How do you tell pulmonary embolism from asthma or anxiety?

June 26, 2015 11:23 AM

Okay, you are not my doctor and I have an appointment with my doctor first thing on Monday but I just want someone to reassure me I won't die over the weekend and don't need to go to the ER.

For the past several days I've been having shortness of breath. I had a DVT once years ago so I'm aware that can be a sign of pulmonary embolism. However, I also have asthma AND a history of panic attacks. Swell.

I've been using my rescue inhaler and it helps for a while but then the shortness of breath comes back and it does feel a little different from the worst asthma attacks I've had - there's no wheezing, just a heaviness at the center of the sternum. And I have been able to sleep relatively well in spite of everything.

It DOES feel similar to panic attacks I've had and I can feel the shortness of breath getting worse when I start thinking about the situation. The thing is I've been to the ER twice before for what turned out to be panic attacks and I'd rather not repeat that as it is both expensive and rather embarrassing.

Another factor is I recently started on progesterone only birth control (this week). I know that the progesterone only pill has not been shown to cause blood clots but it hasn't been shown not to cause them either. So I figure it's a possibility my new birth control is giving me a pulmonary embolism OR it's giving me major subconscious anxiety which is manifesting itself in panic attacks. The other possibility is that my asthma control regimen is suddenly just not working as well as it used to.

I'd just like to rule out PE. Could a pulmonary embolism even last this long without becoming painful or killing me? Is the fact that my inhaler seems to work to relieve symptoms a tip-off that it's not a PE?

posted by Jess the Mess to Health & Fitness (19 answers total)

You can't rule out anything without going to see a medical provider. If you're worried enough to ask us this question, you're worried enough to go get checked out.
posted by killdevil at 11:26 AM on June 26, 2015 [9 favorites]

I agree with killdevil. Breathing is pretty important and it warrants a trip to the ER if you are having difficulties.
posted by dawkins_7 at 11:38 AM on June 26, 2015 [1 favorite]

do you often have asthma attacks without wheezing? for me and my asthma, my rule is that if it changes from the norm, then i have to go to the doctor, even if it doesn't seem worse than things i know i can get through. even if it's not a pulmonary embolism, asthma can be deadly.
posted by nadawi at 11:41 AM on June 26, 2015

Can you go to a walk-in or urgent care? You don't need to go to the ER if the cost is putting you off.
posted by DarlingBri at 11:42 AM on June 26, 2015 [5 favorites]

I am NOT a doctor, or your doctor, and I second what killdevil says above - you should go see a doctor. PEs are not something to mess around with. Asthma and panic attacks and anything that disrupts your breathing should be dealt with by a doctor.

That being said (and please, please, do not discount it), I also have a history of blood clots, and empathize with your predicament of not knowing whether a pain is something that's life-threatening that needs to be dealt with IMMEDIATELY or just, you know, a medical issue that needs to be seen to promptly. I've gone to the ER with a suspected PE that turned out to be nothing, and I agree it sucks. I've also gone to the ER and been diagnosed with a pretty serious PE.

The difference between the PE and the not-PE symptoms was the level of pain I was in. With the not-PE, it hurt/was uncomfortable, but that was it. With the PE it hurt in very sharp way with every breath, it continued to hurt, and it got to the point (after being admitted) where even morphine didn't make it stop hurting. At one point I wasn't sure if I could keep breathing because breathing just hurt. so. much. I've only had one PE, so I don't know if those symptoms are typical or not. :/

I hope you feel better soon, and that you don't have a PE. Please take care.
posted by Jaclyn at 11:48 AM on June 26, 2015 [3 favorites]

I think you should go to the ER. A friend of mine just had the exact same symptoms and it was blood clots in her lungs and legs. She's fine now. Just go.
posted by Beethoven's Sith at 11:57 AM on June 26, 2015 [2 favorites]

Many insurance companies have an advice nurse hotline. I would at least call one of those, if you can. Also regardless I hope you ask this same question of your doctor when you go in.
posted by nat at 12:24 PM on June 26, 2015 [1 favorite]

I'm not a doctor, but I've had both a massive DVT and a PE, and distinctly recall the awful pain. I tried to ignore that awful pain even as it increased over the course of around two days, and that only made things far worse. I'm certainly glad I finally came to my senses and staggered off to the emergency room.

(That said, I've also thought to myself many times, with the onset of certain pains or lung issues, that I might be having another PE. But those weren't PEs. So I totally know where you're coming from on that front as well.)

