrence.
In 8/2014 I started having trouble with trigeminal neuropathy. My neurologidst put me on Tegretal……too strong for me . He left on vacation, my primary care dr was out of town on vacation. Went to emergency room 3 times…… More drugs and pain killers. Finally pain was unbelievable. Called primary dr and his fill in dr answered. He understood, put me on steroids and calmed down some. Changed neurologist….. She put me on chewable drug that slowly calmed me……saw a surgeon……more meds. 2-3 weeks stayed in bed or chair screaming from pain. Primary dr came back , got me to his office, did d-dimmer. Sent me immediately to ER that could do Doppler. God got me there and they immediately started work .. D-dimmer was 1286. Ran Doppler, ct scan , shot for blood thinner, oxygen and off to hospital. Was in hospital for 2 weeks. Had substantial blood clot go through right side heart and into both lungs. 6 months of warfarin slowly absorbed clot, but have scarring in lungs and lower sacks in lungs have collapsed. Breathing is not perfect, but I am still alive and will be on warfarin rest of life. God saved this 74 year for some reason. My sons were told I might not make it .
What happened to your trigeminal neuralgia? Was there a link between the two other than you being in bed for a couple of weeks?
My husband died suddenly of a pulmonary embolism, but none was seen in his autopsy. Why not? Is this common? Does it mean that the clot dissolved before his autopsy (which was a couple of days after his death)? Please give me any thoughts or information that you can. Thank you.
How was the pulmonary embolism diagnosed? Was there a CT scan?
My father is 84.has heart block and has recently been quite immobile as he’s had a bad chest infection.he’s had 2 lots of antibiotics as well as steroids.he has 2Nd varicose veins and asthma.he’s managing the stairs but I’m worried he may develop a thrombosis? He takes junior aspirin daily.
I’m a 27 year old male. Fairly active and was diagnosed with a PE in each lung. Protein S and C and factor V came back negative. I was started on Xarelto and was told I need to be on it for at least 6 months if not life. My question would be is do I need to be scanned or checked for any cancers? If so what scans? I’m healthy as far as I know other than those PEs. Thank you!
Depends on many factors, and would need a full discussion and consultation in each case, however in general only age appropriate cancer screening is advised in those with otherwise unremarkable screening.
I would like to know if you systolic number is high, can it make it feel like the house is spinning when I lay down at night and also, can it make you feel very unstable on your feet? I can be walking, let’s say, from the kitchen to the living room and back, then I loose my balance and I will catch myself before falling. I will be still, then resume walking. At night when I go to bed, I will lay down on my back and then it feels like the whole house is spinning. To stop the feeling, I will turn over and lay on my left side.
I do have a history of heart problems. I had a heart attack in 2004 and two stents put in place. Also have congestive heart failure problems. I am diabetic, over weight, inactive because of bulging disc in my back and in remission from Leukemia.
Hi, I’m 25 years and I have a large pulmonary embolism in my right lung . I’m also 13 weeks pregnant. I have been to the emergency room 3x since being diagnosed New Year’s Day. Every time they have done a echo exam to check my heart they have not seen a strain and every thing functioning fine. They said I’m having anxiety… my Blood work came back normal. Do my chances look good? Do pregnant women survive this?
I’m also on blood thinners twice a day
Yes pregnant women survive this, it just needs to be handled appropriately. Your care needs to be managed by high risk ob, hematology, and possibly cardiology / pulmonary. You will need to be on appropriate blood thinner. Its good that you right heart isn’t showing strain.
Thank you very much Dr. Mustafa. I’m currently seeing a high risk Ob Doctors who specializes in this situation.
Dr. Mustafa is there way to help the body eat the blood clot besides being on the blood thinners?
Is there any way having a tumor on the brain can be related to a blood clot on the lung.
Yes, tumors, particularly if malignant lead to hyper coagulable states that predispose to clot formation.
Hi my mom (82) had hip surgery in august, 2 weeks after she end up have a pe that was busted using catheter therapy. Clot was busted and she is on the road to recovery, additional test for clots have been done and came back negative.
She is on eliquis and metoprolol for heart rate. She has both a cardiologist and pulmonary specialist. She has been doing the echo test for pulmonary pressure and hers has gone down, she was in 70 now down to 52 and the last 2 echo where the same at this 52 she is schedule for a right heart cath and v/questions scan. Her oxygen levels are 98 when she does the 6 minute test with slight breathlessness after the 6 minute test.
Should we be very worry. The fact that here pressure went down is good I think but I think her age makes recovery slower for her. I guess my question is how long does it take for lung pressure to normalize after having a pe? Pulmonary dr did say if her pressure was decreasing he would just watch but the fact she had 2 echo with level same he wants to do more test.
When i perform the catheter treatment for PE on select patients i typically check the pressure the next morning through the catheters and if the treatment has been successful then i typically see the reduction has already occurred by that time. I m not sure in your mothers case as i don’t know the situation or the medical history but the baseline may be 50’s. Was there a prior echo in the past that documented her baseline? Im not sure why heart cath is being repeated or how it would change management, but that is something to discuss with your treating team so you get a better understanding of their thought process.
Yes, this was most excellent in letting me know what I was up against. I was told that I had a Massive Pulmonary Embolism, and that it was very serious. My Doctor said I was a very Lucky Man. He said, This Kills People. What had happened was, I was having difficulty breathing, especially when I’d walk in, or walk to fast, in cold air. I was at my Feonsaes House, and I had been coughing quite a spell, as I also have COPD, with Chronic Bronchitis, and thought it was that, because I’ve had these problems before. I work at a Livestock Job, and we were penning some Cows in June, and I got in that hole, and got pinned, by a 2385 pound cow, she was big, and I know how to box, and was covering up my vitals as well as I could, and she pinned me, and pressed me really hard, and after that, with having all that weight on me, I was coughing a lot, so, I don’t know if it was that event that caused an injury that caused my blood to pool, and when conditions are right, caused some clotting issues, or what, but, I tried to go across the floor to the kitchen, a very short distance, and had to hold onto the wall, and then I got some water, and then on the way back from the kitchen, I coughed, and was so short of breath, I had to lay on the floor, and thought I was gonna die right there. Then, I called my brother, and told him I needed to go to the hospital, and in the car, as I was getting in, I passed out. We got to the hospital, I got x-rayed, and I got a CT Scan, and some more X-Rays, and then an EKG, and just a whole bunch of stuff, and me and Shawna, started kinda crying when they said they thought I had a Blood Clot in my lungs, and then, the Doctor of the E.R., cane back, and said you have clots in both lungs. I guess they were Massive. That was January 1sr, 2017. That Night, and I went Home, The 5th of January, and am walking, and trying to help things along, but, I walked 3 miles, or maybe 4, yesterday, and I was so exhausted. I just slept, and slept, and slept, and my mother said, maybe you should slow down a little bit. You know, your probably so exhausted, because your body just went through a very Traumatic Incident, and, well, she’s right. But, anyway’s, The Doctors, Nurses, Nurses Aides, at St. James Healthcare in Butte, Montana, Were All, EXCELLENT. Emergency Room, to Hospital, and The People at The Butte Community Health Center, are also Doing an Excellent Job by me. They said, my Health is Coming Along Fine, and that, My clots seem to be healing nicely. Although, you pretty much gotta watch what you eat, it’s worth the Trade Off, and also, I Might add, The Lord Jesus Christ was Riding with me on this one, I said that to my Doctor, and he even Agreed. This Could have killed me, and if I’m not careful, still could. A Weight loss, when I’m in better condition to get to a Gym, is in Order, a Healthier Diet, and even weight loss, right now, are in order. I just Thank God I’m Still Here. That was a really scary thing for me, though, because when that Doctor came in, and said I had Clots in both my lungs, he looked at the Floor, and I thought I was a Dead Man for sure. I’m here, though, Thanks to, Jesus Christ, and his father God, and ALL THOSE WONDERFUL PEOPLE HE PUT IN MY PATH, WHEN I WAS IN DANGER. THANK YOU ALL. Tom
I had an accident late December 2012 where a pallet jack trolley offloaded its contents onto the lower backs of both legs. An MRI determined a significant meniscus tear. But my gut instincts said that I might have a blood clot. Indeed less than 6 weeks post accident, a doppler confirmed 3 clots in the left leg & a CT scan determined multiple pulmonary emboli in both lungs.I was transfered to hospital, released the next day on Xarelto 20mgs. I remained on this for 12 months and wore a compression stocking for 2 years. I now take 1 or 2 aged Kyolic garlic tablets daily for peace of mind. My situation has been complicated by the diagnosis of CRPS 6 months post accident, which mimics multiple symptoms of dvt. I am a 56 year old female & was extremely fit prior. I now struggle with walking & terrified of further clots. Can you advise if I am worrying needlessly or is it true that once you have had pulmonary emboli, (with or without dvt) you have a greater chance of having another one.
Duration of anticoagulation after PE should be personalized on a case by case basis and risks vs. benefits weighed up. Patients that have had an embolic event are in general considered to be at greater risk of a repeat event. In those that are at significant risk with ongoing factors such as lack of mobility, no clear provoking factor and such, i will often discuss extended duration of anticoagulation. In those that are at risk from blood thinner, such as those that have easy bleeding or significant complication there is a more compelling case to stop it. I suggest you discuss the risks vs. benefits of this with your treating physician, no two cases are the same in terms of clear cut management.
In April of 2016 my daughter, 14 yo at the time, had multiple PE in both lungs. There was no evidence of a DVT. She is very active, (plays soccer year around) and is not overweight. A few months before the PE, her dermatologist put her on BCP for acne. She was found to have PAI 1 4g/4g; however, her hemotogist feels that had having the PE and considers the BCP to the cause of the PE. My daughter was on Lovenox for 8 weeks (until the clots dissolved). She is back to playing soccer and has no further problems. What are your thoughts on the PAI-1 4g/4g gene mutation and PEs?
The mutation itself has long been considered a risk factor for thrombosis however the studies looking at population have led to conflicting results, i think most would say that in the setting of having the mutation its best to avoid triggers such as the BCP.
Thank you for this informative article. In December, I was diagnosed with a multiple clot burden, a DVT in my upper right calf and after being misdiagnosed 2 x I continued to work out thinking I just had a bad cold later Bronchitis.
I had 5 clots lodged in my lungs. Two large in my left. Three smaller in my right.
I have led a healthy Life, workout daily, follow a good sound nutrition program and docs believe I developed a DVT the result of 2 broken ankles and developing MRSA which left me with bad Lymphedema for 11 mos.
In 3 weeks my two left clots dissolved via aggressive Heparin and Coumadin therapies. Lovanox Injections 4 a day in stomach and pills twice a day.
I was released after 12 days. Sadly had suffered 5 large lung infarcts leaving my right lung beat up.
Readmitted for 7 more days. Released to my mountain home at 7,000′ with Oxygen. My Arterial Blood Gas was 53.
I didn’t do much when I first came home. Every workout I did prior to December was aerobic swimming, cycling running. Never was much for just walking.
Had to convert from a racehorse to a snail. Not easy for we active types. I am 54 and rarely ill so you can imagine the utter shock of all of this.
I did very well by week 3 and began walking (at hospital I moved 6 steps) within weeks I was at a mile than 1-1/2 and then 2 and 2-1/2.
On day 49 of my recovery I had bad chest pain and headaches and felt dizzy. All while sitting so I grew worried. Back to ER was there 10 hrs. More good news 3 clots in Right lung are gone!!
Praise God!
CT of brain showed no bleed, no clot, no aneurysm. CT of chest showed fluid build up. And CT of Thyroid showed enlarged (Goiter)
Two nodules on one lobe.
I left feeling relieved but concerned about fluid. Any ideas what the cause would be. Docs want to rule out Congestive Heart Failure. Would that be possible to stay so asymptomatic til now??
I want to wean myself off Oxygen and get back to swimming. Meeting with Cardiologist and Neurologist in the next two weeks.
Any info you could share would be greatly appreciated.
Have you had a recent echocardiogram, if so what did it show?
My mom was hospitazed last monday with extreme chest pain and shortness of breath they found out only today why….she has a pulmonary embolism…she is 90 years old ,n 4 months ago survived 3 strokes … i want to know if possible her chances to get better from this,at her age are they high or low…..what is the next step to fix that …i feel in the dark with doctors …could she get better….thanks for a response
A lot depends on her overall health and her state of health prior to the event, if she was a ‘good’ 90 then she may well improve although at that age setbacks are harder to recover from and the recovery often slower.
Hello Dr.Mustafa,
This article is really helpful.My Sister had a severe leg pain ,so sge went to doctor and they confirmed thats its a DVT.The did all kinds of test and found found that she also has clots in the lungs.
The report says” There is a moderate volune PE,right upperlobe,lingular segment left upper lobe”
Currently,she is having blood thinners.This is what the doctir prescribed “Apixaban 5mg oral tab twice a day”.After a week,Doctor told my sister that they are going to reduce the dose to 5mg per day after 1 week.
So my question is,Which type of PE my Sister fall into?Is it massive or submassive or Lower Risk.
Is she in the right direction,
?
I am a 58 year old female who has had 2 pulmonary emboli events, the first in 2008 with also DVTs, the second in 2009 after being off coumadin for 2 months due to hemorrhage. I was found to have the mthfr mutation. I was followed by a hematologist and cardiologist at that time and forward. I was switched from coumadin to Xarelto in 2015. I fell July 2016 and injured my left knee ultimately ending up with reduction of activity and partial bedrest, hospitalization for cellulitis in the affected leg and septicemia with extended IV antibiotics and PICC line at home. Since this event my legs have started hurting again with swelling off and on, my shortness of breath is back and worsening. I am having some chest discomfort as well.
My initial diagnosis in 2008 was delayed by my doctor attributing my leg pain and shortness of breath at that time to my arthritis and asthma. My current physician is attributing my symptoms to decreased physical conditioning due to the extended reduction of activity and hospitalization, etc I recently experienced. I’m concerned about being misdiagnosed again and actually developing PEs again. I’m still on Xarelto and am working on my conditioning. Should I be concerned that due to the reduction of activity and illness I had, that I actually am experiencing PEs again?
My paternal grandmother and paternal aunt both died of clotting events.
With those symptoms returning i think that recurrent events need to be ruled out and you need to get advice from a physician familiar with this without delay.
My mum had a stroke last July, she recently had a fall and has been diagnosed with a small bleed on her brain. CT scan has revealed she has a small blood clot on her lung. She is 81 years old and had a bad chest infection for the last month. She is currently still in hospital and last night we were told that she cannot have any operation such as inserting a mesh to stop the DVT in her leg sending showers of blood to the clot in her lung. She cannot have any clot busting thinners due to the bled on her brain. Basically they have told us there is nothing they can do! I am distraught at being told this by the staff nurse of the word. This information was relayed to us from my mums consultant via the senior nurse and just feel debated to be told in this day in age of pioneering medicine they have given up and want to simply send her home. They also told us if my mum had a massive heart attack they would not do CPR as her chances of survival would be so slim. I could not believe what I was being told. Any advice?
