The patient was young, healthy, and short of breath. She had not been sick recently, other than a minor cough. Her oxygen level was normal and her lungs sounded clear. Her heart rate was a little fast and she was breathing rather quickly, too. She was anxious about it, but she knew there was more to this than anxiety. Meanwhile, she was taking an antibiotic for bronchitis which did not seem to be helping. We did some additional tests, some blood work, to look for other possible causes. One test result gave us a big clue: her “d-dimer” was elevated. While not tied to a specific diagnosis, this gave us more reason to keep looking.
We proceeded to get a CT pulmonary angiogram, a special scan of the chest, specifically looking at the vessels that run from the heart to the lungs, looking for a blood clot. Sure enough, that is what it was: a pulmonary embolism. The treatment was medication to help thin the blood, which helps the clot to gradually dissolve. She was relieved to know the cause of her symptoms and within days she was feeling better.
Without treatment a pulmonary embolism, or blood clot in the lungs, can be fatal. Thus, early detection and treatment is key. Unfortunately, detecting it may be difficult, especially since the symptoms are often vague and common with numerous other illnesses.
In addition to shortness of breath, coughing, wheezing, coughing up blood, or pain with breathing can be symptoms of a blood clot. Another hallmark symptom of a blood clot may be calf pain or swelling. Unexplained swelling and pain of a limb may indicate a deep vein thrombosis (DVT), a blood clot in the leg or arm. Left untreated, a DVT can become larger and may break off and go through the heart to the lung vessels and cause a pulmonary embolism (PE).
A person may be at increased risk of a clot due to a genetic condition, an illness, pregnancy, after surgery, after an injury, because of cancer, or because of medications such as birth control pills. Covid has been a more recent cause. Sometimes a clot happens for no apparent reason. Prolonged travel is also a reason, so on a long drive or flight, take time to stop and stretch your legs. Wearing high compression socks while traveling may also be helpful.
Shortness of breath can be a symptom of numerous ailments, major or minor. No matter the reason, however, please consult your doctor if you are short of breath or have unexplained swelling of an arm or leg. It could be a blood clot.
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show based on science, built on trust for 21 seasons, streaming live on Facebook most Thursdays at 7 p.m. central.
