Blood that has solidified can form a so-called blood clot. Blood clots in the bone or other parts of the body can sometimes accompany the blood to the lung. There, the blood clot may get stuck and hinder the blood flow. Blood clots in the lungs can in some cases be life-threatening and must therefore always be treated as soon as possible.

The most common treatment for a blood clot in the lung is a blood-thinning medication which makes the blood more difficult to solidify. A few clots lead to life-threatening stress on the heart, with falling blood pressure as a result. In this case, prodrugs that are injected directly into the blood are often used.

Blood clots in the legs can, if they become loose, accompany the blood and get stuck in the lungs.

Symptoms of a blood clot in the lung

You may have one or more of the following symptoms of a blood clot in your lung:

  • You get shortness of breath.
  • You get a cough.
  • You get hold of the side that hurts when you breathe in.
  • Suddenly you get chest pain or back pain.
  • You feel more tired than usual.
  • You have less energy than usual.
  • You get a fever.

You usually do not notice if you have received a small plug because they can often be dissolved by themselves without any problems.

Larger plugs are clearly visible

 The symptoms may be these if you have a bigger plug:

  • Sudden shortness of breath, sometimes with dry cough. In rare cases, you can cough up mucus in which there may be some blood in it.
  • A feeling of holding on one side of the chest or that it hurts when you breathe deeply. Sometimes you may feel pressure in the middle of the chest which can be difficult to distinguish from other causes of chest pain.
  • Cold sweats, dizziness and it feels like you should faint. To faint for no apparent reason is a serious symptom.
  • Heart palpitations and anxiety are common and the discomfort can be very unpleasant. You feel that you have happened to something very serious.

High heart rate, fast breathing, and irregular heartbeats

Breathing can be quick and superficial because it can hurt when you breathe deeply if you have a blood clot in your lungs. But all blood clots in the lungs do not cause so-called holding pain, that is, it hurts when you breathe deeply.

The skin may turn pale gray due to a lack of oxygen in the blood if you get a large plug in the lungs.

The heart rate is often high and the heartbeat sometimes irregular. When a doctor listens to the heart with a stethoscope, it may sound a little different than it usually does. The doctor can sometimes see changes caused by the blood clots in the lungs if you are examined with the so-called ECG. But about every fifth patient has an ECG that is as it should be despite a blood clot in the lung. Even lung radiographs can show that everything is as it should be despite a blood clot in the lung.

When and where should I seek care?

If you think you have a blood clot in your lungs, contact a health care center or an on-call clinic immediately. If closed, seek care at an emergency room.

If it’s in a hurry

  • You have shortness of breath
  • You have chest pain
  • You are sweating cold, feeling dizzy or very sick.

How can I reduce the risk of blood clots?

To avoid blood clots in the veins in the legs, and thus in the lungs, it is important that you use the calf muscles and move as best as you can. It’s good to walk. If you are in bed, try pedaling, waving your toes and touching your legs several times each day. The contractions of the calf muscles compress the veins and help to move the blood towards the heart.

If you sit still for a long time, for example, during a flight, it is good if you regularly move and tread your feet. Even better is to walk around the plane, if you have the opportunity. You can also use support socks to prevent blood clots when sitting still for a long time, for example when traveling. Support socks you can buy prescription at pharmacies or in stores that sell different types of aids. You can ask for help to get the right size tested.

If you have a known increased risk of getting blood clots, you can in some cases, for example for a longer flight, get a blood-thinning drug for preventive purposes. You will receive such a drug in the form of a syringe or tablet after consulting a doctor. There are blood-thinning tablets that work faster than warfarin and can replace syringes.

If you stop smoking and lose weight if you are overweight, you can reduce the risk of getting blood clots in the veins.

Investigations

The most common examination for the doctor to safely see if there is a blood clot in the lung is so-called computed tomography, which is also called a computerized X-ray or DT. It means that you first get contrast fluid injected into a blood vessel in your arm. The fluid makes the blood vessels appear on the X-rays. Then the doctor can study the lungs using pictures showing thin sections of the lung.

It is common for you to have blood tests. With the help of a so-called blood gas analysis, it is possible to measure how much oxygen and carbon dioxide you have in your blood. Then blood is taken from a pulsing vein in the wrist or groin and analyzed in a special device. It is also possible to estimate the oxygen content in the blood indirectly by putting a small squeeze on a finger. You can have blood gas values ​​that are as they should be and then it is usually a smaller blood clot. 

You may undergo an ultrasound examination of the heart if you have any problems suggestive of heart failure. The doctor can then see if the right ventricle of the heart is dilated and pumps worse. It may be a sign that the heart is pumping against an obstacle, such as a blood clot in the blood vessels of the lung. The study can also show if you have elevated blood pressure in the lung, which is important for prognosis and treatment.