My mom was diagnosed with pulmonary embolism after taking birth control for a ovarian cyst. She has been on blood thinners for 6 months but she is still getting chest pains. It seems her symptoms got worse now. Not only does she have more severe chest pains now she also has very low blood pressure she feels weak and dizzy and was also told she has high cholesterol. She refused the cholesterol medication. They told her that they couldn’t find the blood clot after a CAT scan. But she seems to be getting sicker with different symptoms popping up, her doctor isn’t very helpful so im looking for any advice or maybe just an idea of what you think might be going on with her.
If the CT scan does not show evidence of residual clot then its unlikely the symptoms are related to pulmonary embolism. Its often useful to do an echocardiogram to ensure there is no strain on the right side of the heart. Its worth ensuring a good work up has been done to rule out other causes of the symptoms described.
Hi,
I’m 52 and after a fall which resulted in my leg being in a cast, two weeks later I found I couldn’t breath and was going light headed and my lips turned blue, my son called a ambulance and I was rushed into hospital, they did a chest x ray & a CT scan but that had to be cut short as my oxygen levels crashed, anyway they gave me the ‘Buster’ begins with a T by IV, I had to have a brain scan as list feelings in my left side plus they did another CT scan, where the found a massive saddle pulmonary embolism,
After 9 days in hospital and being told I was a very lucky lady to be alive etc..I was released to go home, I was on 15ml Rivaroxaban twice a day and now I’m on 20mg Rivaroxaban a day for the rest of my life. I have to go back in 6 weeks for a review.
I find I’m tired most of the day, and still get out of breath easily, I can not stand for long either as that exhaust’s me plus I find my voice gets quite hoarse through out the day, sometimes normal, othertimes hoarse.
I suppose my question is will I ever get completely better? As in activity,
And what are my chances of getting one again or infact is this one actually gone?
I’m a no smoker and I do not drink alcohol.
Thank you for any answer in advance.
I’ve been out of hospital three weeks on Friday.
I’ve seen patients get significantly better over time. Was your right sided heart function and lung pressure normal ? If not they need to be surveyed intermittently to see if treatment is required.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I understand that a pe is not always found with an an ultrasound of the heart. Recently I just took my daughter off life support. She had 3 er visits in 20 days, 3 different diagnoses and given the same trx ea time. She went thru a rescue inhaler and a regular inhaler as well as several neb trx in a week. The day she went to er she literally walked out her door as she was going unconcious. That day she had 5 neb treatments in less than 8 hrs and her inhalers, she was suffocating. No prior history of asthma. We suspect an embolism. I had to fight with Dr just to get a basic heart ultrasound. They did say her heart was strong. We don’t know if it was pe. We know her sat levels were low and co2 high. For a 27 yr old non smoker with lugging around a kiddo, dogs wheel barrows of dirt for her harden, canning supplies, walked to work every day and grew organically, it doesn’t make sense that a cod would be asthma. We don’t understand why the 3rd trip to er, why they didn’t realize that their trx weren’t working and why they didn’t look further and why they didn’t admit her.
Firstly, sorry for your loss.
PE is not diagnosed by ultrasound, rather ultrasound can be used to determine the significance of a PE. In cases of significantly large PE, the right side of the heart may show signs of enlargement and strain. In most cases it is allied testing in combination with a CT scan however in some cases where CT cant be performed it is used as a primary method of investigation often with a VQ scan. Once could argue that if the echo is normal and the right heart normal, a large PE is very unlikely.
Thank you for this great explanation of PE. I am 70 yr old female, admitted to hosp.in March with multiple sub-massive pulmonary embolisms…
I recieved the Ekos treatment, and heparin for a week before coming home; I now take Eliquis x2 daily. I continue to improve, tho recovering my breathing is slow, which led me to find your site. Does the Ekos procedure damage the lung tissue? Cardiologist says my heart seems good, tho stress test is scheduled for next month. I’m very paranoid about sitting too long, which is apparently what triggered my episode, so manage to walk a couple of miles a day, tho not all at once.
Thank you again for providing such clear and easy to understand descriptions and explanations…
Hi, i’m glad to see you appear to have made it through your ordeal in a stable manner. The blood thinning medication is now key. The EKOS is a type of catheter directed treatment of pulmonary embolism and is not known to have long term effects on lung tissue. Often after a PE the lung tissue that is supplied by the blocked areas dies in a process known as pulmonary infarction, the process does improve as the tissue regenerates however can lead to symptoms that persist a little while. In general that improves over time. Its also important to know pressures in your lungs and heart function as they can underlie symptoms also. If your heart was said to look good, that is reassuring. Its good to keep active, although with the blood thinner on board its unlikely that low activity would lead to clot development.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I was hospitalized last mont with blood clots in my lungs. They could not find the source but my blood test showed Factor 8. I will have to be on blood thinner from now on. How do you get Factor 8?
It is an inherited condition.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I was hospitalized last month for blood clots in my lungs. Through a blood test it showed Factor 8. I will have to be on blood thinner from now on. Is Factor 8 hereditary? They told me I was at risk of this happening again is why I will be on blood thinners.
What is your blood group ? On reading up on my recent saddle pe i found that my AB Rhesus pos blood has more factor 8 so more likely to clot.
Hi, my dad has been to many doctor/hospital appointments with bad chest pains, shortness of breath. He has rather bad varicose veins in his legs and they’ve swollen recently.
He’s been told he is at “severe risk” to a PE but there is unfortunately nothing they can do for him and the consultants door is always open if he needs them and sent him away.
I’m not sure if I’m hearing this right but that sounds very vague and scary.
Please tell me what this means.
Many thanks.
Im not sure exactly what they mean. In terms of risk for PE, he may have risk factors but the good news is he hasn’t had one yet. Im assuming his legs were scanned and there was no evidence of clot. If there was, he would have been placed on blood thinner which would then be protective. I suggest you have a discussion to clarify the exact risk with his primary care physician.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
My extremely active and fit 58 year old friend just died at the finish line of a running race. The whole community is devastated as he was as fit as an 18 year old. The autopsy showed pulmonary embolism. There was no family history. How does something like this happen?
It is unfortunate and rare in those that are fit and active. It likely started as a clot in the leg that then travelled up the body to the lungs. Although uncommon there have been multiple cases of elite athletes suffering from blood clots. This article may shed some light http://www.news-medical.net/news/20160506/Reasons-for-life-threatening-blood-clots-in-elite-athletes.aspx
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
My 55 year old husband had a 4cm Saddle PE 3 weeks ago resulting from a DVT in his calf. We know he is very lucky to be alive. His only symptom was shortness of breath which came on suddenly and became increasingly worse. He was placed on Xeralto and an IVC filter was placed. He is doing better but reports felling tired all the time, even when he first gets up in the morning. I am concerned. Is this normal? His follow up with the pulmonologist is next week (4 weeks from his hospitalization). He was supposed to follow-up 2 weeks after discharge but they had no earlier appointments. He did follow-up with his PCP, the same one he had seen twice the week before his diagnosis and was told it was his asthma and prescribed an inhaler. I know it takes time for the clot to dissolve but am concerned about his fatigue.
Thank you.
The large lung clot can cause 2 issues that lead to symptoms, firstly right heart strain and secondly lung infarction. The lung infarction will typically improve over a few months, the heart strain often improves more rapidly. Its not uncommon for those with PE to take a few weeks to get over the symptoms. Its important to know right heart function and pulmonary artery pressure and monitor this over time in large clots particularly. Also important is that the development of chronic clot is ruled out. When you follow up be sure to ask about these factors. If fatigue persists then other causes should be investigated also.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I’m 64 and just 6 months down the line from having had a massive saddle pe. I had experienced no pain , no symptoms, i just collapsed and was taken to Resus then HDU where i was thrombolised and had 10 heart arrests, 6 of which were PEA’s ( hard things to deal with i hear) Think i had 1hour 36 with no pulse, which caused acute liver injury, acute kidney injury, then i was allergic to the Heparin which ate my platelets apparently (level dropped to 35) I blocked the filtration machine in ICU so had to go to another hospital for dialysis as my creatinine clearance had dropped to 3. So after almost 4 weeks in 2 hospitals i came out and felt very tired for the first 3 or 4 weeks, but every week since has got better and now 6 months on i’m back to normal, just on 2 x 5mg Apixaban a day and 2.5mg bisoprolol – which i no longer think i need now. I tell you all this just so you know that if i got over all that then so can your husband, he’s just got to be patient and not beat himself up if he doesn’t feel like doing much right now, he will soon, the tiredness does eventually go. And also to say how on earth with all that going on did those brilliant doctors and nurses manage to keep me alive, i am just so thankful that they were all there. I think they are pretty damned wonderful.
I had a PE after my Hysterectomy in 2003. I was hospitalized on Heparin then followed up with Warfarin for 6 months. I have had a couple surgeries since and they have always had me do Loveox injections for 2 weeks after. Going to have a shoulder arthroscopy and this office said they didn’t think it was a big deal and should be ok without Lovenox post operatively. What is your take on when you should or should not take a post operative thinner? I have read a second embolism is usually not a good outcome.
Thank you Dr Ahmed for this very useful article and informative comment/reply section.
My query:
Just turned 70 and diagnosed last week with DVT in femoral vein/popliteal vein of right leg. Have had numb/painful foot/toe for about 3 weeks. I thought it was sciatica but my practitioner got me into coagulation clinic quickly and DVT was diagnosed by ultrasound. It’s quite big and unattached at the proximal end (flapping about was the phrase used!). No evidence of troponin.
Clotting time determined by INR which was 1.0. Given warfarin orally and also self-inject LMW Heparin subcutaneously into abdomen area once a day since then. It has taken a week to get my INR up to 1.7 and they want it to be 2.5 before stopping the heparin. Have support socks on both legs every day.
I know from reading your work and others that there’s a good possibility of risk of PE. My worry is a bit of this clot, or even all of it, will break off.
My query is whether regular exercise is bad to do? Would I increase risk of PE if I walk regularly? At the moment even after 1 week of wearing the stockings, my toe and foot is still painful.
Thanks for your comment on this.
Yours
Duncan Hannant
Of course medical advice should be taken from your treating Dr.
In terms of exercise, the following article will be of interest .
https://www.ncbi.nlm.nih.gov/pubmed/18078981
The conclusion is
Early walking exercise is safe in patients with acute DVT and may help to reduce acute symptoms. Exercise training does not increase leg symptoms acutely in patients with a previous DVT and may help to prevent or improve the postthrombotic syndrome.
Looking a little deeper in to this and it is stated that
Acute DVT: There were no statistically significant differences between early walking and bed rest in the risk of pulmonary embolism at 10 days (four RCTs) or risk of thrombus progression (two RCTs). One follow-up study reported a reduced risk of post-thrombotic syndrome in the early walking group, but the difference was not statistically significant.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Thank you Dr Ahmed for your detailed reply and the link to the PubMed site.
I wonder if I could make a supplementary query?
I have been on Warfarin since 29 May when my diagnosis of DVT was made (and s/c LMW heparin for about 2 weeks) and my INR has gone up from 1.0 to about 2.2. I wear support socks and exercise gently as per your previous reply and my GP’s advice. The rather severe pain in my foot has reduced considerably although my toes are still “numb”.
I am wondering if this means that the clot in my femoral/popliteal vein is reducing and the blood flow is less restricted? Or is this just an effect of taking the Warfarin and the pressure socks? If it is likely to be the former, do you know how long it might take for my clot to disperse (approximately, of course!)?
The hospital (NHS, in the UK) will not re-scan my leg at intervals because they said the treatment I am receiving will not alter. Further, they do not scan the calf muscle on the same leg or the other leg if they get a positive ultrasound image – because the treatment will be the same and there will be no significant benefit to the patient. I can understand this. I can get a scan done privately but I am wondering if it would be worth it, because perhaps it’s too soon to determine if any shrinkage of the clot has occurred?
Thanks for your attention
Duncan Hannant
Hi, my name is Katie.
I had a dvt which then transferred into a PE.
I have now been put on lifelong pradaxa. As my sister died 7 months ago at 34 from a blood clot.
We have been told it’s hereditary. But do t know what.. very scary and frustrating.!
I am also 34, had no problems after having 2 children, until now.
It has been 2 months since the clot in my lung..
over the last day, I have had slight chest pain In my other side.. not constant.. only now and then.. but as I’m on pradaxa, I don’t know what to do.
Could it just be from the previous clot? And is it possible to get one whilst on blood thinners?
Thanks
If there is a hereditary component then some of the blood tests that you have had may shed some light on this. There are certain inherited thrombophilias that can predispose to clot formation. Regardless the treatment would be the same as you have now most likely, that is blood thinner. I realize that is is scary and frustrating, however you are being treated with the blood thinner that will confer protection. With regard to the chest pain, my advice is that you go and get evaluated given your history. The pain in your chest now should not occur due to the clot 2 months ago, and while it may be nothing, its important to seek evaluation.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hi.
My dad had been feeling short of breath and weak for a few days, he collapsed at home banging his head all due to him having a cardiac arrest.
He was given CPR within a minute or so and came around. The paramedics arrived and rushed him to hospital. He had a further 4 cardiac arrests within 2 hours before he was made stable and sedated.
After a CT scan it was shown that he had 2 massive clots in his lungs.
He was given clot busting drugs and was on a ventilator for 36 hours.
A further scan showed no bleed on the brain and that the medication was working.
He woke up 2 days after the 5th cardiac arrest, and just a week later he is back home. Obviously still being in some discomfort from chest pain and aching all over, touch wood, he is initially showing no signs of any further damage.
Naturally he is feeling down but his personality and movement seems very normal.
He is still finding himself short of breath when walking about but says he’s feeling better day by day.
I assumed many visits weekly to the GP would be on the agenda but that is not the case. The hospital doctor who looked after him has told him he will see him again in 3 months for another CT scan to check over his chest, abdominal area and legs.
The only medication he has been given is Apixiban.
Can you give any advice please as to how he should go about his rehab now that he is home? What he should and shouldn’t do?
Also, is it proven that what he has been through will decrease life expectancy? Or is it very possibly he could make a full recovery?
My dad is 63, a non smoker, in an active job. I would say he is very fit for his age and has had a healthy lifestyle for as long as I can remember (25 years).
The doctor has said he couldn’t believe he survived what he had been through and his signs of recovery so far had been “remarkable”.
Look forward to hearing your response. Thank you.
Regards,
A very concerned son.
Hi,
Its important that any comments made here are limited as they are made without evaluation of the patient, and all recommendations need to be discussed with an evaluating physician.