The chest pain that comes from a PE is generally pleuritic - it hurts far worse when you breathe deeply. Do you feel a stabbing pain when you inhale deeply? Go to the ER right now! Seriously.

When I experienced the PE, the chest pain felt like gas pain more than a lung issue. It wasn't actually where I consider to be my chest - the pain radiated from my side, not my breastbone. It alternated between a dull pain and stabbing depending on my breathing pattern, and escalated to the worst pain I ever felt in my life. Does it feel like that? Go to the ER right now!

Is there some other dull or sharp pain that you feel in your chest or sides? Go to the ER! Don't mess around with the pain.

But if it's just shortness of breath - you feel like you can't breathe deeply because of the heaviness, but doing so doesn't cause you any tangible pain - I would probably seek out care sooner than Monday, but perhaps not go to the ER. Can you call your doctor's office and see if they have any cancellations, or perhaps you can speak with the doctor briefly about your symptoms and they can make a recommendation or referral?
posted by eschatfische at 12:38 PM on June 26, 2015 [2 favorites]

Typically a PE has a rather sudden onset and symptoms, including pain, escalate. That doesn't sound like what you're describing, but it doesn't mean there isn't something equally serious going on. Trouble breathing can be caused by any number of things and is always worth getting checked out sooner rather than later. I second the suggestion of going to an urgent care if you cannot get in to see your doctor today.
posted by pecanpies at 1:41 PM on June 26, 2015 [1 favorite]

IANAD, IANYD. If you can't get into your doctor I'd recommend urgent care centers or the ER in that order. A trip to urgent care is much less expensive than the ER. Trust me, medical professionals would much rather deal with a false alarm than someone who waited too long to seek care. Asthma attacks or PEs aren't to be messed around with. Go get seen and make sure you're okay.



I have asthma and have dealt with anxiety issues, and it's tough to tell one from the other. They can feed off each other and asthma medications can make you anxious, too. In the future, invest in a peak flow meter and maybe a blood pressure cuff. Record those numbers every day and find out what's normal for you. Talk to your doctor about those numbers and come up with a solid asthma action plan. That should include:

How much/often to use each of your medications.
What numbers mean you should use your inhaler.
What numbers mean you should call your doctor for an appointment.
What numbers mean you should go to an urgent care or ER.

These numbers will be a big help to you and your medical providers. They'll help everyone differentiate anxiety from asthma from possibly something else.
posted by estelahe at 1:44 PM on June 26, 2015 [2 favorites]

How do you tell if it's a clot? You go to the doctor. My SO had a PE about 2 years ago and the urgent care doctor did a d-dimer test to see if his clotting factor was elevated. It was, and he was immediately referred to the nearby ER. CT scan confirmed it was a PE.

My SO had difficulty breathing and chest pain, but pulmonary embolisms can also be asymptomatic. Since you already have some history with abnormal clotting issues (even if there was a specific known cause), it's worth getting checked out ASAP.
posted by i feel possessed at 4:43 PM on June 26, 2015

Shortness of breath that is not responding to the current regimen is a good reason to go the ED.

PEs often are accompanied by tachycardia; heart rate around 120 to 150 bpm. If you are not tachycardic you still cannot rule out PE, but its a data point.

Other data points to consider-
Do you have any risk factors for PE or DVT? Are you a smoker? Are you pregnant? Are you immobile for long periods of time? Do you have a known history of coagulopathy? In your family? Any close relatives that had strokes, heart attacks, PEs at early ages? You mentioned birth control. What else do you take? Do you eat foods high in vit. K? I think leafy greens are the worst culprit.

Good luck.
posted by brevator at 7:03 PM on June 26, 2015 [1 favorite]

If you have a history of clots, go to some sort of doctor, now. You'll feel silly if it is not a PE, but that is better than the alternative.

I've had one PE and my experience was very different to the other people here: no pain whatsoever, just slowly escalating shortness of breath (heavy sensation on my chest) over about a week and a dry cough when I tried to breathe in. I was a stupid 19 year old and didn't think anything was wrong until I collapsed, fortunately in a public place.

The difference for me between the PE and a (mild) panic attack was that the PE was more a heaviness in my chest, the panic attack a tightness. With the PE I really couldn't breathe deeply at all, while with the panic attack it felt hard, but I could take a full breath.

But really, just go to a doctor.
posted by neatsocks at 9:43 PM on June 26, 2015 [3 favorites]

If you can't breathe, and your inhaler doesn't help, go see a doctor. Severe asthma attacks often resist the dose you can get from an inhaler, and may require a nebuliser dose or a different bronchial dilator.

