Do I have a PE?

[Emz2019]

Hi I’m 40 weeks pregnant and was due to be induced tomorrow however yesterday I was feeling unwell with heart palpitations, I called the hospital and they invited me straight in. My heart rate was 130 and my ecg was showing the right side of my heart was in distress. I was given an injection to thin my blood and sent to x Ray which appeared normal. Today my heart rate is much better but still hanging around the 110 mark and I’m going for a CT scan soon, they tell me they are highly suspicious of a PE, they ask if I’m breathless which I’m not except talking makes me a little breathless which is highly unusual. And they asked me if I had any pains or swelling in my calf’s but I haven’t... could it really be a PE?

In a word, yes. Pregnancy is a provoking factor for DVTs and PEs and they symptoms you describe are all too familiar to me.

I had a sub-massive PE 4 months ago due to knee surgery. I had 2 days of breathlessness on exertion but the actual night I was rushed into hospital I had no breathlessness or pain, just heart palpitations. Like you I had right heart strain and an elevated heart rate which eventually came down after 4 days on CCU on O2 (oxygen levels were low). I was put on an initial blood thinning drip in resus followed by deltaparin (heparin) injections for 2 weeks whilst I was in hospital and then Rivaroxaban tablets for 3.5 months (last tablet tonight!). They also put in an IVC filter (Now been removed) in to prevent any more reaching my lungs when they located the remainder of the DVT (behind my knee - no obvious swelling or discolouration).

They were initially very worried (hence CCU) that I was going to go into haemodynamic shock (blood pressure plummets), especially since the heart was struggling due to the pressure being placed on it due to the clots, which would have meant being resuscitated and pumped with clot busting drugs (which they were umming and ahhing about anyway due to size/severity of the issue) - but this in itself comes with risks (stroke/haemorrhage) so they will steer clear of this until absolutely essential.

Yes PEs can be serious, BUT you are in the right place, they are treating you and are ready at the drop of a hat to give you more intensive treatment if you need it. And you'll have a definitive answer very soon, after the CT scan. All the luck and thoughts in the world. And feel free to ask me anything and I'll try my best to answer.

What is ccu? I have only been allowed tinsaparin I think it’s called they said other things would effect the baby so they have to be so careful. What was your heart rate for the 4 days? It’s so scary isn’t it I did have a VQ scan but it was abnormal and inconclusive so now I need a CT scan but t may not be today they have said

Yes I'm afraid you may have. If there is a problem with the lungs it can place a strain on the right side of the heart which will show on an ecg. Breathlessness on exertion is also a symptom along with a raised heart rate (though may be raised due to pregnancy). Treatment will be with tinzaparin until delivery and then continue probably if you're breastfeeding. Having said that try not to worry as complications will be prevented with the treatment.

Sorry, coronary care unit (icu for hearts really). My heart rate was 140, like yours, then 120 for a few days before it started to reduce back to normal levels as my body began to break the clots down. The thinners you're on will stop any more clots forming or the ones you have (all still hypothetical until you've had your CT) getting any bigger, giving your body the chance to start breaking them down. I would imagine they aren't rushing for a CT as you are stable and on the right treatment (suggesting they're pretty convinced of the diagnosis, the x-ray ruling quite a few other things out and the VQ although inconclusive giving a fair idea I guess).

I have had multiple ECGs and an Echo of my heart since and they have both normalised (took a while and I could probably teach on how to read ECGs now!), as I am sure yours will too now you're being treated. But be prepared for the psychological impact of all of this - it's pretty brutal.

Yep - super scary, and you have the addition of a little one to worry about, so my heart really does go out to you. But the NHS really are bloody fantastic and will do whatever is needed to keep you and your LO safe 💐

How long did they keep you in for? I’m a bit demented being in here and having no answers and them not rushing for my scan

I was in for 10 days in total in the end. How are your sats (oxygen levels)? Are you on oxygen? Are they keeping a close eye on your BP?

Easier said than done but try to relax and keep calm, the less stress on your heart the better.

Says were 98%, heart rate has stabilised into 80s and occasionally going back up to 100, my bp was low at first but that’s also fine now they said I’m on a high dose of tinsaparin

That's really good - sounds like the tinsaparin is working and your body is starting to deal with the clot(s) - onwards and upwards!

Hi OP, just wondering how you are? Did they give you a CT scan yesterday?