Firstly it sounds like he has been very fortunate to survive the event and clearly appears to be making a recovery. He is over the most dangerous acute phase. The mainstay of treatment from this point is to prevent a recurrent event and the blood thinner is key. The fact he is fit and such is a huge advantage. In terms of rehab, activity should be performed as tolerated, i personally would recommend he partake in a formal supervised cardiac rehab program and your provider can make a referral for that. Many people with large clots, if treated appropriately can expect a good quality of life and make full recovery. Its important that the heart is monitored over time to ensure no development of elevated lung artery pressures or right sided heart strain.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hello again Dr Ahmed
I think I may have made mistake with my last query. I meant to contact you with a supplementary question but clicked “reply” to my query. I wonder if you would be able to comment on my query about re-scanning and shrinkage of large clots in the leg (14th June)
Sorry to bother you again
Thanks
Duncan Hannant
Hi Dr. Ahmed,
Ten years ago, at age 47, I was diagnosed and treated for PE, “all over my lungs”, “a significant number of significant size”. I had Pleurisy and Pulmonary Infarction. I was treated and released after one week. On blood thinners since then; turns out I have a blood mutation that can cause an increased homocysteine level. I just found some paperwork from this incident, as I said, ten years ago. The EKG done at the time indicated hypertrophy of the left ventricle suggesting left atrial enlargement. The echo showed 1. Mild Sclerosis of the Aortic valve, with normal opening and closing. 2. Mild aortic regurgitation. 3. Ascending Aorta was upper limits of normal in size. I am currently asymptomatic, and will be seen by a cardiologist next week. My internist has replied to my concern by telling me that these things can all be associated with PE. I’ll have more answers next week after I see a cardiologist, but I don’t know how concerned I should be. Are these findings “normal” with a PE, or are they not? From what I’ve been reading, it sounds like the right side of my heart could have been affected, but that is not consistent with the above findings. Obviously, if anything, progress has been either non-existent or very slow, as I’m doing fine. Thank you in advance.
It sounds like you have done well since the initial diagnosis and are on the appropriate treatment. The finding of left atrial enlargement, and mild aortic sclerosis and regurgitation are not to do with your pulmonary embolism and are incidental findings and not of clinical significance at this point. The prudent thing to do is to address your traditional cardiac risk factors. Yes right side of the heart can be affected by PE and if your right side of the heart is normal that is reassuring.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hi,
4 months ago I had a little baby boy, before this I was on bed rest for 6 weeks for complications with the pregnancy with medication that can cause clotting. I did get leg pains while on bed rest and after, but I’m also a sensitive person and I am hyper aware of everything when I had nothing to so on bedrest.
Anyway, I’m 27 years old. 2 months ago i went to the doctor with chest pains and shortness of breath. He diagnosed me with acid reflux. I started having chest pains and shortness of breath again 2 weeks ago, but I brushed them off to acid reflux and took my meds that didnt help the pain.
So last week I was standing a the fridge putting a drink up and I got lightheaded and tingly and almost passed out. We went to the er they did some heart tests and monitored me-I did keep having tachycardia when I sat up- everything was fine except when I sit or stand up my pulse rate sky rockets, (I asked them about PE but the nurse said I would not be able to talk and be in extreme pain if that was the case and they wouldn’t do a ct scan because they didnt want to expose me to unnecessary radiation when my symptoms weren’t acute) if I’m lying down my pulse rate is normal or up to 90 or 95, when I sit up it rises to 125 to 130. My chest pains are made worse by an annoying cough or even laughing, but the doctor said he doesn’t know what’s going on and is sending me to a cardiologist scheduled in a week. Anyway do PEs possibly cause your heart rate to rise extremly quickly, but become normal lying down? Im having to stay laying down in bed currently until they figure this out because everytime i stand i get lightheaded and faint feeling with rapid heart rate, chest pains and shortness of breath…needless to say it alittle scary feeling like my body is crashing around me but no answers. Should i push for them to check for PE?
I’m not a doctor, and I know this is late, but when I was diagnosed with bilateral pulmonary embolisms I was still able to talk. I had burning chest pain, was short of breath, and had a resting HR of 135 while sitting. Overnight or laying down it would be back to normal. I think it’s pretty irresponsible that they didnt check into that since your resting HR shouldn’t be that high.
Hi,
4 months ago I had a little baby boy, before this I was on bed rest for 6 weeks for complications with the pregnancy with medication that can cause clotting. I did get leg pains while on bed rest and after but nothing severe.
Anyway, I’m 27 years old. 2 months ago i went to the doctor with chest pains and shortness of breath. He diagnosed me with acid reflux. I started having chest pains and shortness of breath again 2 weeks ago, but I brushed them off to acid reflux and took my meds that didnt help the pain.
So last week I was standing a the fridge putting a drink up and I got lightheaded and tingly and almost passed out. We went to the er they did some heart tests and monitored me-I did keep having tachycardia when I sat up- everything was fine except when I sit or stand up my pulse rate sky rockets, (I asked them about PE but the nurse said I would not be able to talk and be in extreme pain if that was the case and they wouldn’t do a ct scan because they didnt want to expose me to unnecessary radiation when my symptoms weren’t acute) if I’m lying down my pulse rate is normal or up to 90 or 95, when I sit up it rises to 125 to 130. My chest pains are made worse by an annoying cough or even laughing, but the doctor said he doesn’t know what’s going on and is sending me to a cardiologist scheduled in a week. Anyway do PEs possibly cause your heart rate to rise extremly quickly, but become normal lying down? Im having to stay laying down in bed currently until they figure this out because everytime i stand i get lightheaded and faint feeling with rapid heart rate, chest pains and shortness of breath… Should i push for them to check for PE?
You may want to consider a diagnosis of postural orthostatic tachycardia syndrome (POTS), i suggest you have at least an echocardiogram. Given the pleuritic chest pain a work up for PE is not unreasonable and you can seek a second opinion or alternative ER if you are concerned.
If you are interested in cutting edge information and therapy for pulmonary embolism and heart disease then feel free to follow our twitter at @MustafaAhmedMD
Hi Dr Ahmed, I was diagnosed May 16 with PE at age 68 and did not have any DVT they don’t know how they developed they ran a lot of test on my blood and think that my body is making a lot of clots this is all new to me and as far as I know it didn’t run in the family the diagnoses was bilateral pulmonary embolism with supraventricular tachycardia they didn’t say that my heart was damaged due to the Pe so I am on blood thinners for now till I have a blood test in August to see if it is symptomatic or not I also have a under active thyroid I wonder if the two are connected I read if your thyroid is not working it affects your whole system I haven’t found any info yet about it .I wonder if I should be watching my heart rate they didn’t say I should even thou it was high at 140 and had to bring it down I due worry when I am being active what would you due I would like your opinion and I will talk to my physician when I see him.Thanks
The thyroid is not likely connected to the clot development. The clot in the lung most likely started in the leg and then travelled up to the lung and so wasn’t identified when they scanned the legs. There are many potential reasons (sedentary, surgery, inflammation, trauma etc.) that clots can develop, although i must say, having dealt with a tonne of these, often no cause is found. The good news is that your heart handled it well. Blood thinners are the key treatment at this point and should prevent recurrence. I have most my patients keep a blood pressure and a heart rate diary, it cant hurt. In most cases of clot in stable patients that are discharged, early mobilization and activity is felt to be a key component of the treatment plan.
If you are interested in cutting edge information and therapy for pulmonary embolism and heart disease then follow my twitter at @MustafaAhmedMD
Thank you Dr. Ahmed , i just read your reply but the blood clots were to many to count if I did I would say they was over twenty on both sides and were small but they did not due a scan on my legs and now it feels like there are building up again and my legs hurt and I see a lot of blue veins I am going to my doctor on Monday and see if he thinks that I have varicose veins my mom had them and later she ended up with a ulcer on her ankle that never really healed i am still taking my blood thinner and a blood test is due next week and a appointment in sept so I guess I will find out then what they say. What is your thoughts on the color doctor wrist band that will tell you your blood pressure and heart rate I am thinking about getting one it would be a good way to keep track of everything let me know what you think.Thanks
P.S. I due want to find out more info on the new findings will go to your web site later.
Hi Dr. Ahmed, my wife was diagnosed with PE on June after walking into the er with chest and back pains. She was hospitalized and monitored for 5 days. She was on blood thinners and pain killers throughout her days there.
Once she was released, blood thinners were the only thing prescribed to her. Its been a month since she was diagnosed and her pains come and go. She is still short of breath and gets sting like pains on her back (lung area).
Today she saw her Pulmonologist and explained to him what she has been feeling. He said “it wasn’t normal for her to feel this at this point or be short or breath”. He suggested a CT scan for sometime this week. Is it normal for her to feel these symptoms under her conditions and with the amount of recover time she had? Is there something we should worry about and not wait a week to get this scan?
Its difficult for me to offer too much direction on a platform like this and i always would say if worried, press your dr on the issue. Its somewhat reassuring that the pulmonologist is ok to wait a week. In some cases of PE there is death of lung tissue known as infarction, and this can heal over time but can be somewhat painful and cause symptoms over the weeks to months after the even, this is a possibility here. Im assuming an echocardogram has already been done to assess the structure and function of the heart particularly the right side and to assess the pressures in the lung arteries. The treatment of blood thinner is the correct one and at this stage should be enough to dissolve the clot entirely.
Its not entirely abnormal for some persistence of symptoms, the ct scan appears to be a decent idea, the timng of the ct scan depends on her stability as determined by the treating physician.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Hi Dr. Ahmed,
I am a 40 yr old female. A month ago (6/22) I injured my left knee mountain biking. A few days later rode 14 hrs home only getting out once as my knee was so painful. Also I was on OCP. MRI showed completely torn ACL, grade 2 sprain MCL, lateral meniscus tear, bad bone bruise, micro fracture of femur. Ortho said toe touch weight bearing for 6 weeks. On 7/01 I woke with bad calf pain in injured leg went to ER. US showed 3 DVTs from below knee to ankle. Was sent home on Lovenox and Pradaxa. On 7/4 had faint feeling for several hours went to ER found small burden of PE in right lung. Another US was done which showed no change in the DVTs (all were still distal) I’m now at home on Pradaxa. I’m still on crutches due to knee injury hopefully in a few week the clots will be stable and I will be able to wear ACL brace and start PT. I am no longer on OCP. As the DVTs and PE were provoked how long would you recommend treatment? Some say 3 months others 6 months? I am very concerned about bleeding on anticoagulant as I do not accept blood transfusions. Also after therapy would you recommend treatment with Asprin 100mg? Thank you for your time.
If there is ongoing concern with mobility and injury 6 months would not be unreasonable. In this setting i would recommend repeat ultrasound at that point prior to stopping treatment to ensure resolution of the thrombus.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Hi I was diagnosed 7 weeks ago with multiple bilateral PEs and am due an echocardiogram in 2 weeks time. Will this still show if there was any heart strain caused or will it have healed by now?
The test will be useful to assess for right heart strain, hopefully there will not be any and it would have healed! It is also useful in assessing pressures in the artery of the lung, this should be monitored after a PE.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Hi, I’m 47 and 5 weeks ago had bilateral PEs, and right massive one and a left small one, no known cause as yet, they think it was the acute septic arthritis I was diagnosed with in March after a a chest infection.
I had a ruptured brain aneurysm 2 years ago which is coiled, so they had to get the neuro team down, and couldn’t clot bust me. I’m on apixaban now, but had 2 chest infections since. Will the clots go naturally as I’m still getting chest pain and how long does that normally take? Thanks
Often even the largest clots will dissolve over time with treatment, typically blood thinning medicines. If there are still residual symptoms with uncertainty as to the diagnosis then in some cases repeat scanning may be of use particularly if there is residual evidence of new or worsening right heart strain on echocardiography. Scans are not generally repeated in uncomplicated cases. The chest pain is not uncommon and can be a result of pulmonary infarction, the tissue scarring up somewhat as it heals.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Hi Dr
Iam 32 and on 14/7/17 and 15/7/17 i was rushed to the ER for shortness of breath, chest pain and numbness in my arms. I was misdiagnosed and send home on both occasion. Symptoms reoccured and I made an appoitment with a specialist and only got an appointment on 21/7/2017 of which I was immediatly hospitalized for a suspected PE. What was strange is both my chest xrays and CT scan did not dectect any PE. Only when I was refered for a VQ scan it was detected..how is this possible
Was the CT scan performed with contrast? If so it is the preferred test and should show pulmonary embolism clearly. The VQ scan would typically not demonstrate findings above and beyond a CT scan, rather it is used in cases where CT is not performed. The case does not make sense, do you have a treating physician you can discuss the findings with, maybe the CT scan needs re-review.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Hi Dr Ahmed
I had been feeling unwell for about 4 weeks, extreme tiredness, lightheadedness, breathless, pulse 100-115. Went to my GP a few times and was told it was anxiety. Past week I had terrible back pain and chest pain, the chest pain was tender to touch, started on left side then travelled to the right so I thought it was muscular. 4 days ago I started coughing up blood so went to A&E, saw a Dr who did a chest X-ray and said it was fine, was sent home with antibiotics. Then yesterday I woke up at 5 am with terrible back pain and hour later I coughed up blood so went back to the hospital. Long story short they did a d-dimer test and it was positive so they sent me for a scan with contrast, 5 mins later 2 Drs came and told me I had lots of small clots in both lungs and that I’d be hospitalised for a few days. The consultant came around later and said they didn’t actually need to keep me in because I was walking around ( saturation levels were dropping a bit ) and was managing ok so they sent me home with Fragmin to self inject twice a day. He said my case was a mystery and some people just get them for no reason, they are referring me to an anti coagulant clinic in a few weeks. My discharge letter said no heart strain but I had infarction. Feeling weak and tired today back and chest still hurts when I cough but I know this will continue for at least a few months. Should I have been kept in hospital? How long do you think it will take for the Fragmin to work? Really stressed and keeping thinking if my GP had done a d-dimer test a month ago it would have got so bad. Any advice appreciated.
You have had a pulmonary embolism and it appears to be relatively low risk. No heart strain, low clot burden, stable vitals etc. Often i may send such cases home the same day or the next day. It is not unusual for no cause to be found, it is actually fairly common and not a mystery. You are on the correct treatment with the blood thinner, the fragmin literally works immediately. In the long term, anticoagulation is key. The newer agents such as elequis and xarelto may be preferred to warfarin.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Thanks for you reply Dr. I am just wondering If had been suffering this for a while. As i had been suffering lightheadedness dizziness for a long time. I had seen a cardiologist who did an echo, bubble echo and transesophageal echo but found no issue with my heart, this was a few years back. I was recently reading a story of a girl who had extensive clots in both lungs, she went to Papworth Hospital ( specialist hospital in UK ) and was told she could have had clots for years. Is this really possible?
It seems so many Doctors know little about PEs, even my GP said it was really rare to get PEs at my age (42) until I told her to look on the internet because it was awash with stories of young people having PEs.
Thank you for you advice Dr.
