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Blood Clots In Lungs: Before And After Pulmonary Embolism
Medically reviewed by Susan Russell, MD
A pulmonary embolism (PE) is a blood clot that has broken off a blood vessel, traveled to the lungs, and blocks a lung artery. It affects approximately 900,000 people in the United States each year. It is a potentially life-threatening medical emergency.
This article will discuss how long it takes a blood clot to turn into a PE. It will also cover symptoms, treatments, and recovery.
Luis Alvarez / Getty Images
Blood Clots in Lungs: Formation and Travel TimeA blood clot in the lung starts as a deep vein thrombosis (DVT). DVTs are blood clots that form in large veins, generally the arms or legs. When these clots break off from the blood vessel wall, they move through the circulatory system. Blood clots can get caught as they travel through the vessels; when they get to the lungs, it causes a PE.
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A blood clot must break free from the blood vessel wall to travel through the circulatory system and to the lungs.
An article in the journal Circulation from 2014 stated that the risk of a clot breaking off from the vessel wall and causing a PE is more common during the first few days through four weeks from clot formation.
Some people who have blood clots may not have symptoms. The blood clot may only cause symptoms once it reaches certain body areas like the lungs. Therefore, it is difficult to determine the time it takes for a blood clot to travel to the lungs.
Factors That Contribute to Lung Blood ClotsAnyone can get a PE. Certain factors increase a person's risk. These factors are:
Emergency Pulmonary Embolism (PE) SymptomsA PE is a medical emergency. When a blood clot forms, it may not cause symptoms if it isn't causing a blockage.
The symptoms appear once the clot is large enough to block a vein or if it breaks off and moves to another area, creating a blockage.
PE symptoms can vary from very mild, with no symptoms at all, to incredibly severe. These symptoms may include:
Immediate Treatment for Blood Clots in LungsThe treatment for a blood clot in the lungs depends on its severity and how it affects the organs in the body.
Someone who has a blood clot in the lungs and does not have difficulty breathing, has a normal blood pressure, and has a normal heart rate may only be treated with an intravenous (IV) anticoagulant or subcutaneous (SC) injections to stop further clotting. This will not break up a blood clot that is already formed.
Treatment for people with PE symptoms will be more aggressive. Its aim is to break up the blood clot in the lungs and prevent additional clots from forming. Treatments include both medications and procedures.
Medications for a blood clot in the lungs are:
Thrombolytics: Also called clot busters, this medication breaks up or dissolves existing blood clots. It is administered through an IV and given to people who have large blood clots causing serious symptoms. There is a risk of these medications causing significant bleeding and this risk is weighed against its benefits.
Anticoagulants: Also called blood thinners, these medications stop clots from forming. There is a risk of bleeding with anticoagulants. However, it is not as significant as with thrombolytics.
Procedures used to treat blood clots in the lungs are:
Catheter-assisted blood clot removal: During this procedure, a healthcare provider inserts a tube into the vein and advances it to reach the blood clot in the lung. Then, the clot can either be removed, or medication can be given to break up the clot.
Vena cava filter: In people who cannot take an anticoagulant, a filter is placed in the vena cava to stop blood clots from entering the lungs. This does not treat clots that are already in the lungs.
Learn more: Pulmonary Embolism Diagnosis: The 3-Step Process
Factors That Affect Survival and Ability to RecoverThere are several factors that affect a person's survival after a PE. Overall health, comorbidities, and severity of the blood clot will all play a factor in a person's survival and ability to recover.
Another factor is blood clot size. The larger the size, the lower the chance of survival. Here are the types of blood clots in the lungs and their corresponding mortality rate:
Small pulmonary embolism: Up to 1%
Submassive pulmonary embolism: 5% to 25%
Massive pulmonary embolism: 18% to 65%
Healthcare providers use a scoring system to estimate survival. One scoring system used is the Pulmonary Embolism Severity Index (PESI). This system estimates a person's 30-day mortality rate by examining several variables. These variables would indicate that a person has a higher mortality rate:
Older age
Male gender
History of cancer
History of heart failure
History of lung disease
Low blood pressure
High heart rate
Low temperature
Altered mental status (confusion, disorientation, or lethargy)
Low oxygen saturation
After treatment for PE, you will need to take new medications and make lifestyle changes.
Anticoagulants will need to be taken for three months or longer, depending on the underlying cause of the blood clot.
When taking an anticoagulant, you will need to avoid foods high in vitamin K, alcohol, and aspirin. You should also avoid activities that could cause an injury and increase your chances of bleeding.
After a pulmonary embolism, a small percentage of people will develop scar-like tissue in the arteries. This will narrow or cause obstructions, leading to a type of pulmonary hypertension called chronic thromboembolic pulmonary hypertension (CTEPH).
Long-Term Monitoring After PEPulmonary embolisms often recur. Ensuring a long-term monitoring plan is in place to prevent recurrence is crucial. Be sure to attend all follow-up healthcare appointments and tests.