Or it could be something else. Go to a doctor.
posted by His thoughts were red thoughts at 12:34 AM on June 27, 2015

IANYD, you cannot rule out PE without seeing a doctor, it is simply not possible. a person with a history of PE should not try to rule out PE at home on their computer. if you've been to the ED multiple times for panic attacks, look into getting your anxiety treated better, but don't stop getting checked out for serious symptoms.

I generally do not recommend urgent care for anything potentially life threatening such as shortness of breath, chest pain, or abdominal pain. Urgent care is for sore throats, ankle sprains, medication refills, stuff like that. You may not be seen by a physician at all at urgent care (and even if you do, it may not be a physician boarded in emergency medicine). And if you need more resources than what they have, they ship you to the ED anyway and then you're paying for an ambulance ride and a second encounter. since you have a history of PE, it's highly unlikely that it would be appropriate to screen you with a D dimer test, which is intended to be used for low risk patients.

I know that the progesterone only pill has not been shown to cause blood clots but it hasn't been shown not to cause them either. So I figure it's a possibility my new birth control is giving me a pulmonary embolism
that is not how research works. You know what else hasn't been shown NOT to cause PE? Eating broccoli, standing on your head, and wearing the color red. does that mean it's a possibility that one of those things is giving you a PE? There's no scientific evidence to say otherwise but it sure as heck isn't likely.

Could a pulmonary embolism even last this long without becoming painful or killing me? yes.
Is the fact that my inhaler seems to work to relieve symptoms a tip-off that it's not a PE? no. You say you are not wheezing!
posted by treehorn+bunny at 12:51 AM on June 27, 2015 [3 favorites]

IANAD but I have a history of asthma and panic attacks and one exciting day in the ER for suspected PE.

I saw a GP about the breathlessness as it had been bothering me a bit (was not even slightly worried at that time) and somehow i had a positive result on the D dimer test. It triggered a major reaction with the path lab calling the director of the medical centre, who called the GP who almost sent the police to knock down my door when i didnt answer my phone. I had to go to the ER, do not pass go etc.

GP tried calling ahead with the info about my blood test results but I don't think it got through but nonetheless its remarkable how quickly you get seen when you turn up to the ER saying you're short of breath and your doc said something about a D dimer test. I was in no pain either, the absence of that symptom wasnt reassuring anyone. I would bet turning up saying you're having breathlessness that doesn't respond to asthma meds and have a history of DVT would trigger a similar response. Besides which, asthma alone kills plenty of people.

The upshot was, I was totally fine. YAY. But this was determined AFTER theyd used all their medical expertise to rule out the bad stuff. The internet can't do that for you. You need to see a doctor.
posted by kitten magic at 1:45 AM on June 27, 2015

So here's the thing about chest pain. It sucks. I have a chronically inflamed chest wall, asthma, COPD caused by allergies, and a bunch of other things that make my chest hurt upon occasion. It's not fun, and the older I get, the more my body wants me to think I'm having a heart attack.

Overall, I've made six ER trips in the past ten years because of not breathing and chest pains -- three in the past two years alone (for... reasons. I'm feeling better now). It's not fun, but when I call my doctor or the nurse hotline, the minute I say, "My chest hurts" they say, "Get thee to the emergency room." and hang up because they're not going to second guess me over the phone.

So I say the same thing to you, "Get thee to the emergency room." Chest pain is not something anyone can make guesses about without checking you out in person.
posted by patheral at 10:47 AM on June 27, 2015

I had a PE in 2013, and the major thing I remember was the pain (rather than the shortness of breath). There was no way to sleep while it was going on - I tried.

Following the PE recovery I had some anxiety issues about whether it would happen again, including shortness of breath as I panicked about my health. Still, nowhere in the panic was the pain that I felt with the actual PE.

All of that said, PEs can be asymptomatic, so get to the ER if you're even asking the question about whether you should. If you're worried enough to consider the ER you have something going on that you should have looked at.

Good luck - wishing you the best.
posted by owls at 9:13 PM on June 27, 2015

Response by poster: Just wanted to let everyone know I'm still alive and saw the doctor today. I had a d-dimer that came up negative for PE/blood clots, which is a relief, even though I figured as much. She's having me increase my asthma meds and also gave me some pills to take if I suspect I'm having a panic attack which hopefully, in the future, will help me tell if I'm really having a medical emergency or just anxiety. Now I wonder why they didn't prescribe that for me when I ended up in the ER before with panic attacks?

Thanks everybody for your advice and concern.
posted by Jess the Mess at 2:49 PM on June 29, 2015 [2 favorites]