Hello I was diagnose with 2 clots dvt in my left leg and 1in the lung my vitial been normal no short of breath or chest pain the pain and tightness in my calf is gone it all started on 8-12-17 when I felt pain in the bottom of my leg by the ankle I couldn’t take the pain no more so I went to the 08-16-17 hospital and they took blood my d-dimer was high 1600 so they start giving me shots in the stomach and warfarin they did a Ct and a vascular test but the doctor said the clots was small and they sent me 08-18home with blood thinners Elquise I have went to my pcp and she took a lot of blood to run tested I have a c-section 2013 I had caught a bacteria infection my white cells was low so I was antibiotics got 3days then went home besides I have had a high risk during pregnancy sugar and hypertension
Hello I was diagnose with 2 clots dvt in my left leg and 1in the lung my vitial been normal no short of breath or chest pain the pain and tightness in my calf is gone it all started on 8-12-17 when I felt pain in the bottom of my leg by the ankle I couldn’t take the pain no more so I went to the 08-16-17 hospital and they took blood my d-dimer was high 1600 so they start giving me shots in the stomach and warfarin they did a Ct and a vascular test but the doctor said the clots was small and they sent me 08-18home with blood thinners Elquise I have went to my pcp and she took a lot of blood to run tested I have a c-section 2013 I had caught a bacteria infection my white cells was low so I was antibiotics got 3days then went home besides I have had a high risk during pregnancy sugar and hypertension
my son of 25 has just passed due to this pe lung clot he was away with girlfriend no symptoms what so ever fit healthy active young man. Not one symptom she said he was laughing playing about enjoying his food. sea food said it was the greatest but she had this meal as well then got a drink went toilet then collapsed in her arms. He did take a few steriods in his time at the gym and tablet or another medication as such for his male boobs at the same time but no more no less then most blokes do. he drank but only weekends jd and beer in week no more no less then any other young person. he ate well and did go gym what had happened as we still not go test results back as he was in spain when this happened its been 3 months and still waiting to see where it all started from . he had no leg injury no arm injury no cancer and no family history illness s as we are a big family. it has destroyed me and my 3 daughters as we are lost with out him but more lost in this cause of death do you have any thing that can help us solve this. I would love to help others and get this blood clot situation solved or help others especially young men go get a check up not wait till your 50 for a service the young are dying through neglect of not being more aware of the steroids or of even a clot like this that can kill. where or what can i do to help others
Good evening, my cousin passed away from PE, he was 19, he was hospitalized for 8 days and they put him on drips and said that the drips are used to thin the clot, they never suggested any surgery to us, they insisted that the clot will thin and he will be ok, the day before he passed he coughed blood and the nurses said it’s a result of the medication, only once he had passed they said they had done the best they could do and that he’s kidneys were now affected, they then mentioned that he’s heart was functioning at only 10% which is what lead to he’s death, they said they tried what they could, was this not negelegence, they could have had open heart surgery but they basically waited for him to patiently die? I believe that in eight days something could have been done. Thank you for this valuable information
I’ve been on Xarelto since the end of February for having blood clots on both lungs they took me off the xarelto thursday 8/31/17 and I’m so nervous I felt the xarelto was my life saver and now it gone I had a CT scan done on the 8/4/17 and they said that my lungs were clear how accurate are those scans really. Well I need to find out what caused the blood clots in the first place because i did not have a DVT so how did they get there. i’m going to keep praying and keep asking the questions that I need to ask i was wondering should i start taking a baby aspiran to keep my blood thin.
In terms of stopping anticoagulation the length of therapy is dependent on many factors such as cause of the initial event and presence of risk factors. Each case is different and therapy needs to be tailored accordingly. If the PE was relatively small and there was a clear provoking measure that is resolved then at least 3 months of anticoagulation is advised. I cant comment on the suitability of timing of coming of the meds in your case but in my patients we have an extended discussion at the end of 3-6 months to discuss the risks and benefits on ongoing therapy. Believe it or not the data on long term use of aspirin is not well defined. Many physicians would recommend aspirin in the long term in the absence of significant bleeding risk factors and it may be effective to some degree although not as effective as anticoagulation
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD.
Hello I’m am writing I have questions and concerns. I have been overall healthy and never really been sick other than a cold. The only surgery i ever had was a tubal ligation over 10 years ago. I was recently admitted for pulmonary embolism about 2 months ago. I have always been active worked 2 jobs while being a sports mom my kids are 20, 17, 14, and 10 so I have always been active. When I went to the ER I was actually driving back home from a family reunion in Nebraska I lived in North Carolina at the time. I was driving thru Illinois when I got a sudden “sleeping” feeling in my right arm and a slight pain in my chest. I told my 17 year old to google the nearest ER leading me to being admitted and a week stay in the hospital 10 hours away from my home. That was my first time every admitted to the hospital and stayed more than a couple hours. I was told so many different things since then from the hospital I stayed at to the hospital I go to now. I am so confused on how my life has changed drastically since then. They told me I would live a normal life but I have not I’m no longer working I have tried to go back but I just couldn’t deal with dizzy feeling or the nose bleeds I worked a fast paced job both jobs so speed is the key. I bumped into the corners of the bed or a dresser ended up with bruises qwik I was never a easy bruiser. I had quit work and moved home back to South Dakota where I live with my brother. I am at the hospital every week to do my INR but my doses change every time i go and I have been put on high blood pressure pills. I have been feeling like I’m stressed and anxious about things. I have kids and my brother keeps my nephew so the house is full. I have never been bothered by my kids noise but lately I can’t handle. I get headaches constantly but nt taking anything for them. I just want to be able to understand this and why can’t I get stabilized with this. And live a normal life. I can’t do anything anymore with out getting a dizzy feeling or nose bleeds. I can’t even swing on a swing with my daughter with out being normal. I have fears of knives because I don’t want to cut myself n bleed to death. I am barely trying to tell the difference in the way my body feels when my blood is too thin or to thick. I am currently on 10 mg of warfarin.
Have you discussed one of the newer blood thinning medications with your doctor? They include eliquis/xarelto/pradaxa and although possibly more expensive do not need monitoring or INR checks or diet alteration. Maybe see if you are a candidate.
i had the same problem with coumadin (wayfarin) and i transitioned over to xarelto and did so much better.
Hi Dr. Mustafa Ahmed,
I read your responses here and commend you for taking time in life to do such.
I am a 36 year old otherwise healthy female. In late July this year I had a PE diagnosed through VQ scan which showed infarction in about a third part of my right right lung (I looked at the result myself). My vitals were always stable but otherwise I had extreme symptoms of sweating, dreadful pain in my back, extended period of coughing for months leading to diagnosis and extreme malaise 2 weeks before diagnosis. I went on Xarelto immediately after diagnosis. Follow up VQ a couple weeks ago showed my lung is regenerating which is positive. I am still waiting for ECG results. Let’s say my heart is damaged, what are the rammifications of this? Is there treatment?
The PE is unprovoked, no cause determined, no risk factors (I have yet to test for clotting disorders however this seems unlikely as I have a two and three year old). I continue to feel pressure/discomfort in my heart area, fatigue, lightheadedness, poor appetite. Is this normal? I recently returned to work but I am having a hard time keeping up.
My three month bloodthinner treatment period is about to end. Is going off blood thinners then evaluating DDimer levels a safe way to determine how long I stay on blood thinners?
What if I took Asprin and had a glass of wine every day?
A few questions,
Why was VQ and not CT scanning used initially?
Was there evidence of right heart strain?
Was there an associated DVT?
The symptoms you mention may not necessarily be related to the PE however it is possible. I have seen patients with infarction who take several months to feel better. In terms of coming off the blood thinner it depends on many factors, however in general at least 3-6 months is advised. In terms of heart damage, the EKG wont be telling, rather an echocardiogram would be advised. With your symptoms, in addition to the PE, other causes should be ruled out of the symptoms and also echocardiogram may be warranted to evaluate heart/lung pressures and structure and function.
Each case is different and therapy needs to be tailored accordingly. If the PE was relatively small and there was a clear provoking measure that is resolved then at least 3 months of anticoagulation is advised. I cant comment on the suitability of timing of coming of the meds in your case but in my patients we have an extended discussion at the end of 3-6 months to discuss the risks and benefits on ongoing therapy. Believe it or not the data on long term use of aspirin is not well defined. Many physicians would recommend aspirin in the long term in the absence of significant bleeding risk factors and it may be effective to some degree although not as effective as anticoagulation.
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If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Thanks for the reply.
No associated DVT. I have completed extensive physical examination to rule cancer as a cause of the PE, perhaps specific bloodwork would also be informative?
I did have infection type mucous being coughed up and chills/extensive sweating leading to the infarction event – like my immune system was trying to kick in. Can a respiratory infection cause a PE? I should say the infection symptoms cleared months ago, following the infarction event.
VQ was used and not CT due to concerns of exposure to radiation. I’m not too concerned about that. Is there a case to be made for a CT at this point? I guess I don’t know how big the PE was because VQ seemed only to show a large wedge in my lung that infarcted.
No evidence of heart strain (aside from my complaint of pressure/discomfort in the area, however, I should say I am waiting for echocardiogram results so this potential is being explored – previous reference was a typo), and I did try stomach acid – type meds to try to rule out gastro reflux which didn’t change anything. Will any heart deficits from PE be obvious in echo and would this require any type of treatment?
Just hoping to make the right decision in terms of coming off the anticoagulant. I’m also hoping to recover and be able function normally which seems to be lagging. If you can reference any articles that would be tremendous, above and beyond.
My father was due to have surgery tomorrow to have a cancerous tumour removed. He was called into the emergency room tonight and is being admired due to blood clots in his lungs. How long will it take for treatment for the blood clots to work? How long will they wait to reachedule the surgery?
Depends on many factors including the urgency of the surgery and the size and effect of the clots. If there is significant clot burden and evidence of heart strain then the surgery unless absolutely urgent may beed to be postponed depending on the opinion of the treating specialists. If the surgery needs to occur sooner and he is stable with evidence of DVT, then he may temporary placement of IVC filter if he needs to stop blood thinning medicine. Blood thinning medicine is the center of treatment and strategies will revolve around that.
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If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
HiHi Dr.Ahmed,I thought I would let you know what the test result was it was diagnosed as anti phospholipid anti body syndrome it turns out to be that my body was making to much protein in my blood it was a surprise to me still haven’t figure out how my body did it but some day I’ll find out but will have to be on blood thinner for the rest of my life some day they will find a cure. They did a vein test and found no sign of blood clots when the test was done but there could have been when I ended up in the hospital. I was wondering how long does it take to start to feel better when you have had a bout with pe in general it seams like it takes for ever to get your energy back I suppose it takes a few years to feel better . Would like to hear what your opinion is on how long it takes to feel better.
Often within days, however sometimes takes a few months to get back. Keep positive. Blood thinner will be protective and reassuring in preventing further events.
you can follow my twitter at @MustafaAhmedMD
Hi,Dr .Ahmed, I just read your reply I’ll try to keep positive but some days you wonder you want to due things and you due but takes three days to recover from it makes you wonder but I should not complain I know other people are in worse shape then I ‘am so thank you for your replies I will try to keep positive and take my meds maybe some day they will find a cure so thanks again.
In June of 2017 I had a event while I was at work. For the past several months prior to this event I had been experiencing abdominal pain, after undergoing many tests there has yet to be a diagnosis of what is causing the on/off again stomach pain. While at work I suddenly had explosion of pain that started right below my breast bone and expanded throughout my chest, both sides of my rib cage to my upper back. I could not breathe, it was very difficult to talk because of my breathing . My co-workers were worried because my skin tone was greyish and I was sweating pretty bad. At the time I just figured it was my stomach acting up again and after dealing with the pain for 5 hours I went home and went to bed. The next day it was still somewhat painful to breath and my sides were very sore. I finally went in to see my primary care doctor . She referred me to a cardiologist about 3 weeks later I saw him. He ordered a echocardiogram and stress test. Well the results came back showed heart damage and I also found out that I have active heart failure. My heart failure Doctor is referring me to a pulmonologist due to a cough that I’ve had for months now and for enlarged lymph nodes along the right major fissure of my right lung. After having a heart score ct done to check for blockage it shows that there is no plaque and that I’m at zero risk for heart disease. My pharmacist at work was discussing my medication with me and I told her about the test results. She asked me what my symptoms were the night all this occurred and after telling her, she says that it sounds like I had a PE and not a heart attack. Could that be possible and can I still be diagnosed after this much time has passed? I often have leg pains. It is worse at night after I get off my feet. I am constantly on feet and do quite a bit of walking at my job. Any insight would be appreciated. Thank you
It difficult to given accurate insight from limited reports and not being fully familiar with the situation. You have a multitude of symptoms and it seems like multiple tests have been performed. I think its reasonable to discuss with your physician the possibility of PE and whether any of the test results you have had shed light on this or the need for further testing.
you can follow my twitter at @MustafaAhmedMD
I need your advice. In February of 2017 I started experiencing severe stomach pain, after have many tests have been performed the doctor is still not able to tell me what’s the cause. I was told I was anemic and was put on iron pills 3 times a day along with 40mg of omeprazole. Then in June of 2017 while at work out of the blue I had severe pain that started right below my breastbone and it spread upwards into my chest, both sides of my rib cage and into my back. I cannot even begin to describe how bad this pain was. I could not breathe, trying to take a breath was unbearable. I literally could not talk. My co-workers said I was greyish and sweating. I honestly thought it was my stomach again. After 5 hours of work and working through the pain I went home and went to bed. The next day I was so sore in my rib cage area but my breathing was better. I made an appt with my primary doctor who referred me to a cardiologist. 6 weeks later I saw the cardiologist who told me that my ekg show a left branch block but that it wasn’t that serious. He did send me in for a echocardiogram and stress test. About 3 weeks later I went back in for the results. I was told that I had a heart attack (myocardial infarction) and that I also had heart failure. Heart disease and heart attacks run on my dads side of the family. My father died at the age of 56 and his brother, sister, mother and father have all passed on due to heart attacks. I was sent for a heart smart ct scan, it showed I had no blockage in my arteries and I was at zero risk for heart disease. A few days ago I was speaking to my pharmacist about my medications and I told her about the results from scan. She asked me to tell her my symptoms from that night in June . She, in her opinion feels that I may have had a PE event and not a heart attack. My legs have been so sore, sometimes to the point that I don’t want to walk. With my job I am constantly walking . My hear failure doctor did say that on my ct that there were enlarged lymph nodes along the right major fissure of my right lung and I’ve had a cough going on since February also. My latest blood work shows my d-dimer at 0.39ug. Is it possible for a doctor to detect if I did in fact have a PE in June. There is damage to my heart, but if I have no plaque in my arteries how is it possible I had a heart attack? Any advice or input would be greatly appreciated. Thank you
It would in most cases be difficult to try and accurately diagnose a PE from months ago. It may be reasonable to look for associated things such as examine the legs with an ultrasound since they are sore if your physician feels it is clinically indicated. Its very reasonable to start by bringing up your concerns with your primary physician who can determine the need for evaluation.
Hi, I’m a 20 year old female who had a baby about 2 months ago. About 5 weeks post partum I began to have shortness of breath and something that I cannot describe as pain but more light a tightness in the right upper side of my chest. This pain remained on and off for a few days. I had my 6 week PP check where I mentioned it. OB asked if I’ve been feeling anxious at all and I told him yes (I suffer from anxiety/panic disorders prior to pregnancy as well) and he told me it is probably a symptom of post partita anxiety and to speak to my psychiatrist for treatment. Saw my psychiatrist 2 days later and he gave me xanax to take when I feel the chest pain, as he thinks it’s a symptom of a panic attack.
I try to avoid taking the xanax being that I am breastfeeding so I don’t really know if it would help the chest pain…in all honesty I haven’t tried it yet. I had a check up at my primary care doc and she was concerned about PE being a possibility being that I recently had a baby. She ordered me a CT scan that I’ll be getting done the day after tomorrow.
