Surgical Repair of Spontaneous Lung Herniation Induced by ...
What A Blood Clot Feels Like, According To Doctors
WHEN YOU CUT YOURSELF, your blood clots over the injury to keep you from bleeding excessively. Once the injury heals, your body naturally dissolves the clot. So, blood clotting, also known as coagulation, is an important natural process.
Sometimes, however, blood clots can form in your blood vessels or arteries without an injury, and they don't naturally dissolve. When blood clots block your blood vessels and restrict blood flow, a condition known as thrombosis, it can be dangerous and even life-threatening, says Erich De Paula, M.D., associate professor of hematology at the University of Campinas in Brazil, and vice chair of the World Thrombosis Day steering committee.
"Thrombosis is responsible for about one in four deaths worldwide," he says. "This statistic should prompt the interest in learning how to avoid them through lifestyle modifications, as well as by knowing the signs and symptoms and seeking medical attention when necessary."
And they can lead to serious complications too. Blood clots can interfere with blood getting to your organs. They can affect your heart, lungs, and brain.
One of the most common types is deep vein thrombosis (DVT), when a clot forms in a deep vein in your arm or leg. The blood clots can travel to your lungs, causing a pulmonary embolism. DVT and pulmonary embolism are known as venous thromboembolism, and this affects about 900,000 Americans every year, according to the Centers for Disease Control and Prevention.
Knowing the signs of different types of blood clots, which usually revolve around pain, could help save your life, Dr. De Paula says. "Information is key, so men who are prone to thrombotic-related diseases should make informed decisions with their doctors, as to when and how to prevent thrombosis events."
Blood clots are clumps that form when platelets, proteins, and cells in your blood stick together, according to Penn Medicine. Clotting is a necessary bodily process to stop bleeding and heal an injury, and clots normally later break down and go away. When clots form where they shouldn't or not as a result of an injury, they may not break down and can cause other health problems.
What's more, a blood clot can form anywhere in your body. It's known as deep vein thrombosis when it forms in your arm and leg veins. A pulmonary embolism develops when clots develop in your lungs. Blood clots that block blood flow to your brain can cause a stroke, and a heart attack when they form in your heart. Each type typically shows different symptoms.
Signs of a Blood Clot in Your LegDeep vein thrombosis (DVT) refers to blood clots that form in your body's deep veins, usually your legs or arms, according to the National Blood Clot Alliance. Symptoms might include:
DjelicS//Getty Images
"It's sometimes hard to describe," says Bibhu Mohanty, M.D., a cardiologist and associate professor of medicine at the University of South Florida. "It's like I feel pain that won't go away, but I didn't pull a muscle or hurt myself. I feel something that's tight and just hurts."
DVT often happens after long periods of being sedentary—such as taking a long-haul flight or lengthy car trip or sitting for long periods of time, he says. Smoking, being over 60, and being overweight can increase your risk, according to the Mayo Clinic. Women who are pregnant or take birth control pills are also at a higher risk.
You can help prevent DVT by:
When blood clots in your legs break off and travel to your lungs, it can cause a pulmonary embolism (PE). A PE is "the worst-case scenario" when you have a DVT, Dr. Mohanty says.
ozgurcankaya//Getty Images
Symptoms can vary depending on your overall health and the size of the blood clot, according to Penn Medicine, but as blood flow to your lungs becomes more restricted, you might experience:
A PE can be life-threatening, so call 911 if you experience these symptoms.
Sometimes PE has no symptoms, however, Dr. De Paula says. In other instances, "a severe and acute PE can be experienced with symptoms from sudden death to near-fainting, severe chest pain, and abrupt shortness of breath."
Since PE and DVT are closely related, the same groups are at risk, and moving more, managing your weight, and quitting smoking can reduce your risk for PE.
