#17 What are the Signs of Pulmonary Embolism

A pulmonary embolism (PE) occurs when a blood clot (thrombus) gets lodged in an artery in the lung and blocks blood flow to the lungs.

Detecting a pulmonary embolism (PE) during your pregnancy can be hard due to your changing circulatory system. In addition, most of the common symptoms of PE are also pregnancy symptoms (chest pain or shortness of breath) which makes it difficult to accurately diagnose. While doctors can do their best to monitor you, the most helpful thing you can do is to listen to your body and be upfront with your doctor about your medical history.

A PE is not just dangerous but has the potential to be lethal. In pregnancy, PEs usually occur in labor and after delivery. I was called about 2 a.m. about a woman I had not delivered. She had gotten up to go to the bathroom and fell to the floor as she was returning to her bed. When I got there, she was on the floor dying. The only thing I could do was hold her hand.

I called a cardiovascular surgeon who said you can’t do a thrombectomy (surgical removal of clots inside arteries or veins). He told the story of a pregnant woman who arrived at the hospital with a PE. They were ready to do the surgery when she arrived. The baby still had a heart beat. They cleaned out the patient’s arteries and lungs, but after the surgery, she began hemorrhaging from everywhere. She was given 16 units of blood and she still bled to death. Her baby did not survive.

The point?  Be very suspicious of dizziness and fainting. These symptoms are a very reliable indication of a blood clot. Most clots aren’t big enough to kill a person instantly, although some are. Clots usually break off a piece at a time. A piece from the clot in the leg or pelvis breaks off and travels to the lung, where it causes an episode of hypotension and loss of consciousness. This process continues until there are enough pieces of the clot circulating in the blood to kill the patient.

When I was teaching students and residents, I stressed the importence of the art of interrogation. In other words, if you don’t ask the right questions, you won’t get the right answer.

Years ago a young woman came to the emergency room with back pain on her right side. I asked if she were short of breath. She said no. I rephrased the question and asked “Are you short of breath when you walk up steps?” She thought for a while and then answered yes. The radiologist reporting on the woman’s CT scan said she would have died if she had developed any more emboli.

The CTA (cat scan angio) is the definitive lung test. The D-dimer is a blood test, but it’s hard to interpret. A normal test indicating there are no problems is 450 or less. A reading of 2000 can be a PE, a deep vein thrombosis (DVT), or nothing, but it can’t be ignored.

Symptoms of a possible PE include:

elevated heart rate
shortness of breath (dyspnea)
chest pains that coincide with breathing

Risk factors for PEs include:

family history
previous PE of DVT
blood coagulation disorders
age over 35
complications with pasts pregnancies
past c-sections
serious heart conditions
prolonged immobility.

Knowing the symptoms and risk factors for PEs can help you have a safe pregnancy. If you’ve had a PE or VT before your pregnancy, you can be treated with Lovenox subcutaneusly (shots in the stomach given daily).

If you have any of these risk factors, be sure to share them with you doctor.

Knowing the signs and symptoms of PE can help you have a safe pregnancy. By being aware of these symptoms, you will able to seek early treatment to prevent any risk of further complications for you and your baby.