My concerns are, if this is in fact PE, do the blood clots become larger when not treated? Because if so I’ve gone 3 weeks with them just there. My symptoms are feeling kind of worse today but then again my anxiety levels are high so I’m thinking about trying he xanax and seeing if that helps improve them at all. The shortness of breath and chest tightness are not constant. They come and go. Seems to only happen when I am alone at home with the baby. It improves with movement- when I am up and active and keeping busy I feel 100%. Does it sound more likely that this is anxiety?
Any answers would be appreciated, for the possibility of it being PE is causing immense anxiety on its own. I keep worrying I’m going to die before my CT scan.
If you are very concerned then you need to discuss this with your physician and seek reassurance that its ok to wait. While a CT scan may be appropriate, i would also consider an echocardiogram to evaluate heart structure and function, particularly if the symptoms persist.
Hi. I was wondering if you could explain this. I’ve searched on the internet and can’t find anything. My grandma recently passed away with what they called a pulmonary embolism (no autopsy) she was found in bed with a very large amount of blood from her mouth, is this possible with a pulmonary embolism?
Hi. I was wondering if you could explain this. I’ve searched on the internet and can’t find anything. My grandma recently passed away with what they called a pulmonary embolism (no autopsy) she was found in bed with a very large amount of blood from her mouth, is this possible with a pulmonary embolism?
Firstly, sorry for your loss. Pulmonary embolism is a very common cause of death. In most cases there is no blood from the mouth coughed up (hemoptysis), it does happen however and is certainly possible.
you can follow my twitter at @MustafaAhmedMD
Hi. A couple years ago my grandma passed away of what the doctors thought was a pulmonary embolism (no autopsy)
She was found in bed with a lot of blood that had come from her mouth. Is this possible? And what would have happened? I have tried to research on the internet but have not been able to find anything about bleeding from the mouth.
PLEASE answer my question…my mother was recently treated for a blood clot in her leg. xarlato for 3 months . Now the medication is finished but she is having severe pain in both legs so bad that she cant walk more than a few feet. To complicate things , she failed a medicine stress test and the cardiologist plans to do a cardiac catheterization (there is some reason to believe she had a heart attack at some point unbeknown to her and there is “25% blockage with 10% reversible”. I encouraged her to get the leg pain re-evaluated but the Dr said the pain is due to her diabetes and refused to order a follow up ultrasound. The cardiologist told me that her blood clot can not travel and cause a pulmonary emobolism? PLEASE HELP…are they correct and is se at a higher risk for complications from the cardiac catheter test?! they are planning on going through her forearm. Thank you sooo much
Hi, i answered this on the blood clot in leg page.
What is the shortest and the longest amount of time it takes for an untreated DVT blood clot to travel to the lungs?
Depends on many factors such as mobility, size, chronicity etc.
Five years ago I had a quadruple bypass and I had a pulmonary embolism a few day afterwards. I was treated in the hospital with medication that dissolved the clot. I was also put on warfarin for six months. I was then told to take an aspirin each day. I have moved to a different state and two months ago my new primary doctor put me on Xarelto and told me I should never stop taking it. Since my prior cardiologist and primary doctor didn’t put me on Xarelto I’m wondering if I really need to take it. I would very much appreciate hearing back from you.
Such decisions are made on a case by case basis taking many factors in to account. In those with large clot burden or multiple risk factors it is at time reasonable to recommend lifelong anticoagulation.
you can follow my twitter at @MustafaAhmedMD
I just got out of the hospital after having suffered a sub-massive PE. This article is, as far as I’m concerned, the clearest and most informative primer on the topic that I’ve seen. In my own case, I had a non-symptomatic blood clot in my thigh stretching from my hip to my knee. Over a period of weeks if not months it threw increasing amounts of clots to my lungs. At first I thought I had a summer cold, then I thought I had seasonal allergies, then after suffering from shortness of breath and a hammering heart, a pulmonologist began treating me for a viral bronchulitis. The pulmonologist ordered a CT without contrast, which showed no inflammation in the bronchioles like he had predicted, but did not show the blood clots. Fortunately, when I had gone to Urgent Care as my symptoms worsened, my x-ray (in which they searched for fluid in my lungs, which was absent) showed an enlargement of aortic vessels. This led the pulmonologist to prescribe an echocardiogram. Unfortunately, I never made it to my echocardiogram, or not to the one originally scheduled. Several days before my echocardiogram, I got extremely winded and felt like I was going to pass out after my morning shower; I felt that if I passed out I’d never awaken. I called 911 and they treated me as if I was suffering a heart attack. The ER sent me to get a cardiac catheterization, which showed my heart was fine aside from thickening of the right heart wall and elevated pressure. This led to another CT, but this one with contrast, which showed considerable blockage and clots throughout my lungs. This then led to a pulmonary catherization which led to application of a bolus of heparin and a 24-hour dosing of clot-busting medicine. During that 24-hour period, they did a ultrasound of my legs and found the clot in my thigh. (Even though this was all this past weekend, I think I have the timing wrong. They put in a ‘basket’ in to catch further clots being thrown from the leg to the heart, so I’m thinking the ultrasound might have been before the catheterization). After 24 hours, they gave another bolus of heparin and then extracted the pulmonary catheter. The procedure went so well that most of the big clots were cleared up. I am currently on Eliquis, and will likely be so for the rest of my life because they still don’t know why this 50-year old male got the leg clot in the first place.
Good Morning
Im 35 and I’ve recently been hospitalized for multiple clots in both lungs as well as a Saddle PE. My Troponin levels were elevated but a ultrasound and EKG were both negative. I have been told that because of my history, PE in 2006 and DVT in 2014, that ill be on bloodthinners indefinitely. That is a long time. What are some things that i can expect over the years to come? How does this affect my quality of life?
If the clot dissolves, and another is prevented with the blood thinners, and the right side of the heart functions well and the pressures in the lung arteries are controlled then your quality of life can be excellent. Of course sensible precautions are required by those on blood thinners.
you can follow my twitter at @MustafaAhmedMD
Hello,
I am 63 years old , good health , exercise regularly. I had a minor pulmonary embolism and DVT that just required blood thinner therapy 7 years ago. I have always felt where my 4 clots in my left leg were present, my doctor said that I will always feel the vein damage from this condition. However my left lung (PE) had 2 separate clots which did not turn out severe or dangerous. Would I feel the same vein damage in my lungs where my colts occurred. Its not painful but it’s always there from the start, feels like a mass or lump my chest. I take Eilquis 2.5 mg x 2 for this condition, and have never had any major problems with this drug. Is this something that would require a doctor’s attention. Thank you
I would recommend you discuss these issues with your primary physician to ensure physical exam is not concerning. You should not feel any damage in the lung at this stage. The treatment of blood thinning medication will hopefully prevent further clot formation.
you can follow my twitter at @MustafaAhmedMD
i was admitted to hospital with shortness of breath and and finding it hard to breathe.they done a lung scan and i was told that i have bi laterial blood clots in both lungs.i am on warfarin tablets and having regular blood tests. This condition has not been explained to me properly by the hospital they just said they are dangerous,What is the chance they i am going to die,i am worried sick and keep thinking that the blood clots i have will kill me.
i will appreciate your rely
thank you mrs st .cyr
Do you have any specific concerns that werent adressed in the article?
The blood thinner is the correct treatment in most case and should prevent recurrence.
you can follow my twitter at @MustafaAhmedMD
good morning .i am 69 years of age and have recently been admitted to hospital with shortness of breath.i have been told i have bi laterial blood clots on both lungs. i am being treated with warfarin and injections in my stomach if it drops below 2. i was told that having these blood clots are dangerous but they don;t explain why .can these cause a stroke or a heart attack or sudden death.please can you give me some further information as i am worried sick for my future.
thank you
mrs st .cyr
The main issue is the clot causing your heart to become unstable and in a few cases increase the pressures in the lungs. It sounds like you have done well from the initial event, the clots should dissolve in the short term and the blood thinner prevent them from returning. There is no reason you shouldn’t return to normal.
I have been on warfarin since last November after having developed multiple blood clots in both lungs also right heart strain.i have spoken to my GP and he has told me that in September he will not send me for another scan on my lungs,how can he tell that the blood clots have dissolved .shoud I insist that he sends me for another scan as how can he tell if they are gone without one. this is really worrying me.
I would appreciate your reply .thank you.
I’m 41 years and I was diagnosed with a sub-massive PE 15 weeks ago. At diagnosis my pulm artery pressure was 59 (TTE). I underwent ultrasound-assisted catheter thrombolysis. Discharged on day 5 and echo showed pressure down to 40. At four weeks an echo was unable to give artery pressure because no tricuspid regurgitation. I coughed up blood during week 10 and had a CT scan that showed “near complete resolution” of my old clot and no new clot. Only “minimal residual” clot remained on a segment artery on right lower lobe. A week later I had a bronchoscopy that did not identify cause for hemoptysis. My pulmonologist said he is confident that there is no pulmonary cause for my hemoptysis and is sending me to an ENT for scope. Amount of blood being coughed up is relatively small and seems to be decreasing. I’m back to exercising the same amount as before clot (ran 3 miles this morning). No dyspnea or fatigue. I still suffer from anxiety about pulmonary artery pressures. Given this info is this still something I should be worried about?
Of course its difficult to give a sound opinion on such a forum without knowing or seeing the case. The tests so far certainly seem reassuring, the thrombus has resolved almost completely and the PA pressures reduced, I’m assuming the right sided heart function has normalized also. The hemoptysis is improving and your symptomatic status is improving to baseline. Seems like things are going well if the treating physician is reassured also.
you can follow my twitter at @MustafaAhmedMD
Thank you for your response. Yes, the right sided function of the heart normalized also according to the echo four weeks after the event. Of that my hematologist remarked, “According to this your heart has fully recovered.” As for improving to baseline I don’t feel any physical limitations compared to before the event. Working, coaching youth hockey, running approx. 3 miles a few times a week. I had to build back up to recondition myself and that took about 3 mos. Now it’s just a small amount of blood in my phlegm on occasion and this darn anxiety.
My father was diagnosed with a fib earlier this year and was taking rivaroxiban as well as high blood pressure medication, he suffered a haemorrhagic stroke on sept 26th and is now paralysed on his right side and is bed bound, he spent 9 weeks in hospital and was discharged on the 5th Dec, a few days later we thought he had a chest infection and he was re-admitted to hospital on the 12th, he had chest X-ray , ecg and was diagnosed with multiple blood clots on his lungs. The doctors won’t give him any blood thinners because if the type of stroke he had, he has had a filter fitted and is having another brain scan today, my question is will his existing clots dissolve and does the filter stop any more getting through to his heart?
Sounds a very difficult situation. The most likely reasons for the clot is the prolonged hospitalization and the bed bound state leading to clot formation in the leg that then travelled to the lung. The filter would in that setting appear appropriate, then in the long term a discussion with a neurosurgeon and a neurologist regarding the possibility of blood thinners in the future. Depending on the size of the clots they may well dissolve, however if large it is difficult to know. Often i will rescan patients after an interval to see the natural history of the clots and to help guide further management. The filter should stop clots travelling freely to the heart from the legs.
you can follow my twitter at @MustafaAhmedMD
My 39 yo friend just died of a massive pe. He was dyspneic for a few days, even went to urgent care where they did chest xray and ekg, but unfortunately sent him home and less than 12 hours later he died. Furthermore, he had a history of dvt! Seems to me like a preventable death. I feel terrible for the family and also for the provider who missed this. People need to be educated that once they have a dvt they remain high risk and any shortness of breath should be suspicious for pe. So sad
hi dr ahmed,
i was diagnosed with a lower left PE 08/16 i was on coumadin and was never therapeutic so i switched to xarelto. i had some genetic testing done and found the lupus anticoagulant was part of my underlying issue. while on xarelto a superficial clot the length of my arm was formed.
here’s my question- i have some exercise issues which is know is common but when i wake up in the morning- i can’t breath to full capacity for a few hours; could this be due to lung damage or any of the other post PE lung problems? also, could you shed any other light on lupus anticoagulant..?
thank you so much in advance!
sarah
The PE itself appears to have been localized to the left lower lobe? if so its not likely to in isolation have a lasting effect on the lung if treated appropriately. Its odd that you continued to develop clots on the anticoagulants and i would recommend you are under the care of a hematologist. With regard to the symptoms of shortness of breath, have you had an echocardiogram? is there any pulmonary hypertension? this should certainly be ruled out. Lupus anticoagulant antibodies can lead to a pro-clot state and if you have had clots and a clear diagnosis then lifelong anticoagulation is typically recommended.
you can follow my twitter at @MustafaAhmedMD
I had an injury in my leg and the clot travelled and got lodged in my lower left lung. i wasn’t treated properly to begin with. i never reached a therapeutic level until 6 months later when i started new medication. i have been under the care of a hematologist but have not had an echocardiogram. the diagnosis was borderline so it’s been a baby aspirin a day.
thank you for your time i really do appreciate it!!
Hi Dr Ahmed
Your comments throughout this forum have been very useful, thank you.
My question is:
I had DVT diagnosis in femoral and popliteal vein in May 2017. Managed to get INR to about 2.6 and controlled usually except for the odd problem, not really explained (INR =6.9, stopped Warfarin and if undershot to 1.8). Now pretty stable. I get small amount of bleeding when blowing nose in morning but nothing significant. No obvious symptoms related to PE. But one question please – I’ve noticed haematospermia on one occasion recently, dark brown in colour with small streaks/clots. Not sure if this is still there – it’s difficult to notice I guess. I had done some very heavy lifting about 2 days before I noticed this. I’m 70 and also take diclofenac to control OA symptoms.
Is this a possible side effect of Warfarin treatment and diclofenac?
I would recommend an opinion from a urologist to ensure no underlying issue.
Three weeks ago today, my father, age 65, suffered a massive PE and received catheter based treatment, TPA was used and administered for 12 or so hours. He suffered from his symptoms for 24 hours prior to seeking medical attention. He is now recovering, taking Xarelto and is experiencing constant fatigue and some discomfort at times. His primary care doctor did an EKG today and it came back normal. In your opinion, how long can recovery take and is it possible that the severity of the PE will lead to long term effects?
It all depends on how the patient is doing at baseline. If someone was fit and healthy then they often bounce back relatively quickly, those with complex medical history and pre existing symptoms may take longer to bounce back. If the PE was a truly massive PE (as opposed to submassive) then it is a high stress event to the system and it may well take weeks to months to fully bounce back depending on the situation. Long term recovery from the PE itself is often good, close follow up and surveillance is necessary.
you can follow my twitter at @MustafaAhmedMD
My son had a dvt and pe in March 2017 and is taking Xeralto still. His Dr. said he was going to take him off the Xeralto in Sept if his lungs were clear of any clots after the ct scan and ultrasound of his leg. However there is still some residual clots in his leg and lungs so he has to stay on the medication for three more months. Shouldn’t the clots have dissolved by now? And would you recommend that he see a hematologist instead of his current physician because of this situation. This incident was non provoked and my son was only thirty years old with no family history. Eight months prior he was misdiagnosed with pneumonia and presented to the er with chest pain and sob and sent home with antibiotics. We are certain he had a pe because he had a abnormal d dimer. He wasn’t given a ultrasound of the leg so unknown if he had a dvt as he had no complaint of leg pain or swelling. Would appreciate your advice.