Signs of a Blood Clot in Your HeartBlood clots can form in the arteries of your heart and block blood flow, causing a heart attack. Symptoms might include:
boytaro Thongbun / 500px//Getty Images
"It is common that patients do not point to a specific area of the chest, but rather to a more extensive and poorly defined area of the chest when asked to identify the pain point," Dr. De Paula says.
The symptoms can occur gradually or suddenly, Dr. Mohanty says. You might also experience sweating, gas, and bloating, and it might feel like acid reflux or heartburn. Symptoms also vary depending on which artery of the heart is affected and the size of the artery.
You can reduce your risk for a heart attack by:
Blood clots can also block blood vessels to the brain, which can cause an ischemic stroke, the most common type of stroke.
andreswd//Getty Images
A stroke can happen when a blood clot forms within a blood vessel that supplies blood to the brain, known as cerebral thrombosis, according to the American Stroke Association. It can also occur when a blood clot forms in the heart or another part of your circulatory system, breaks loose, and travels through the brain's blood vessels. This is known as a cerebral embolism.
The F.A.S.T. Warning signs can help you spot a stroke:
Numbness, confusion, trouble seeing, difficulty walking, and severe headaches can also signal a stroke.
"Basically, if you're noticing a marked change in your face, your ability to talk and move your hands or arms, one compared to the other, it is extremely important to go to the hospital," Dr. Mohanty says.
You can lower your risk for a stroke by:
The individual symptoms of different types of blood clots can vary, but any time you have chest pain or discomfort that's radiating to the upper limbs or neck, shortness of breath, or a cough, seek medical attention, Dr. De Paula says.
Also, if you have unexpected pain or cramping in your leg that's not related to an injury and doesn't seem to be going away, get checked out, Dr. Mohanty says.
Basically, any time "something isn't right and is different from your human experience, and it won't go away, it's definitely time to go in and have things looked at," he adds.
Erica Sweeney is a writer who mostly covers health, wellness and careers. She has written for The New York Times, HuffPost, Teen Vogue, Parade, Money, Business Insider and many more.
PE Looks Like Me: A New Initiative From The National PERT Consortium™
To physicians, the complexities and broad reach of pulmonary embolism (PE) are not new. The medical community is accustomed to the insidious and potentially fatal presentation of PE, and providers are trained to look for its symptoms. But, unlike conditions and events that can easily be recognized by nonclinicians (heart attacks, fractures, etc), PE can affect anyone of any ethnicity, gender, or age and with varying degrees of health and wellness. Although the understanding of the need for PERTs (PE response teams) is still growing across the medical community, patients and families are even further removed from how to spot the symptoms of a PE (when they present at all) and how to understand treatment options. Barnes et al stated that "optimal care of patients with venous thromboembolism (VTE) requires the input of patient preferences into clinical decision-making. However, the availability and impact of decision aids to facilitate shared decision-making in care of VTE is not well known."1 In addition to low patient awareness and understanding of PE, the investigators conclude that "despite numerous calls to increase use of shared decision-making, a paucity of data exists to help patients engage in the treatment decisions for VTE. Future studies of additional VTE clinical decisions with longer-term clinical outcomes appear necessary." Although PE may lack the flashiness and celebrity spokespersons of other conditions, the need to educate patients and families on recognizing symptoms is both clear and urgent. By leveraging the focused but meaningful efforts already undertaken by colleagues to broaden understanding of PE and help patients and families be active partners in treatment options, we can bring a new level of awareness to clinicians and patients—and save many lives.
THE NEED FOR INCREASED AWARENESS OF AND EDUCATION FOR PE Unknown True IncidenceThe presentation of PE can be insidious, and this fact makes true demographic data difficult to ascertain. PE is estimated to occur in 60 to 70 patients per 100,000 of the general population.2 However, much of these data were generated from autopsy studies and rates of VTE, which again cloud the true incidence of PE. What is known is that approximately 10% of patients with PE present with sudden death. This falls in line with the fact that PE is likely the leading cause of in-hospital death for patients in the United States. Septuagenarians have the highest rates of PE, but diagnosis is often difficult in these patients given other comorbid conditions that may mask or mimic PE symptoms. All of these data are sobering and reflect the significant challenges that PE presents to both patients and providers.