In some major hospitals, so-called lung scintigraphy is sometimes used. Then a radioactive substance is injected into the blood. The level of radioactivity is so low that it is not harmful to the body. With the help of a so-called gamma camera, the doctor measures how the radioactive substance is distributed in the blood vessels of the lungs. It allows the physician to assess whether blood circulation is disturbed in the lung. You can also inhale a radioactive substance that allows the doctor to assess how the air is distributed in the lungs. It may mean that you have a blood clot on the air but no blood reaches a part of the lung.

It is rare, but sometimes you get a so-called lung angiography. Then you first get local anesthesia at the groin and then the doctor puts a plastic tube into a blood vessel in the groin. The tube continues up to the lungs where contrast fluid is injected into the blood vessels of the lungs and makes the blood vessels clearly visible on the X-rays.

Right to information

The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. That way you can help decide which treatment is right for you.

In order for you to be active in your care and make decisions, it is  important that you understand the information you receive. The healthcare staff is obliged to make sure that you do so. Ask questions. You can also ask to have the information written down so you can read it peacefully.

Treatment for a blood clot in the lung

You are usually treated in hospitals if you have a large blood clot in the lungs because it is serious and needs immediate medical attention.

How it works depends, among other things, on the size of the plug, how old you are, how quickly you receive treatment and whether you have other heart-lung diseases. You can usually go home already after a few days if you feel good. In the case of a minor blood clot that is not considered to be serious, it may sometimes be sufficient to receive treatment at home. 

You cannot treat blood clots on your own or with alternative medicine.

Clot-dissolving drugs are used in large blood clots

Blood clots in the lungs can be dissolved with clot-dissolving drugs that are injected directly into the bloodstream. This is especially true if the plug is large and the heart has difficulty maintaining adequate blood circulation. The treatment is not completely risk-free but can cause you to have serious bleeding at any other place in the body. The doctor, therefore, assesses whether the treatment is necessary and whether it can be performed.

It is also possible to remove the plug if plug-soluble drugs do not produce a sufficiently good result. It is rarely needed and the surgeries are only performed in some hospitals.

To relieve the problems caused by the blood clot, you receive treatment with oxygen and painkillers, often morphine. You can also get medicines that allow the blood vessel where the plug is located to relax instead of being pulled together. Sometimes you also need to get medicines that strengthen the heart or make the heartbeat more like they usually are.

Common to get blood thinners

The most common thing when you get a blood clot in your lungs is that you are being treated with blood thinners which means that the blood does not live as easily as before. The treatment prevents the plug from getting bigger and helps the body to dissolve it. In addition, the risk of new plugs is reduced. The treatment lasts for at least six months, but sometimes you need longer treatment. This applies, for example, if the risk of new plugs is high or if you have had a large plug that has affected the heart and caused you to get high pressure in the lungs. Sometimes you may need treatment for the rest of your life.

You are given blood-thinning medication, regardless of whether you have been given a plug-in treatment or not.

Different kinds of blood thinners

There are various types of blood thinners, such as heparin in syringe and tablets containing for example warfarin. It has also become common with a new type of blood-thinning drug. They are taken as tablets and do not require regular blood tests.

The blood thinning treatment usually starts with syringes containing so-called low molecular weight heparin. Heparin is a substance that prevents the blood from solidifying. You get the syringes in the abdominal fat. Often you will learn how to take the syringes yourself so that you can continue with them once you have returned from the hospital. The syringes should be taken once or twice a day and you can get help from a district nurse if needed.

A few people need blood-thinning treatment with heparin as a drip.

The doctor will make an individual assessment of whether you should continue with the heparin injectors throughout the treatment period or whether you can switch to tablets containing warfarin. It is also a substance that prevents blood flow. Treatment with warfarin is checked regularly with blood tests so that a doctor or nurse can determine how many tablets to take each day. Initially, you may submit tests every week, but when the values ​​become more stable it may be sufficient if you submit tests every two to eight weeks.

New blood-thinning drugs

There are newer blood-thinning tablets with active substances apixaban, dabigatran, edoxaban, and rivaroxaban. The active substances are similar in the treatment of blood clots but have some practical differences. Dabigatran and edoxaban require heparin injections in the first week, while you receive apixaban and tear-edoxaban at a higher dose at the beginning of treatment. Rivaroxaban and edoxaban are taken once a day while dabigatran and apixaban are taken twice a day. These newer drugs do not require regular blood tests as with warfarin. The doctor treating you will determine if you are suitable for using any of these tablets.

The risk of bleeding increases

Because the blood-thinning treatment reduces the blood’s ability to survive, you bleed more easily if a blood vessel is damaged. For example, you may get nosebleeds, blood in the urine or dark stools which is a sign that there is blood in the stool. The bleeding can in a few cases be life-threatening and if you get bleeding, contact your doctor immediately.

New plugs can be formed

There is an increased risk that you will get a blood clot again if you have once received one. This is especially true if you belong to one of the groups that is easier to get a blood clot. Some people never get any more blood clots and become completely healthy again.

To reduce the risk of getting additional blood clots, be sure to take the blood-thinning medication according to your doctor’s instructions.