Dissolution of clots is expected, however different in different cases. In my PE clinic i work closely with a pulmonologist and hematologist and so would always recommend multidisciplinary team input. In general most would recommend testing for predisposing factors including hematologic assessement so decisions regarding long term treatment can be made. In our case, the pulmonary specialists also take care of the testing for clotting disorders and such.
you can follow my twitter at @MustafaAhmedMD
Hi Dr Ahmed
I was wondering how long after PE you can still have referred pain?
I was diagnosed with multiple blood clots in both lungs in March 2017 (no heart damage or strain) and stopped Xarelto 20mg in September 2017. I had 3 places where I had what my Drs told me was referred pain since there are no nerves to feel pain in the lungs. Now, almost a year from first diagnosis, I still feel the pain which is on the front of my chest, approximately halfway above the heart and towards my left shoulder.
Is this something that I’ll always have or can referred pain eventually disappear?
I would advise further evaluation of the pain. You should not be getting referred pain from an old pulmonary embolism.
you can follow my twitter at @MustafaAhmedMD
Your article regarding PEs was helpful and interesting, but referred to only Leg DVTs – in my specific case, i was recently diagnosed with a moderately/significantly sized Sub-clavian Vein DVT on my right side shoulder, source/cause unknown (no trama, no genetic or blood anticoagulant issues/malformations, nor hormonal medications – otherwise an active and healthy 48 yr old woman)…which is, aside from the Sub-clavian DVT, is the only other diagnosis that most doctors agree upon – source unknown (Diagnosed due to severe endema of my right arm). Three days after Xarelto treatment (most traditional treatment) due to increased shortness of breath I went to ER and per a CT Scan, bilateral PEs were identified, at least 3 small PEs in right and left lower lobes of lung. Drs. couldn’t identify if what came first –
the PEs in lungs or from the SCLVN DVT. I don’t know if my continued symptoms are due to Xarelto medication side effects or if PEs and/or Sub-clavian DVT are to be reason for not feeling better….
Dr. – do you have any information on Subclavian DVT as opposed to leg DVTs and effects/studies. Struggling to find answers.
Dr. –
Your article regarding PEs was helpful and interesting, but referred to only Leg DVTs – in my specific case, i was recently diagnosed with a moderately/significantly sized Sub-clavian Vein DVT on my right side shoulder, source/cause unknown (no trama, no genetic or blood anticoagulant issues/malformations, nor hormonal medications – otherwise an active and healthy 48 yr old woman)…which is, aside from the Sub-clavian DVT, is the only other diagnosis that most doctors agree upon – source unknown (Diagnosed due to severe endema of my right arm). Three days after Xarelto treatment (most traditional treatment) due to increased shortness of breath I went to ER and per a CT Scan, bilateral PEs were identified, at least 3 small PEs in right and left lower lobes of lung. Drs. couldn’t identify what came first –
the PEs in lungs or the SCLVN DVT. I also had a recent doppler on my legs (3weeks after being on Xarelto 30mg- because of tightness in my legs and light swelling) – doppler results showed no clots.
I don’t know if my continued symptoms (light headaches, pain in right arm, intermittent shortness of breath, tightness in legs and muscle soreness), if they are due to Xarelto medication side effects or if PEs and/or Sub-clavian DVT are to be reason for not feeling better….
Dr. – do you have any information on Subclavian DVT as opposed to leg DVTs and effects/studies. Struggling to find answers with Sub-clavian DVT & bilateral PEs.
Respectfully, Karen
Had a massive PE in October Two PE cardiac arrests. Kidneys shut down coma for a week or so. Three weeks in ICU they did dialysis and had to be given blood on four occasions. Right side heart enlargement hemodynamics collapse and shock. Was already at the hospital only hing that saved my life. Recovery is slow have permanent kidney damage and upper body pain. Six weeks in total in hospital still not sure if heart and lungs are ok
Last year at this time I started feeling very weird . I thought I had the flu and after 6 days of still feeling bad I went to CVS Minute clinic and after waiting 3 hours I had a 15 minute run thru and was told outside of a 102 fever I was just having allergy issues ( which I never had before) She said my heart and lungs sounded fine and that she would prescribe me something for the allergies. I went to HEB and got my prescription and suffered a heart attract while driving home with my son in the car and passed out for a few minutes. Still not knowing what had happen I was in bed for another three days when I kept passing out for a few minutes at a time. I had a friend take me to an emergency room where I found out I had blood clots to both lungs and my heart had a clot completely clogged they also found a hole in my hear . I was then life flighted to the main hospital and underwent emergency open heart surgery. I’m only 47 and I served my country and play football at a high level and this caught me off guard big time. I’m a full-time single dad to a autistic son and he was my soul purpose to keep fighting and I pushed myself hard everyday after waking up in ICU. I was told it would be a few weeks of recovery in the hospital but my son needed his dad and I walked out of the in just 9 days on my own power. I’m taking the blood thinner eliqis for the rest of my life now and I’m slowly getting back into my workouts in the weight room but I know life will never be the same and I am now feeling I’m living life on borrowed time.
Dr. Mustafa Ahmed,
On March 11,2018 I was admitted to the hospital, ( Ambulance Ride ), and diagnosed with acute hypoxemic respiratory failure, Bilateral PE ( Massive ) with RV heart strain, PHTN. I received the full compliments of tests over the next 24 hrs. I was admitted to the cardiac floor and placed on a heparin drip.
My short hospital report read:
Encounter Reason: MASSIVE BILATERAL PE Encounter Diagnosis: 175 , ACUTE RESPIRATORY FAILURE WITH HYPOXIA , ACUTE EMBOLISM AND THROMBOSIS OF LEFT POPLITEAL VEIN , ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED , SYNCOPE AND COLLAPSE , PURE HYPERGLYCERIDEMIA , OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE , OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE , NONSPEC ELEV OF LEVELS OF TRANSAMNS & LACTIC ACID DEHYDRGNSE , OTHER SPECIFIED POSTPROCEDURAL STATES Discharge Disposition: Discharged to home or self care (routine discharge)
It seemed like I had a steady blood draw ever hour or so for test until I was discharged the following day around 2 pm. My wife indicated that there was discussion of possible surgey to remove the clots. I have no idea why they did not operate. I have not received a lot of information about my future potential health. I am on Eliquis, double dose week one and now on normal dose of 2 per day. Likely I will be on Eliquis for 6 months according to my family doctor. When discharged my blood pressure and pulse was normal. My oxygen was around 93%. I was tired, but walked out of the hospital. This seems to be a surprising recovery, especially after reading you very informative article.
It seemed to me that having a bilateral massive PE, I might have need a little more in hospital care. Also how long until these clots will potentially dissolve. I have no idea how large they are. I am receiving care from my family Doctor at this time. Would it be better for me to seek out a cardiologist for follow up care.
Thank you for your article, it was very informative.
Hopefully the medicine (blood thinner) will lead to fairly rapid resolution of the clots. I recommend that an echo be repeated maybe at a month after, it wil be reassuring if the right heart is not strained. Follow up care should ideally be with a physician that specializes in PE.
you can follow my twitter at @MustafaAhmedMD
Thank you so much. I am making an appointment with a pulmonologist.
Best wishes to you Doctor. Ahmed
DR Ahmed,
Below is a copy of information from my hospital discharge papers. I see a cardiologist in the AM following this post. How serious is this information. I am on Eliquis, my blood pressure has been good to great but fluctuates. 145 / 90 to 108 /71. Mostly in the middle of this. Oxygen mostly averaging around 95%. Here is the info :
1. Chest x-ray was unremarkable.
2. CTPA had multiple scattered bilateral segmental pulmonary emboli with
moderate RV dilatation.
3. Ultrasound of the lower extremities had nonocclusive clot involving the
proximal left popliteal vein.
4. Echocardiogram had EF normal with moderate dilatation of the RV and
moderately reduced to severely reduced function. PAP 51 mmHg. Moderate right
atrial enlargement, mild to moderate MR, moderate TR, mild PI.
5. Further laboratory details can be viewed in the chart
How serious was this heart strain, your opinion.
Thank you,
Dallas
Great article Dr.Ahmed. Comments and Doctor responses have been very helpful to me.
It seems I ran a half marathon with a bilateral P.E. which came from leg DVT. Age 70 male and runner for 40 years. After a 10 hour car ride (broken up over two days), and probably not drinking enough fluids, I ended up walk/jogging over the last 4 miles of the race and finished 25 minutes slower than my normal time. Walked around Disney for days then family obligations prevented me from running again for two weeks. No symptoms of PE or DVT until I finally did get out for a slow three mile training run. I was breathing unusually hard, like I was sprinting, and stopped at 2 miles. Requested EKG from primary care physician. Normal. X-ray of chest normal. High d-dimmer resulted in CT scan of lungs which showed “filling defects in bilateral main, segmental, and subsegmental pulmonary arteries. No saddle embolus. No evidence of right heart strain. 2.4 centimeter lower left lung lesion, likely an infarct.” I had done three other “destination” half marathons of about 4 hour car trips so nothing about this one alerted me that it would be different. On blood thinner for 6 months as my primary care physician said my clots are large and, “Hell, I have never heard of anyone running miles with clots like yours”. My pulmonologist said my clots were “pretty good sized” and he would do a follow up lung and leg scan in 6 months to check on progress. He told me I could begin running again and I have been doing a slow two miles every other day combined with 3 miles of brisk walking on the alternate days. I am 8 weeks out from diagnosis but I think 11 weeks out from occurance.
My questions are, I suspect some of my clots are old and have read that they may be difficult or impossible to dissolve. Do all lung clots eventually dissolve and can they tell if some are old? Will I be able to run like before? I had already determined that I would retire from Half Marathons and only do 5K’s but still wish to do maximum effort without the worry of putting my body at more than usual risk. Lastly, when and if I come off blood thinner, can I just take one or two aspirins per day since this is the first and hopefully last time I have had one of these? (Tests show no hereditary blood condition) I think my pulmonologist said the was a 4% chance of recurrence with my Eliquis and an 8% chance with aspirin, although we didn’t talk about that much but I have begun to think about it. Considering the expense and possible complications of blood thinners it seems aspirin may be a viable option as long as I am more careful about hydration and moving more during travel. Thank you so much for your time and expertise! Wayne Crowder
Many good questions, ill not give you individual clinical advice, but ill provide insight in to the questions.
Super long distance in itself is somewhat a stressful endeavor for the body and more and more reports suggest although it may not be ‘dangerous’ it is certainly not benign. It is possible the inflammatory response to such a stress may contribute to endothelial damage and set up the cascade for thrombus formation. In my clinic, i personally would advise such patients, yes by all means exercise, but keep it in moderation. With regards to the blood thinner, contemporary management allows somewhat of an individualized approach to treatment. If the cause was known with certainty (i.e surgery, illness, injury, medications etc. then i would say it may be reasonable to come off anticoagulation after 6 months in many patients. If unknown however it is less certain what to do, if my patients have a large or life threatening clot, and they tolerate it well, i am keeping many of them on lifelong blood thinner. Complications always possible yes, but recurrence of the thrombus may be life threatening. With regards to the repeat CT scan, i’m not sure what it will be useful for, other than to document thrombus resolution if certain to come off blood thinners. If originally there was right heart strain, a follow up echo may be useful to document resolution of that and establish a baseline PA pressure. Most acute lung clots, will completely disappear.
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Thank you Dr. Ahmed for your detailed and insightful answer. I had no right heart strain. Can’t recall seeing your opinion of a filter to catch future clots but assume that is wrought with possible devastating complications and reserved for those who can’t tolerate blood thinners.
Im wondering is the blood work most accurate? I was diagnosed with PE in December 2016 while i was 7 months pregnant. I was hospitalized for 4 days and given blood thinners (lovenox); i had clots in both lungs. I was taken off in April 2017 the dr said they were gone. A few weeks ago i started having severe chest pain but figured it was due to anxiety; well now im having shortness of breath too. I went to the ER; they did EKG, Chest xray and blood work (d-dimer), and oxygen was at 100 so it all came back good. Is there a chance those could be wrong? i only asks because when i was previously diagnosed everything came back good except the blood work it cam back positive for clots so they did a CT scan which showed the clots. I’m nervous it may have come back; what are the chances it would?
In general a negative d dimer will rule out the presence of thrombus. Clinical evaluation still needs to be performed however and risk assessement done at that time.
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November of 2016 I supposedly had relatively small bilateral pes with a rvs. Was on blood thinners till may 2017. Have had like 8 cat scans since due to paranoia and no more pes. I never saw a pulmonologist until now and he read my cat scan from November 2016 and said he can’t tell if I had pes or not due to the ct scan not being very good. My hematologist took me off thinners in may 2017 after a clear ct. I went back February 28 for another check up and he said all good just keep taking baby aspirin. They don’t know why I got it. I don’t have a genetic clotting disorder. Although my mom has had blood clots and is on thinners for life. She never got any testing done. I had an echo 6 months after pe and no rvs. Hematologist said I was at like a 10% of getting another one. They think because I kicked a door like 20 30 times and then in a psych hospital for 8 days. I got the pes 2 weeks after getting out of the psych hospital. Do I have to worry about another pe? I’m always scared. And I didn’t have symptoms other then slight chest pain and high BP.
I have been on warfarin since last November after having developed multiple blood clots in both lungs also right heart strain.i have spoken to my GP and he has told me that in September he will not send me for another scan on my lungs,how can he tell that the blood clots have dissolved .shoud I insist that he sends me for another scan as how can he tell if they are gone without one. this is really worrying me.
I would appreciate your reply .thank you.
Typically they disappear, and if symptoms have improved, and echo improved, i dont order repeat ct on most patients.
I had 84 years old grandpa with lymph cancer , after the treatment ,due to his old story of hypertension and stroke he had stroke attacks effecting his right side of body , problaly caused by ischemy in frontal cerebral artery.And we had no treatment and exact diagnosis for him .They just began to give him aspirin which he used to avoid popssible stroke attacks before the cancer .At the end of 1.5 month he had increased pulmonery secretion,wheezing,voices and possible shortness of breath.İt seemed like failure of organs.At the end of the week that difficult breathing started we lost him. However as a med student at his first year at med school , i wonder is it possible for a person to live for a week with pulmonery embolism?And are these symptoms pointing pumonery embolism or more likely failure or casued by infection?I would be greatful if you explan me that sir,thank you .
In November of 2016 I was told I had bilateral relatively small PEs. They don’t know what caused them, they think maybe kicking a door 20 or 30 times might have caused it. when they scanned my legs there was no DVT. I never saw a pulmonologist only recently I decided to see one due to a breathing problem brought on by a beta blocker. I gave him my scan from 2016 and he said he can’t confirm or deny that I had a PE due to the scan being bad. My hematologist and my Pulmonologist tested me for every blood clotting disorder possible and I have none. My hematologist says I’m only at a 10% chance of getting another one. I’m 37 years old. How does he come up with this number? I’ve been off a blood thinner since May of 2017. My mom is on blood thinners for life for whatever reason she doesn’t know because she never goes to the doctor so I don’t know if she has a clotting disorder or not. According to all my test I do not have a clotting disorder. But what are my chances of getting another one?