Variable and Nonspecific Risk FactorsRisk factors for PE are varied and often not specific to one certain population. Certain causes of PE are not preventable and include prior family history of PE or the need for surgery. Others, such as obesity and relative inactivity, fall into a category best labeled as modifiable. Regardless of whether a risk factor for PE is modifiable or not, PE can affect patients from all backgrounds and all ages. As an example, 2% of patients with PE in the RIETE registry were aged 10 to 24 years.3 Younger patients with PE tend to be female, but males develop more risk factors for PE beyond age 60 years, including malignancy and heart failure.4
The ubiquity of PE is undeniable, as any patient at any age can potentially be affected. However, there are special subpopulations of patients at higher risk for PE throughout their lifetimes. Patients with heritable thrombophilias represent a nonmodifiable risk factor for the potential development of PE, the most common of which is factor V Leiden deficiency, affecting 3% to 8% of people of European ancestry.5 Although common, this genetic mutation does not increase VTE risk as much as other genetic mutations like protein C or protein S deficiency, which may increase VTE risk 10-fold. Malignancy is another potential nonmodifiable risk factor for VTE and PE. Certain cancers, such as lung cancer, can be associated with VTE rates of 17% to 43%.6 Special attention should be paid to symptoms in patients with known risk factors for PE.
By Scott Kaatz, DO, MSc, FACP, SFHM CANCERMalignancy has a well-known association with VTE, and the type of cancer, chemotherapy, presence of metastatic disease, age of the patient, and need for surgery effect the risk. The American Society of Hematology (ASH) guideline recommends either low-molecular-weight heparin (LMWH) or a direct oral anticoagulant (DOAC) in the first week of acute VTE treatment, but suggest DOAC over LMWH for the initial 3 to 6 months of treatment. The guideline also recommends long-term (> 6 months) treatment with a preference for DOACs.1 For extended treatment, it is vital that bleeding risk is continuously evaluated because many cancer patients are at high risk.
PREGNANCYASH guidelines recommend treatment with LMWH for VTE during pregnancy and, although not explicitly stated in guideline statement, they allude that treatment is similar to nonpregnant patients, with a minimum of 3 months of treatment. There was general agreement among panel members that treatment should extend to 6 weeks postpartum.2 The panel suggests against systemic thrombolytic therapy for PE, with evidence of right ventricular dysfunction, unless there is hemodynamic instability. On the other side of the spectrum of the disease, they suggest outpatient therapy for low-risk VTE.
The guideline panel suggests a scheduled delivery with discontinuation of LMWH and muse about transitioning LMWH to unfractionated heparin if there was a recent proximal deep vein thrombosis or PE to shorten the interruption of anticoagulation. Additional considerations in pregnancy include a suggestion not to perform routine anti–factor Xa monitoring and recommends against the use of DOACs while breastfeeding.
THROMBOPHILIAASH has also published a guideline to address thrombophilia testing. For patients with unprovoked VTE, the guideline panel recommends against testing because other guidelines suggest indefinite treatment for these patients.3 For surgically provoked VTE, the panel suggests not testing because treatment is usually limited to 3 months. When a patient is in the gray zone between VTE that is clearly provoked (surgery) and unprovoked (eg, hospitalized for medical reason < 3 days, confined to bed for > 3 days, out of hospital with an acute illness, or leg injury with decreased mobility > 3 days), caused by pregnancy or postpartum, or estrogen-associated VTE, the panel suggests testing for hereditary and acquired thrombophilia to guide the duration of treatment beyond 3 months.