To prevent another DVT, which could lead to a PE, adopt these lifestyle changes:
Avoid smoking.
Exercise regularly.
Eat healthily.
Wear compression stockings, excet in a leg where there is a known blood clot (DVT).
Move around on long trips or flights.
Learn More: Prevention of Blood Clots During Chemotherapy
SummaryPEs are a serious medical condition. When identified and treated promptly, outcomes are typically positive. Recovery may include anticoagulants and lifestyle modifications to prevent additional clot development. Contact a healthcare provider to clarify any questions surrounding clot management and life after a PE.
Read the original article on Verywell Health.
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Pulmonary Embolism During COVID Infection A Deadly Mix
HONOLULU -- During the first year of the pandemic, patients with pulmonary embolism (PE) had higher in-hospital mortality rates when they also had concomitant COVID-19, according to a nationwide retrospective cohort study.
Using data from the 2020 National Inpatient Sample Database (NIS), 19.8% of patients with both PE and COVID died in the hospital compared with 7.1% of those with PE but without COVID (adjusted OR 3.16, 95% CI 3.07-3.25, P<0.001), reported Rana Prathap Padappayil, MBBS, of Upstate Medical University in Syracuse, New York, during the CHEST annual meeting hosted by the American College of Chest Physicians.
Patients with PE who had COVID were also more likely to require vasopressors (5.31% vs 2.66%; aOR 1.16, 95% CI 1.11-1.22) and extracorporeal membrane oxygenation (0.76% vs 0.30%; aOR 1.62, 95% CI 1.41-1.86), and had longer lengths of stay (7 vs 4 days; P<0.001).
Padappayil noted that acute PE is one of the most common causes of cardiovascular death, with in-hospital mortality rates of around 30%. Studies have shown that COVID is an independent risk factor for developing PE.
Of note, patients with both PE and COVID were less likely to receive certain procedures versus those without COVID, including systemic thrombolysis (2.83% vs 4.71%), catheter-directed thrombolysis (0.13% vs 0.49%), and thrombectomy (0.73% vs 1.94%; all P<0.001).
Because the study data are from 2020 -- the first year of the pandemic -- this may have played a role in the differences among procedure utilization, Padappayil said, noting that a lack of personal protective equipment, a high patient burden, and concerns about evidence likely resulted in patients with both PE and COVID receiving fewer interventions compared with those without COVID.
However, it is unclear if this lack of interventions resulted in higher mortality in patients with PE and COVID, he added.
For this study, the researchers used data from the NIS, which included 425,640 hospitalizations for acute PE (the admitting diagnosis); 11% of these patients also had a COVID-19 infection.
Median patient age was 65, and the majority were women (41.6% with COVID and 50.6% without COVID) and white (53.4% and 70%, respectively); 23% and 19% were African American and 16.4% and 6.7% were Hispanic.
Among the comorbidities present among the patient population were hypertension (62% in both groups), smoking (20% with COVID and 23% without), chronic obstructive pulmonary disease (COPD; 21.6% and 27%, respectively), congestive heart failure (16.5% and 24%), diabetes (13.7% and 10.7%), malignancy (4.1% and 16.6%), and history of venous thromboembolism (4.5% and 9.4%).
Padappayil and team noted that patients with PE and COVID were more likely to be men and non-white, and less likely to have comorbidities, including prior myocardial infarction, diabetes, congestive heart failure, COPD, chronic kidney disease, end-stage renal disease, malignancy, and history of venous thromboembolism.
Limitations to the study included the fact that the NIS database is subject to selection biases and ICD miscoding. In addition, the analysis was limited to in-hospital outcomes, which means the researchers were unable to assess long-term outcomes after discharge.
Padappayil stressed the need for further research using data from the subsequent years of the pandemic. As NIS data become available, his group will look into whether providers have been more willing to use thrombolysis and thrombectomy in patients with both PE and COVID.
Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow
Disclosures
Padappayil reported no disclosures.
Primary Source
CHEST
Source Reference: Padappayil RP, et al "Concomitant COVID-19 infection and pulmonary embolism: incidence and in-hospital outcomes in a nationwide cohort" CHEST 2023.
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What Can Cause Back Pain While Breathing?
If back pain occurs when a person breathes, it can signal an underlying medical condition. Possible causes range from improper spinal curvature to lung cancer.
Back pain while breathing can also indicate a medical emergency, such as a heart attack or pulmonary embolism, particularly if the person is also experiencing shortness of breath or chest pain.
This article investigates some possible causes of back pain while breathing and describes when to see a doctor.
Scoliosis is a sideways curvature of the spine. Although it can affect people of any age, it typically occurs in preteens or young teenagers.
In some people, the spine can become so curved that it places extra pressure on the lungs, making breathing painful.