Salam,
I am c. pathologist,60, P/H of 2 DVT, with family history of DVT, now just diagnosed with bilateral extensive PE by spiral CT. Apart from dyspnea on exertion I am clinically free. BP N, O sat about 95%, echo cardiogram N for age. started with LMWH and shifting to warfarin. My questions are
which is better warfarin or DOAC?
when should i repeat CT to check if clot is dissolved?
when could i resume my physical activity, walking, jogging, biking?
Thank you and Ramadan mubarak
The normal echocardiogram is reassuring. I would recommend enrolling in a cardiac rehabilitation program that will allow a stepwise increase in monitored activity.
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Thank you for your concern. Actually I dont know what you mean by cardiac rehabilitation program.
Would you please answer my questions?
Is there a chance for the clot to travel to another place? I was advised to rest, but to what extent abd for how long?
When could i resume my full physical activity?
For lifelong treatment which is better warfarin or NOAC?
Should i repeat CT?
Thank you and best regards
A cardiac rehab program is a specially endorsed program where activity is done under monitored conditions.
Im sorry, its not really safe or possible online to answer specific questions regarding management decisions without knowing the ins and outs of a specific case. I recommend you seek these specific answers from the treating specialist.
My mom has a blood clot in her lung she went to the doctors and got some medication but Is still going in and out of the hospital and I’m scared that she is going to pass away what are the chances or percent that she does pass away or do you guys think it will be fine and she will end up living
Many people treated for pulmonary embolism will go on to do just fine if treated appropriately.
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I’m a 40 year old women. In October 2017 I was diagnosed with PE after a VQ scan was done. Found small blood clots in 3 places in lungs. Went on Pradaxa. In April this year had similar symptoms (shortness of breath, headache, pain in chest, extremely tired, cannot do the smallest activity without getting very tired, pain in upper stomach under rib cage, also back ache).
Went for another VQ scan, places where clots were previously still the same, found another 2 new places where blood clots are. How is it possible that blood clots are still forming whilst on blood thinning medicine? Did blood tests in October for e.g. thrombosis, D-dimer, blood tests were normal. Not on any hormone medication, also did not have surgery. What can the cause of the blood clots be, and why is it still appearing?
Is there a reason why the vq and not a CT scan is being performed?
In November of 2016 I was told I had bilateral relatively small PEs. They don’t know what caused them, they think maybe kicking a door 20 or 30 times might have caused it. when they scanned my legs there was no DVT. I never saw a pulmonologist only recently I decided to see one due to a breathing problem brought on by a beta blocker. I gave him my scan from 2016 and he said he can’t confirm or deny that I had a PE due to the scan being bad. My hematologist and my Pulmonologist tested me for every blood clotting disorder possible and I have none. My hematologist says I’m only at a 10% chance of getting another one. I’m 37 years old. How does he come up with this number? I’ve been off a blood thinner since May of 2017. My mom is on blood thinners for life for whatever reason she doesn’t know because she never goes to the doctor so I don’t know if she has a clotting disorder or not. According to all my test I do not have a clotting disorder. But what are my chances of getting another one?
Its different on a case by case basis. A personalized risk assessment and tailored anticoagulation therapy is essential to improve prevention of recurrent events. We see all out patients with pe or dvt as part of a specialist multidicsiplinary clinic for that reason.
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was diagnosed with massive saddle pulmonary embolism 8 months ago.Still unable to participate in previous activities (hiking, biking swimming etc.) due to feeling chest pressure and like i’m going to pass out, lifting stuff will also bring it on. Workup has been negative except for exercise part of the echo and right heart cath which showed a significant drop in blood pressure with exercise. I keep trying to exercise and just go until I start feeling symptomatic then stop hoping it will improve eventually. Any thoughts on what else I can do to fix this?
Did the right ventricle function recover?
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A few weeks after a routine appendectomy, my healthy 21 year old son suffered a massive double PE, pulmonary infarction to the lower half of his left lung & a partial collapse of his right lung. Then he developed pneumonia while in the hospital. He will be on Eliquis for at least 1 year.
Thankfully, he survived. After this happened, we learned that Factor V Leiden runs in the family. My husband tested positive for it last week.
My son is back to work full time, but on limited duty. This morning, a workplace doctor expressed concern that he isn’t currently restricted from using vibrating equipment (such as chipping hammers – which are basically hand held jack hammers; and needle guns). The doctor was concerned that the vibrations could cause a piece of the clot to break loose and travel to another dangerous spot.
My question is: After the clots “land and settle” in the lungs, is there still risk of them breaking off and moving again? I can’t seem to find any information online about what to do now. Is he still in danger?
Usually once settling in the lungs, they are stable there and as long as prompt blood thinning treatment is given the body breaks these clots down within days to weeks.
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Just had 6 month post DVT/PE scans done of legs and lungs to verify resolution of clots and another look at a couple of lung “spots” (originally thought to be infarcts). Results were: Legs clear, no evidence for residual or recurrent DVT. CT Pulmonary Arteriogram showed clear lungs. “They look great”, said my Pulmonologist who has released me from taking Eliquis, which I have been on for the full six months. It was my only DVT ever, likely caused by travel. I WILL be on the alert from now on. My question for you Dr. Ahmed, as I see you are a cardiologist as well as a DVT/PE expert, concerns a heart related matter not mentioned by my pulmonologist. In fact, I just noticed this when I got the scan result printout after return from the pulmonologist. I see noted on the results, “No coronary calcification.” I have considered getting a Calcium Scoring Test done as I am 71 years old and have been a runner for over 40 years. Just wondering if this means my Calcium score would be near zero or at least fairly low and therefore not necessary to have a Calcium Scoring Test done. I do know there is some controversy about that particular test as it does not pick up soft plaque. Have never had any heart issues other than family history but do know runners who have had heart issues and just want to stay in a preventative mode. I know they were looking specifically at the lungs but can also some critical heart information be seen as well? Thank you in advance for your expertise and taking the time to answer questions. Have found your thread very interesting. Thanks, Wayne Crowder
My 28 year old friend passed away July 1st from “acute bilateral pulmonary thromboembolism caused by DVT”. I found this article, trying to read up on it – even though I’ve read quite a few articles on it.
She had arthroscopic knee surgery just two weeks prior. She was having a hard time at work so three days before her death, she thought the shortness of breath was due to a panic attack. Our on-site health care clinic sent her home with a nebulizer, despite the fact that she was on crutches, recovering from recent knee surgery.
This kind of “hindsight is 20-20” is heartbreaking. I really had no idea this was common. I wish I had so that I could have told her to consider this.
A very well-written article for people like me, who are not well-versed in the medical field.
Im glad you found this useful.
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Hello Dr. Ahmed:
Your article is helping me to understand what our amazing 37 year old son-in-law, experienced just before he passed away, a year ago this Labor Day 2018. What a great article with actual video of blood clots in the lung. His right leg in the fibular area had bothered him for several months, he and doctor thought it was an achilles pull. (He also flew from Northern CA to Mexico City the month before- long period of inactivity) That is where the Coroner said the thrombosis was located, in the fibular vein. More people need to know the symptoms of PE and thrombosis. I am willing to do whatever I can to inform more people.
Sorry for your loss, im glad you found this resource useful. Spreading awareness is critical.
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Hello Dr. Ahmed,
I was diagnosed with DVT and Many PE’s about 5 months ago. I am currently on 20mg of xeralto a day. I had the PE’s for about 2 years before being diagnosed. I know this because I would have episodes of shortness of breath off and on that would last a few weeks each time. Because I am in very good shape physically my Doctors always thought I had a virus. They did EKG tests a number of times but these always came back negative. I even had lung capacity test done. All good. It turns out my factor VIII is a bit high so it is assumed this is the cause. My question is are my clots likely to return even on the Xeralto. I used to feel light pressure in spots in my chest and the clot in my leg would feel odd. These feelings mostly disappeared for a month but recently I started noticing feelings in my lungs again and the sensation of pressure in my calf. My calf won’t be tight like it is swollen but there is the sensation. These feelings make me a bit concerned.
Firstly its important that the symptoms are evaluated by the treating physician to ensure no further work up is required if you are concerned.
In general the use of blood thinner would prevent recurrence of further clots.
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I was admitted to hospital and diagnosed with septic pulmonary embolism.im 38 and have a drug history.the infectious disease Dr said 4 weeks at a facility on vancomycin.they sent me to a facility and the conditions were so poor it was one of the worst experiences of my life so I asked to go to different facility but in mean Time I was sent back to same hospital.the next morning a Dr I never seen before said we r discharging u and u r gonna a take levofloxin daily.im scared that this won’t do it cause the infectious disease Dr was very adamant about the 4 weeks of iv vancomycin.i said there is no other facility I can go to. He didn’t even answer and said my discharge papers will be ready so.. everything in my soul is saying find a lawyer because the treatment I received was almost degrading. Can u plz tell me u r tthoughts and from what I’ve read it seems like blood thinners r one of the first meds u get put on. I was never told that or was it even brought up.all I know is I’m scared and looking for a little guidance.thanks for your time.i greatly appreciate.
Given the complexity of the issue i recommend discussing this with the treating team or seeking a second opinion.
they found p/e on both lungs, unprovoked..age 67 fit walks a lot, have been on Xarelto 20mg for 12 mnths and they say I will be on them life long..is there a danger involved if I had to have surgery breast implants
I had a DVT at age 52 with no known risk factors. This was following my mother dying from a massive PE 10 weeks post rotator cuff surgery and then three weeks after mine my niece has multiple PEs (she is 30 and on birth control pills-otherwise no risk). They did genetic testing on me which showed nothing. Do you think that is correct? All just a coincidence? Also, insurance says genetic testing is not covered because it is “investigational”. Any advice for that? It seems to me that it is standard of care as every doctor that I have spoke to said they would have done the same thing. Thank you for this great article.
Im not sure the testing would necessarily help. With an unprovoked event and a high risk family history there is a case for lifelong blood thinner regardless if it can be tolerated.
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I was diagnosed with a dvt in the right leg on July 2, 2018 and my PC sent me home with a prescription. I was put on xeralto on July 3, 2018. On the morning of July 9, 2018 I was driving to work and I felt the clot move under my knee…30 seconds or maybe even sooner, I felt an intense pain in my chest, lightheadness, and an overwhelming feeling that I was dying right there in the car, followed by rapid breathing, and shortness of breath…luckily, I was about 15 minutes from the hospital…I management to pick up my cell and dial 911…Jennifer answered and help to save my life…she talked me through driving to the ER…A ct scan was performed and I was diagnosed with small to moderate size bi-lateral PE’s…Heparin was started immediately and then I was put on warfarin…4 days in the hospital and then sent home. I was tested by my PC on July 2, and found to have an elevated anticardiolipen reading, but tested negative for FACTOR V Leiden. I was referred to a hematologist, who has done a second test, that showed all 3 antiphospholipids elevated and diagnosed me with possible APS syndrome..I go for another test on Oct 30. This was very disheartening to me and so I started doing my investigations as to what could cause APS. I learned that antibiotics, especially tetracycline ones can cause APS-like syndrome. Around the end of last year, I was prescribed solodyn for my accute 1st rosacea flare up. I took 40 mg of it every day to help with my symptoms. My research found that an adverse side effect of this drug (occuring in 9%) was APS-like syndrome, and dvt and pe in about 4%. Further I discovered that if these adverse side effects are experienced, then they are most likely intensified side effects. I also saw a significant decrease in my eye-sight during this time…before I took the antibiotic, I had perfect vision…now it is very blurred…QUESTION: Is it possible that the long-term use of this antibiotic caused APS like syndrome, my dvt, and PE’s? I took myself off of Solodyn for good on Aug 22nd and will NEVER take it again…would rather live with my awful rosacea, then take this very dangerous drug. ANOTHER QUESTION: Is it possible that if it caused APS like syndrome, that it will go away now? Thank you, Jenny (age 44), otherwise no other health issues before this incident…
I have heard of amoxicillin causing anti-phospholipid syndrome. Whether this was related or not is not possible to know without knowing the entire clinical situation and the timeline. It may be worth discussing with the hematologist.
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I have a stent in lad, been there for 19 years. I am now 65 years old and having issues that seem to have occurred in a short period of time (last 2-3 weeks). I have shortness of breath, I can no longer complete normal workouts on the treadmill, I fatigue quickly and my shortness of breath becomes acute. The cardiologists ordered a stress test and said preliminary results indicate symptoms are not cardiac. Where do you suggest I go from here?
What are my chances , I went in to er Friday morning with severe side pain, found out I have a clot in every lobe of my lungs, a total of 5. They kept me over night in the hospital and sent me home the following afternoon on blood thinner and pain meds as I am unable to take deep breathes at all without crazy amounts of pain. Am I outof the woods? Or am I still at risk of death? How long before my pain goes away? The dr gave me a week of from work, he said no stress, you need rest, take it easy. Is it really that serious?
If treated appropriately and the situation is stable the hope is that the clot will dissolve, blood thinner will be the mainstay in preventing recurrence and follow up is essential to ensure there was no causative factor and determining the long term treatment plan. You can do just fine.
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Hello sir .. i was diagnosed with pulmonary embolism(subsegmental bilateral embolism in basal segment lower lobes) after recieving 6 month of treatement my situation is same i have shortness of breath chest pain and pressure and along with pain in left arm too
Had my best close friend die recently Sept 2 2018 of this.
Had a soccer injury to his right foot which developed into a thrombosis
which traveled to the pulmonary region and eventually caused his death.
Our high altitude didn’t help either.
He showed no symptoms (except his leg being sore)
until less than 24 hours before he passed. Then he was
complaining of shortness of breath so he was taken to hospital.
He was feeling better the next day and they were going to release him
in the evening around 7
About an hour after I saw him, and he was looking fine, he died.
This condition is sneaky and serious, so don’t risk it.
If you suspect this or have a genetic predisposition to thrombosis have it looked at
immediately. Don’t wait. Please,
-flek
Very serious
my husband died from pulmonary embolism after an operation would it have been sudden and painless
Yes. So sorry for your loss.
My condolences Susan. I was just released from the hospital after being treated with blood thinners for my PE. I’m sorry that this happened to your family.
Hi, I am a 34 year old pregnant woman who has had severe shortness of breath and dizziness for weeks. The hospital did tests for a PE, one test showed an abnormality and the other test was fine. Was told blood and oxygen aren’t reaching part of my lung and heart. They put me on heparin blood thinners twice a day. Will I be okay now or am I still in danger? Being pregnant I can’t get anymore tests done yet or other treatments.
What tests were done and what was the final diagnosis?
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Hi tests done were VQ scan over 2 days, first i had to be injected with something then next day was breathing stuff in. Was told diagnosis is probable PE and kept on clexane injections twice daily for rest of pregnancy. I still feel no better still very breathless and dizzy.
