If someone has chest pains, they are most likely to think they are having a heart attack, but a pulmonary embolism is almost as common. About 1 in every 1,000 people suffers from a pulmonary embolism every year, making it the third leading cause of cardiovascular death. But many people know very little about this possibly deadly condition and aren’t aware they are even at risk until they end up in the hospital. Here is what you need to know to keep yourself from falling victim.

What Causes PE?

In most cases, a pulmonary embolism is caused by a blood clot that starts in another part of your body, such as in the legs, called deep vein thrombosis, that travels to the lungs. Blood clotting is a normal process that prevents bleeding, but if the body cannot break down a clot, it can result in a serious problem. Blood clots may form because of long periods of inactivity which slows blood flow. This can include sitting, bed rest, or during long plane or car trips. This is why people in hospitals who are recovering from surgery or trauma are at considerable risk. “Acute medical problems that lead to hospitalization and surgeries, particularly those which result in decreased physical mobility all increase the risk of pulmonary embolism,” explained Dr. David Hill, director of clinical research at Waterbury Pulmonary Associates and an American Lung Association Board Member. “Severe traumatic injuries, particularly those that involve the spinal cord are a particularly high risk.”

For most people, blood clots form in the legs and, if left untreated, a clot can break loose and travel through the circulatory system until it lodges in a lung artery. Less commonly, the blood vessels can be blocked by something else, like an air bubble, part of a tumor or a fat embolus (often caused by breaking a bone). Whatever the blockage, it prevents the flow of blood to the lungs. In some situations, this obstruction can also cause the heart to work too hard which increases blood pressure in the lungs and can lead to pulmonary hypertension.

Who’s at high risk?

Certain people are genetically disposed to blood clots, putting them at higher risk of a pulmonary embolism, so a family history can help your doctor identify the issue. Additionally, preexisting conditions like heart disease, interstitial lung disease, COVID-19, or many forms of cancers can make clotting more likely. Lupus and other rheumatologic diseases may be associated with increased clotting. People who smoke are at high risk because smoking narrows and damages the lining of blood vessels, making it more likely for blood clots to form. Being overweight or taking supplemental estrogen (birth control pills) increase the risk of blood clots especially in people who smoke or have high blood pressure. Those who are pregnant can develop clots if the fetus presses on veins in the pelvis, slowing blood flow from the legs.

Can I Prevent Pulmonary Embolism?

If you are worried about a pulmonary embolism, there are some simple things you can do to lower your risk. Because inactivity is one of the most common causes of a clot forming, you should try to move as much as possible. For instance, trying to get up and move after surgery or a traumatic incident not only prevents a clot but can speed up recovery. If you are traveling, stand up and walk around the car or plane cabin every hour or so. Elevating your legs or using compression socks can also increase blood flow, preventing a clot from forming. “I advise patients to choose an aisle seat on long flights and get up and walk around if possible as there is some anecdotal association with long flights and DVT/PE in at risk patients,” said Dr. Hill.

“Patients should seek medical attention when they have unexplained leg pain or swelling, particularly if it is in only one leg. Particularly if there is an onset of shortness of breath or chest pain after a recent hospitalization.” - Dr. David Hill

Because inactivity is not the only cause of pulmonary embolisms, it is important to recognize the signs of a blood clot so that you can seek medical care immediately if you have symptoms. Some of the signs to watch for include swelling, pain, or unexplained tenderness in your leg; difficulty breathing, coughing up blood, or chest pain.

Additionally, around 33% of people affected by a deep vein thrombosis or pulmonary embolism will experience another within 10 years, so it is important to pay attention to your body even after you have recovered. Blood thinners are commonly prescribed to people who have had a pulmonary embolism, but they need to be monitored cautiously as you can be at a risk of extreme bleeding.

“Recurrence of pulmonary embolism can occur when patients are poorly adherent to their medications or when they have underlying problems that continue to increase their risk. Rarely pulmonary embolism can lead to chronic stress on the heart which might require surgical or medication intervention,” Dr. Hill explained. “It is important for patients to adhere to their medical regimen, follow up as scheduled, and contact their provider with any persistent or unexpected symptoms."

Get more information about symptoms and treatment for a pulmonary embolism.

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