Circulation in the lungs can be slower if you have had a large blood clot or several small ones. This means that the right side of the heart can work towards a greater resistance than usual and more than the left side. It can eventually lead to higher blood pressure in the lungs. Therefore, you may have to undergo a doctor’s check-ups until the heart is functioning properly again.

What does a blood clot in the lung cause?

A blood clot that gets stuck in the lungs is usually formed in the deep veins of the legs or in the veins in the pelvis. You can get a blood clot in the veins and thus in the lungs for many different reasons. For example, you may get a blood clot in the following situations:

  • After surgery in the stomach and pelvis, especially after cancer surgery.
  • After accidents, especially in bone fractures that require plaster and reduce mobility.
  • After hip and knee joints.
  • After lying down for several days without using the calf muscles regularly.
  • After sitting for more than three to four hours, for example on long journeys.
  • After pregnancy and childbirth or the use of birth control pills.

During surgeries and accidents, many changes occur in the body which, among other things, make the blood easier to live than usual. Combined with the fact that you are still in connection with the operation or the injury increases the risk of getting a blood clot.

This is mainly due to hormonal changes that make it easier for you to get plugs in the veins after giving birth. The risk of blood clots can also increase if a blood vessel is damaged during childbirth.

Some get blood clots easier than others

You are at increased risk of getting a blood clot in the veins and thus in the lungs if any of this is right for you:

  • You have an infection.
  • You are older than 65 years.
  • You’re pregnant.
  • You are overweight.
  • You’re a smoker.
  • You have cancer. The increased risk is found especially during surgeries or if you are treated with anti-cellulite drugs, called cytostatic drugs.
  • You have an unusually high number of blood cells.
  • You are taking birth control pills or medicines containing estrogen.
  • You have disorders that are sometimes hereditary in the blood’s ability to live or dissolve clots.

What happens in the body?

The blood has the ability to thicken and solidify to stop bleeding. It is called blood clotting or coagulation. When a blood vessel breaks down, the platelets called platelets clump together and attach to the damaged vessel wall. A blood clot is formed which stops the bleeding. The platelets release substances that partly attract more platelets and partly that the blood is released. In this way, the plug is reinforced. Once the blood vessel has been repaired, other substances in the blood ensure that the clot dissolves again. This is something that is constantly going on in the body and that protects against bleeding.

Blood clots can also be formed without damage to the blood vessel. This can happen, for example, if the blood composition changes or if the blood flow is slower than usual. Then platelets may start to get stuck on the sides of the blood vessels. In the veins, most blood clots are formed in the veins, which are a type of valve that prevents blood from flowing backward.

The plug can accompany the blood to the lungs

All or part of a blood clot in the bone, for example, can come loose and accompany the blood. In health care, a blood clot that accompanies the blood is called embolism. A clot that accompanies the blood and gets stuck in the lung is called pulmonary embolism. 

Blood clots can also form in the right part of the heart and then get stuck in the lungs if the heart is weakened and does not pump well.

In the lungs, the blood takes up oxygen

The air you breathe in and pull into the lungs contains oxygen needed for the body to function. The oxygen is taken up by the blood which passes it into the body via the blood vessels called arteries.

When the oxygen reaches the body’s various tissues, the blood is returned to the lungs through the blood vessels called veins. In the lungs, the blood retrieves new oxygen and releases carbon dioxide. It is a residual product that the body gets rid of when you exhale.

The plug obstructs blood flow

Blood flow is prevented if a blood clot gets stuck in the blood vessels of the lung. The flow is hindered partly by the blood clot itself and partly because of the vessel contracts around the clot. The blood vessels that are beyond the obstacle are shut down and can no longer participate in the exchange of oxygen and carbon dioxide that usually occurs in the lungs.

Other types of blood clots

Blood clots that have formed in the left part of the heart or in the arteries of the throat can also accompany the blood, but not through the veins. Instead, this type of blood clot follows the so-called arteries, that is, the blood vessels that carry the blood from the heart to the body. The blood clots in those blood vessels can cause strokes if they get stuck in the blood vessels of the brain or myocardial infarction if they get stuck in the small blood vessels that supply the heart muscle with oxygenated blood. They can also get stuck in arteries that go to the intestines or legs, but they can never reach the lungs.

There are also superficial blood clots called thrombophlebitis. This means that you have inflammation of the vessel wall and a plugin a superficial vein under the skin. It can feel like a little sore redness just under the skin. Thrombophlebitis is inherently harmless, but can in some cases spread to the deep veins on the upper part of the thigh or inside the knee and increase the risk of deep blood clots there. It is more common for you to get thrombophlebitis if you have varicose veins because it is the same superficial blood vessels that are then affected. If you suspect you have a superficial blood clot, contact a doctor for examination and assessment.

How common is a blood clot?

More than ten thousand people are hospitalized every year for blood clots in the veins. Many times there is no explanation as to why a person has had a blood clot.

You have an easier time getting a blood clot again if you have had one in one leg or lung before. For example, it may be because you have a disease that makes it easier for you to get blood clots. It may also be because you have remnants of a previous plug that obstructs blood flow or makes the vessel wall uneven.

Ehtisham Nadeem

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