PEDIATRICSMany of the recommendations and suggestions for pediatric patients with VTE are extrapolated from literature in adults given the relative paucity of strong evidence in the pediatric population. The panel recommends treatment of symptomatic VTE but recommends anticoagulation or no anticoagulation in asymptomatic disease (such as incidental findings on imaging) and suggests against thrombolysis in submassive PE unless there is hemodynamic compromise.4 Warfarin or LMWH are the suggested anticoagulants in pediatric patients, with a duration of ≤ 3 months for provoked VTE. For unprovoked VTE in children, the suggested duration is 6 to 12 months versus a longer duration (as is suggested for adults), as the burden of treatment and bleeding risk is considered to be higher in this young population.
Pregnancy is another common risk factor for PE and can affect many unsuspecting mothers and mothers-to-be. Pregnancy increases the risk of VTE by four- to 4.5-fold when adjusted for age.7 Moreover, PE during or after pregnancy accounts for just over 9% of all maternal mortalities. Indeed, 60% of maternal mortalities related to PE occur within 42 days after delivery. Pregnancy is an extremely common medical condition, and slightly over 50% of the United States population may be pregnant during their lifetimes. Although a good deal of effort and patient education has gone into the recognition of certain risk factors for PE such as thrombophilias and cancer, less has been mentioned about pregnant patients and PE. The National Pulmonary Embolism Response Team (PERT) Consortium™ aims to change that.
THE "PE LOOKS LIKE ME" CAMPAIGNThis article serves to highlight that PE can and does occur to a wide variety of patients, some of whom have known risk factors but many of whom have common medical conditions that predispose to PE. The National PERT Consortium™ is proud to announce a new campaign called "PE Looks Like Me," and hopefully, through this article and indeed through this entire supplement to Endovascular Today, the point has been reinforced that PE is a ubiquitous yet underrecognized disease. PE can afflict the young and the old, the seemingly healthy and the seemingly ill, and patients of all races.
"PE Looks Like Me" seeks to bridge the gap between care providers and patients to raise awareness of the diagnosis of PE in all patients and discuss prevention of PE on a broader level. The National PERT Consortium™ is uniquely positioned to accomplish these goals given the pioneering, team-based approach to the treatment of PE and the many treating specialties involved in The Consortium. The reach of The Consortium is far, but in partnering with our patients, we can further improve PE care. With our patients as partners in this endeavor, "PE Looks Like Me" will broaden the scope of knowledge of PE and save lives through increased prevention and awareness.
Brent Keeling, MDAssociate Professor of SurgeryDivision of Cardiothoracic Surgery, Department of SurgeryEmory University School of MedicineAtlanta, Georgiabrent.Keeling@emory.EduDisclosures: Consultant to AngioDynamics, Penumbra, Inc., and Viz.Ai.
Amy Ranier, MPMBoard Member, The National PERT Consortium™Vice President, Marketing and Communications StrategyBeth Israel Lahey HealthBoston, MassachusettsDisclosures: None.
Scott Kaatz, DO, MSc, FACP, SFHMClinical Professor of Medicine, Michigan State University–College of Human MedicineClinical Professor of Medicine, Wayne State University–School of MedicineSenior Staff HospitalistMedical Director for Professional Development and ResearchDivision of Hospital MedicineCo-Director, Anticoagulation ClinicsHenry Ford HospitalDetroit, MichiganDisclosures: Consultant to Janssen, Pfizer, Bristol Myers Squibb, AstraZeneca, Gilead, Phase Bio, Boston Scientific; research funding from Janssen, Bristol Myers Squibb, Osmosis Research, NIH; board member for Anticoagulation Forum, National Blood Clot Alliance; scientific advisory board for The PERT Consortium™.
Pulmonary Embolism Clinical Trial Updates
With Mona Ranade, MD; Akhilesh Sista, MD, FSIR, FAHA; Stavros V. Konstantinides, MD; Kenneth Rosenfield, MD, MHCDS; and Rachel P. Rosovsky, MD, MPH
Created with Sketch. Previous Article
Artificial Intelligence and Acute Pulmonary Embolism
By Kenneth Rosenfield, MD, MHCDS, and Patrick E. Muck, MD, RVT, FACS
Next Article Created with Sketch.
