The study, published in March 2021 in Research and Practice in Thrombosis and Hemostasis, focused on 72 patients ranging in age from 28 to 85 years old who had recently been diagnosed with a pulmonary embolism and received follow-up care at a hospital clinic for patients with blood-clotting problems. All of the patients completed mental health questionnaires, and half of them also agreed to sit down for longer interviews to provide a more detailed picture of the psychological impact of their diagnosis. Half of the patients had some degree of ongoing psychological distress, the study found. One-quarter of the patients felt more anxious since their diagnosis, and two of them had symptoms consistent with post-traumatic stress disorder (PTSD). However, almost two-thirds of these patients didn’t seek out mental healthcare. “Unlike strokes and heart attacks, pulmonary embolism happens to people who are young and healthy, so the diagnosis can come as a surprise and can be a shock,” says senior study author Kerstin de Wit, MD, an associate professor at McMaster University in Hamilton, Ontario. Compounding patients’ stress, the condition is rarely discussed unless it kills someone, Dr. de Wit says. Many of de Wit’s patients don’t know about pulmonary embolism until they have it themselves, and it upends their lives, she says. “It is no wonder that people diagnosed with pulmonary embolism can feel isolated, scared and down,” de Wit says. RELATED: 11 Celebrities Who Battled Deep Vein Thrombosis Risk Symptoms can include sudden shortness of breath, unexplained sharp chest pain, a rapid heartbeat, dizziness, and excessive sweating, according to the Cleveland Clinic. Some patients, however, have no symptoms at all. Patients who arrive at the hospital with PE may be treated with a type of clot-busting medicine known as tissue plasminogen activator (TPA). They may also require surgery to remove a clot from the pulmonary artery or to place what’s known as a vena filter inside a large vein to catch future clots before they can reach the lungs. Afterwards, patients may be prescribed a daily blood-thinner medicine or advised to wear compression stockings to help prevent new clots from forming.

One earlier study, published in BMJ Open, followed patients with PE for up to five years to see how the diagnosis impacted their mental health. During interviews, patients described feelings of shock and a loss of self after the diagnosis; some also described classic symptoms of PTSD such as flashbacks, hypervigilance, and intrusive thoughts. Participants described having a PE as a life-changing experience comprising initial shock, followed by feeling of loss of self, life-changing decisions, and behavior modification. Features of post-traumatic stress disorder (PTSD) were described with flashbacks, hypervigilance, and intrusive thoughts being most prevalent. Participants identified several areas of support needed for such patients, including easier access to support through information giving and emotional support. A more recent study, published in 2019 in BMJ Open, identified similar themes in patients with venous thromboembolism, a blood clot that in veins that carry blood to the heart. These patients described their lives as forever altered by the diagnosis and reported lingering trauma and anxiety. Another study, published in the Journal of Health Psychology, also found long-term anxiety in these patients, with symptoms of PTSD triggered by living with the ongoing fear that another clot might form at any time. RELATED: How 1 Woman Used Mindfulness to Cope With Having 2 Pulmonary Embolisms in Her Twenties

Physical Symptoms Trigger Stress

“A pulmonary embolism can be a very frightening event in which the individual may feel they are fighting for their breath, and at its worst, people may actually feel they are going to die,” says Paul Bennett, PhD, a professor of clinical psychology at Swansea University in the United Kingdom, who wasn’t involved in the new study. “They are also generally unexpected and come out of the blue,” Dr. Bennett adds. “This combination of unexpectedness and high levels of fear are classic precursors to post-traumatic stress and, in this context, fear of future events.” Symptoms that occurred before the PE can also recur afterwards because of damage done to the lungs, Bennett says. Patients might feel shortness of breath climbing stairs or trying to talk on the phone while walking, for example. These reminders of the first incident can amplify fear that another one could happen in the future, Bennett says. Beyond this, these symptoms can also trigger severe anxiety, panic attacks, and a state of hypervigilance that all contribute to ongoing psychological distress. “Reminders can be physical, like the feeling of tightness in the chest or breathlessness, or they may be environmental, such as taking an anticoagulant tablet or being in the room where the pulmonary embolism occurred,” says Rachael Hunter, MSc, DClinPsy, a clinical psychologist at Swansea University in the United Kingdom, who wasn’t involved in the new study. Patients can also struggle psychologically because when they have a panic attack, they’re not sure if that’s what’s really happening or if they have another pulmonary embolism, says Dr. Hunter. Support from doctors and family members who take the time to listen when patients are worried and reassure them that anxiety is common can help ease patients’ psychological distress, Hunter says. “For most people these anxieties and even some post-trauma symptoms will naturally resolve over time,” Hunter says. “But of course, if things really are difficult, and are not improving no matter what you do, then it’s important to seek professional support.” RELATED: How 1 Man Utilized Community and Therapy to Overcome Post-Clot PTSD