Symptoms of scoliosis can include:
Treatment optionsDoctors will consider many factors when deciding on treatment options, such as a person's sex, the severity of the curve, curve position, and bone maturity. For example, a doctor may recommend observation for less severe curvature in younger individuals and suggest physical therapy for adults. For people with mild-to-moderate curvature, a doctor may recommend wearing a back brace. Individuals with more severe scoliosis may require spinal fusion surgery to straighten their spine.
In some cases, back pain while breathing can be a symptom of a heart attack. This is life threatening and requires immediate medical assistance.
A heart attack can occur if the blood flow to the heart's muscles suddenly becomes blocked, by a blood clot, for example.
Symptoms of a heart attack can include:
People with symptoms of a heart attack should contact or visit emergency services immediately.
Treatment optionsTreatment depends on the type and severity of the heart attack. Typically, treatments involve techniques to restore blood flow to part of the heart muscle damaged during a heart attack. When a heart attack is severe, the doctor may pass a type of catheter through the person's groin or wrist to open the blocked artery.
Carrying excess weight can place extra pressure on a person's back, joints, and other parts of the body. Some people with obesity can have breathing problems and find it uncomfortable or even painful to take full, deep breaths.
Treatment optionsLosing weight — for example, through a calorie-restricted diet and regular exercise — may help alleviate back and joint pain. People who are having difficulty maintaining a healthy weight may wish to speak to a doctor about possible hormonal causes, such as low thyroid function.
According to the American Cancer Society, lung cancer often does not cause symptoms in the early stages. However, a common sign of lung cancer is chest pain that usually worsens during deep breathing or coughing.
If the cancer spreads to other organs, it may cause bone pain in a person's back or hips. A lung tumor can also press on nerves in the spine, affecting a person's breathing and causing back pain.
Other symptoms of lung cancer can include:
Treatment optionsTreatment for lung cancer depends on several factors, including:
Treatment options can include surgery, radiation therapy, and chemotherapy.
Kyphosis is a condition that causes a person's spine to curve forward, which can lead to a hunched posture.
This curvature can develop during adolescence, following a spinal injury, or result from aging.
Kyphosis can also cause back pain, swelling, and balance issues. Symptoms may get worse over time, which can lead to difficulty breathing or eating in some people.
Treatment optionsTreatment for kyphosis can involve attending physical therapy, wearing a brace, and taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. For severe kyphosis, a doctor may recommend surgical treatment, such as a spinal fusion.
A pulmonary embolism occurs when a blood clot develops in an artery that supplies blood to the lungs. This can block the flow of blood, which can be life threatening.
A person with a pulmonary embolism often experiences pain while taking a deep breath and pain in the upper back.
Other symptoms can include:
A pulmonary embolism is a medical emergency, and people with these symptoms should seek immediate assistance.
Treatment optionsTreatment options involve keeping the blood clot from growing and preventing the formation of new clots. Options typically include anticoagulant medications to break down the blood clot and a surgical procedure to remove or bypass the clot.
Pneumonia is an infection that causes the tiny air sacs in the lungs to fill with fluid. It can occur in one or both lungs.
Symptoms of pneumonia vary in severity, but people may experience chest, abdominal, or back pain when breathing or coughing.
Other symptoms of pneumonia can include:
Treatment optionsTreatment options will depend on the type of pneumonia a person has. When bacteria are responsible for the infection, a doctor may prescribe antibiotics. When a virus is responsible, supportive treatments are available. Severe pneumonia may require hospitalization.
Intercostal neuralgia is a condition that causes neuropathic pain in the area corresponding to the intercostal nerves (rib, chest, upper abdominal wall). This pain may be constant or intermittent and can be exacerbated by breathing.
Causes of this condition include certain surgical procedures, such as a thoracotomy, shingles, traumatic injury, and pregnancy.
Symptoms are as follows:
Treatment options for intercostal neuralgia depend on the underlying cause. Medication like opioids, anticonvulsants, or nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed for pain control. Other options include transcutaneous electrical nerve stimulation (TENS) and certain antidepressants.
People with severe, persistent, or worsening back pain should visit a doctor. This is particularly important when the pain occurs alongside tingling or numbness in the hands and feet.
Seek immediate medical assistance for back or chest pain that accompanies:
Below are some commonly asked questions about back pain when breathing.
Why does it hurt when I take a deep breath in my back?If a person has pain when they take a deep breath, it could be due to infection, inflammation, or spinal curvature. In more serious cases, it can point to a heart attack, pneumonia, or lung cancer.
Can lung pain be felt in the back?Severe cases of a collapsed lung can cause back pain. Similarly, lung cancer that has spread can also cause pain in the back.
Back pain while breathing may be a sign of a serious underlying condition or even a medical emergency, so it is important not to ignore the symptom.
People with severe, persistent, or worsening back pain should visit a doctor. Anyone with symptoms that could indicate a heart attack or pulmonary embolism should receive emergency medical attention.
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