Walk To Stop The Clot Raises Awareness For Pulmonary Embolism
When Donna Brovender's daughter, Ali Senser, passed away from a pulmonary embolism at the age of 35, two days after giving birth, she was heartbroken.
"Devastated would be an understatement," Brovender said.
Refusing to be paralyzed by the tragedy, she educated herself and others about the dangers of blood clots.
She learned of the National Blood Clot Alliance — an organization devoted to advancing the prevention, early diagnosis, and treatment of blood clots — and reached out to get involved with their cause.
"I got with them and I said, 'I need to raise awareness for this because I need to know as much as I can, and I think people need to know as much as they can,'" she said.
After her daughter died, Brovender herself had a pulmonary embolism. She began to feel excruciating pain in her leg and went to the emergency room.
"I told them, 'Listen, I'm a lay person. I never spent a day of my life in medical school or residency. I am telling you, this is a (pulmonary embolism) or deep vein thrombosis,'" she said.
Upon confirming her diagnosis with an ultrasound, the doctors began breaking up the clot, preventing further harm to her.
"I feel like in my own way, my daughter saved me because I would not have known all about blood clots like this," she said. "This matters because if people know, then they'll know the warning signs."
Brovender worked with NBCA to organize a Walk to Stop the Clot in Aspen on Sunday in memory of her daughter, who visited Snowmass with her family from 1988 until her death in 2016. There is no fee for registration. She said the focus for the event is simply to raise awareness.
The walk will begin at the Jewish Community Center, with a stop at the Aspen Ambulance headquarters.
Dr. Caroline Mears, an internist with Aspen Valley Primary Care, and Gabe Muething, a paramedic and Chief of Emergency Medical Services at Aspen Ambulance District, will give a talk about blood clot risks, prevention, and treatment.
"The spotlight isn't often on blood-clot risk, and knowledge on what to look for, knowing your risk level, etc., could mean the difference between life or death," Aspen Valley Hospital Chief Growth and Marketing Officer Jennifer Slaughter said.
According to Mears, who recently had a pulmonary embolism success story involving one of her patients, most pulmonary embolisms arise from deep vein thromboses, resulting in 100,000 deaths per year in the United States.
"While they can be life-threatening, knowing more about pulmonary embolisms, risk factors, and how to mitigate those risks can go a long way in protecting yourself and loved ones," she said. "Everyone should have access to this information, which I look forward to sharing with everyone on Sunday."
Muething, who has experience in pre-hospital medical care and emergency services, will teach participants on how to recognize the symptoms of a pulmonary embolism. He will also explain treatment options and describe what happens when emergency workers respond to a patient with a pulmonary embolism.
Often, people are not aware that they have a pulmonary embolism, he said. They may call emergency services due to difficulty breathing or passing out. It can be difficult to diagnose a pulmonary embolism since the symptoms are vague.
"Unfortunately, what really causes the most harm in somebody with a pulmonary embolism is that they just write those symptoms off until it's too late, and then those symptoms become very profound," he said. "They end up having life-altering (consequences) or death due to not getting treatment early enough."
The mortality rate for pulmonary embolism, if gone untreated, is 30%, Muething said. But if it is caught early, the mortality rate drops to 8 percent.
"It's amazing how much we can do if we can get it early," he said. "That's really what we're hoping to do with this walk, is to just increase awareness of pulmonary embolism and how it happens, and who's most at risk. If you can get early treatment, we really do have a good system to be able to treat it and hopefully have a full recovery from it."
Once someone is assessed for a blood clot, first responders can provide cardiovascular support by supplying additional oxygen, support for blood pressure, and general support for the body until they are able to remove the pulmonary embolism via surgery or medication.
"It does not discriminate," Brovender said, referencing the NBCA's statistic that 274 people die of a blood clot each day. "It's not any socioeconomic group, it's not gender, it's not ethnicity — (it's) everybody."
Comments
Post a Comment