Hello Dr.Ahmed,
Last week,My sister had a severe leg pain .She went to Hospital and Doctors confirmed that its a DVT. After performing other tests,they found out that there are couple of blood clots in Lungs.
The report says ” There is moderate Volume PE,right upper lobe,Lingular segment left upper lobe”.
She got discharged from the Hospital and Currently she is blood thinners.Doctor prescribed ‘Apixaban 5mg Twice a day Oral” .And also,they are planning to reduce to “5mg per Day”.
Questions:
What kind of PE my sister fall into?Is it Massive or Submassive or Lower risk?
She is stable but still has shortness of breathing issue.How serious is the situation here?Is she in the right direction of treatment procedure?
Appreciate your help!
Thanks,
Rakesh
Sounds like relatively low risk, and should improve over time, follow up is critical.
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Hello, i am a 26 yr old female. pretty healthy for the most part. I always feel SOB everyday at some point and always seem to have aches on the left side of my chest. I recently had a stress test done and a ct scan on my chest and all was normal. i had a echocardiogram done jan 2018 to check to see of my heart was okay after severe preeclampsia. Could pe be a reason for Sob??? nothing else seems to be finding out wht the its happening…kind of scared..
PE can be one of many reasons. A large pe would typically show right sided heart strain on the echo. A PE would be picked up on a contrast CT scan. Pulmonary hypertension should also be ruled out as a cause of shortness of breathe and can be screened for by echo also.
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Hello
I had DVT about 2years ago and am on Factor Xa inhibitor. No significant PTS at the moment. I wear compression stockings most days, take moderate exercise (about 5000 steps per day) and sit with elevated feet when possible. I have blood clotting problems because of the anticoagulant. I’m 72.
Question: should I avoid flying for holidays (maybe twice a year)? Thanks – Duncan
I experienced a DVT and PE on Jan 28, 2019. I was walking 5 miles every other day for two years and came home from my last walk limping and noticed some pain and swelling in my left calf. I am a 62 year old male, 175 lbs in good health.
After much research we’ve discovered that a gut metabolite called TMAO caused blood hypercoagubility. The catalyst were supplements that i had begun taking to help reduce my cholesterol level, namely L Carnatine, Lethicin and Choline. My TMAO level as reported by Quest Diagnostics was 58, the high end of the normal range is 6. The scale didnt go up as high as my reading. This test was developed by Cleveland Clinic and may help explain many of the cases where the cause is unknown. There are many food that reduce TMAO in the gut most of which are in the Mediterranean Diet eg, Olive Oil, garlic, resveratrol, None of 5 doctors I met with including a Hematologist/Oncologist were familiar with TMAO. I found this through my own on line investigative work having been dumbfounded on how a power walker could get a DVT.
My question is this, Ive been on Eliquis for 4 months and have retuned to walking 4 miles every other day. The side effects of Eliquis are aweful for me, causing sleep issues, and brain fog akin to having 24 hour jet lag 24/7.
Is it reasonably safe for me to discontinue Eliquis? My TMAO is now 6, Im walking 4 miles every other day and physically feel good mentally Im like a Zombie.
Hi,
I am 24 years old & was just recently in the hospital (about a week- week and a half ago) & was diagnosed with bilateral PE via CT scan with contrast. Before I went to the ER, I was having chest pain, especially when I inhaled- anything that made my chest expand & I had the constant need to take in a deep breath but couldn’t get one in past my sternum. Even if I did get a deep breath in, it only satisfied me for a few minutes. I was in the hospital for a few days (admitted Saturday, released Monday). I was immediately started on Heparin via IV and now on Eliquis. For the first week I took 2 pills twice a day & I am now only taking 1 pill twice a day. The ultrasound came back negative on my legs, my echocardiogram came back perfect, & my vitals were good as well. As of right now, the cause of my PE is my birth control- I have been on it exactly one year this month. My pain has gone down immensely, but I still have the constant need to take in a deep breath and sometimes I get one in and sometimes I don’t. Since my hospital stay I have some good days & some bad. My question is, is it normal to still have this issue with my breathing? I have an appointment with a hematologist next week to rule out any genetics or mutations
Thank you!
The pain is known as pleuritic chest pain and may persist a few weeks. Any new or worsening symptoms should be reported emergently and evaluation sought.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Two nights ago I presented to my local ER gasping for air. Symptoms of oxygen deprivation started in early May but were intermittent. No leg pain but occasional stabbing pain on right side under ribs (not a “stitch”). After lots of tests I was diagnosed with bi-lateral PE. Prescribed Eliquis for life.
In 2014 I had the same diagnosis after being on HRT for three months (at age 67) for fibromyalgia pain. Logical conclusion was that the clots formed as a result of the HRT. Dc’d hormone, did the stomach injections followed by six months of warfarin and assumed there was no further danger. I have some questions that the doctor said were “not in my wheelhouse”.
Why this second round of PE’s? Was the HRT coincidental and not causative the first time?
Both times the clots were small, around 80 the first time and this time the doctor wouldn’t say. No leg pain either time. Is this common?
My mother had at least two dvt’s but no PEs. My grandson has factor VII Leiden. What test do I ask for to see if I inherited it from my mother, or my grandson from me through my son?
The ER doc said bloodwork showed no heart damage but it could still happen. Should I have a follow up echocardiogram?
Great article however PE is not necessarily only caused by a DVT. There is another cause which has really been over sighted as little education and cases in the past have been viewed. I presented with multiple PE at the age of 27. D-dimer was negative, EKG was fine but could see RV large in Echo. Due to this, completed a CT Angio and multiple clots seen. Duplex of legs showed clear – no DVT. Ironically the onset of chest pain occurred 6hrs into a long haul flight with 7hrs to go…
So it was assumed DVT even though duplex showed clear.
My doctor had a similar case with another <30yo and they were referred to a vascular surgeon as had family history of clotting. As I was trying to determine my cause, I was also referred to a vascular surgeon for venous scans. It appears that I had May-Thurner Syndrome (iliac vein compression) approx 80% causing statis where the vein was compressed by the artery.
My case is now being used at universities to assist with education and my respiratory physician since learning about this has now seen several patients present with PE and no DVT to only refer to venous scans and find out they also have May-Thurner Syndrome – another cause for PE.
Cheers
May Thurner causes the DVT in the iliac vein that can then cause a PE. This is relatively common.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I can personally tell you that PE’s ain’t no joke! On Dec 22nd 2015 I suffered from an Acute Massive Saddle Pulmonary Embolism. I became hemodynamically unstable, passed out and stopped breathing. Thankfully I regained consciousness, but not being able to breath when I woke up was the worst thing that I can remember. Ambulance came and took me to the hospital, where doctors put a
Bi-Pap on my face to force air into my lungs. The doctor told me this wasn’t an effective form of treatment, and that I needed to be admitted to the ICU and intubated. 45 minutes later I coded the first of 6 times that night. They worked on me for 2 hours and 46 minutes that night. Finally after reviving me the 6th and final time, the doctors, after consulting with many others physicians at other hospitals and Universities decided to throw one last hail Mary and gave me tPA. There’s so much more to the story, airlifted to another hospital, with my heart, lungs, and kidneys completely failing, 24 hour continual dyalisis, and 9 rib fractures from thousands of compressions of CPR, I’m so thankful to be alive! It’s real, be aware of your symptoms, and live to tell the story.
Thank you for this web site. I have had a hard time understanding DVT/PE and my own personal chances of survival in the matrix. After some weeks of reading about it on the internet, it would appear that the causes are extremely diverse and sometimes are due to an underlying condition such as cancer that by itself might prove fatal.
This website helped me understand why I was kept in the hospital for two days (cat scan of lungs, ultrasound of my heart, cat scan of lower body apparently to look for cancer) and then kicked loose with: “Here take two of these a day (Eliquis) and follow up with a hematologist.” Apparently my heart functionality was good and the PEs were moderate. I am again able to walk without a limp. I guess I don’t fit the profile, now that I’m on the right medicine and being monitored, of the patient that keels over dead from PE.
But I haven’t really had a sense of whether that is a trustworthy view or not. I updated my will and am trying to get my affairs in order. My hematologist says he has “tons” of patients who have lived 10+ years after DVT/PE so perhaps I have exhibited an excess of zeal. But the will needed to be redone anyhow. It was written when my kid was 10 and now he is in college.
What I’m getting at is that with diseases such as breast cancer they have a very good typology of the stages of the cancer and at what point treatment begins. The statistics about survival rates for various cancers are pretty robust: Even back in 1969, my mother was told that if she made it to the 5 year survivor mark from breast cancer that she probably wouldn’t get it again. And she lived another 35 years. But there doesn’t seem to be the same available statistical profiles for PE. Apparently in many cases the diagnosis occurs when the patient shows up dead or dying in the hospital. That’s pretty grim. Then there are those of us who start limping “for no reason” and end up getting diagnosed with DVT/PE. I guess the limp is a blessing. So they check you out put you on the thinners and cut you loose, telling you to follow up with a hematologist.
I’m becoming much more religious about doing 5,000 to 10,000 steps a day, my dog is very glad of the exercise. I guess I’m averaging 7,000. It’s a little sobering though, to read that Serena Williams had DVT/PE. That tennis star is a solid mass of muscle. She doesn’t lack for exercise.
Hello, I’m 27 years old Man.
I had liposuction procedure for lipoma removal 6 months back. Total 5 Lipomas were removed 4 in arm and one in back. After the procedure, i’m suffering from numbness & tightness in my chest area and back pain from 6 months. Also my vision seems out of focus and I feel dizzy a lot. I have been to multiple doctors for diagnosis. I have done health check up including common blood tests, ECG, Echo many times. They always comes out to normal. Doctor says like i’m suffering from stress/anxiety. But my condition is not improving. I’m afraid that they are not diagnosing me correctly because When I see at my symptoms i seems like a pulmonary embolism. I’m really afraid about my life. Can you please help me at this?
Hi
I have been diagnosed with extensive blood clots in both lungs last week but think I’ve had for at least a month. I have been prescribed blood thinning medication. I am due to fly again in 7 weeks and run a marathon. When is it safe to start running again? I Ran yesterday after 1 week of thinners and was far better than the previous week when I was struggling for breath. The diagnosis was multiple but no description of size or location.
Thank you
Not possible to begin answering these without extensive details. Marathon level exercise not advised i would think. Risk stratification and follow up are important.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
After reading your article, especially the death rates being 25% as a sudden death and 33.3% as an eventual death related to PE, I am quite terrified to say the least. I have multiple bilateral PE and have had them a year. Initially I was supposed to take 5mg Eliquis for 3 to 6 months yet after 3 months my PCP stopped refilling the medication and, without a CT with contrast, said I should be fine. A year later, I again collapsed, gasping for air and had to call for an ambulance as I couldn’t catch my breath and i was alone. (My respiration rate was up to 70 breaths a min.) I was admitted to hospital where they found the PE’e on the right side had worsened while the left side they were slightly better. However due to my now chronic PE ther right side of my heart it’s now slightly enlarged. I pray that it doesn’t progress into CHF as I am oly 37 (next month). I was started on IV Heparin for 2.5 days the switched to PO 15mg Xarelto at a.m. and afternoon and 20mg Xarelto at h.s. for a week and a half then down to 15mg Xarelto BID for 3 weeks and after titrating down again to 20mg Xarelto once daily at h.s. This course of treatment the hospital advised I should follow for 1 year with the possibility of lifelong anticoagulants. I am 5 months into my year and am wondering if I should ask my PCP for CT with contrast to see how the bilateral PC is responding to treatment? Also, I am definitely going to ask for the CT with contrast at a year to ensure the clots are gone before he stops prescribing the Xarelto because, I believe, if I did that a year ago with the stopping of the Eliquis I might not have to be here today. Would you advise a CT halfway (6 months) through treatment to ensure things are progressing positivity? Lastly, I know you don’t know my case but are the morality rates at 33.3% fairly accurate and what can I do to lower that percentage? I’d like to see my babies grow up. :'( Hopefully you see this as this article was posted years ago. If you do and you respond I’d like to thank you ever so kindly in advance. Many blessings! – Megan
After reading your article, especially the death rates being 25% as a sudden death and 33.3% as an eventual death related to PE, I am quite terrified to say the least. I have multiple bilateral PE and have had them a year. Initially I was supposed to take 5mg Eliquis for 3 to 6 months yet after 3 months my PCP stopped refilling the medication and, without a CT with contrast, said I should be fine. A year later, I again collapsed, gasping for air and had to call for an ambulance as I couldn’t catch my breath and i was alone. (My respiration rate was up to 70 breaths a min.) I was admitted to hospital where they found the PE’e on the right side had worsened while the left side they were slightly better. However due to my now chronic PE ther right side of my heart it’s now slightly enlarged. I pray that it doesn’t progress into CHF as I am oly 37 (next month). I was started on IV Heparin for 2.5 days the switched to PO 15mg Xarelto at a.m. and afternoon and 20mg Xarelto at h.s. for a week and a half then down to 15mg Xarelto BID for 3 weeks and after titrating down again to 20mg Xarelto once daily at h.s. This course of treatment the hospital advised I should follow for 1 year with the possibility of lifelong anticoagulants. I am 5 months into my year and am wondering if I should ask my PCP for CT with contrast to see how the bilateral PC is responding to treatment? Also, I am definitely going to ask for the CT with contrast at a year to ensure the clots are gone before he stops prescribing the Xarelto because, I believe, if I did that a year ago with the stopping of the Eliquis I might not have to be here today. Would you advise a CT halfway (6 months) through treatment to ensure things are progressing positivity? Also, as the heart is a muscle, is there a way to tone it and get it back into shape? Lastly, I know you don’t know my case but are the morality rates at 33.3% fairly accurate and what can I do to lower that percentage? I’d like to see my babies grow up. :'( Hopefully you see this as this article was posted years ago. If you do and you respond I’d like to thank you ever so kindly in advance. Many blessings! – Megan
The mortality rates are moreso the acute events that you have already survived so you can do well. In the case of recurrent events like this in general life long blood thinner is recommended if tolerated. An echo would likely be the more useful test to estimate pressures in the right side of the heart and assess the right heart function.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi I have a question at the end of my comment first Iam 37 I got my first clot at 29 it happened in my arm where 2 days after a syringe went in my arm to knock me out to get my wisdom teeth taken out then hell began after one in arm I had 4 or 5 in my legs and another in my arm then into my lung they started me on wayfaring after I had the one in my lung very scary situation since the wayfaring and 6 years later I have not had one clot here’s my question a clot on my leg seemed like it didn’t heal right and by looking at the back of my leg it looks like its bruised and dark and a little white ashy in the middle I can run with no pain but if I touch or scratch it hurts like hell now it looks like around this area there is I think dirt build up Iam thinking that’s why it is so dark because I hardly wash there because of pain should I just take a wash cloth and soap and go to town or try something else and is there a name for what I have on the back of my leg thank you
It’s difficult to comment without seeing it. The leg clot unless swollen as a result isnt likely to affect the skin on the outside. There is phlebitis that is inflammation of the veins that may be a possibility which may explain discoloration and pain. Has a medical provider looked at this?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Yes they said there was a clot there and didn’t heal right or something