What is a pulmonary embolism? How can something so scary happen to a world-class athlete? Do people fully recover from a pulmonary embolism?
To answer these and other questions, WebMD consulted Shirin Shafazand, MD, MPH, assistant professor of medicine in the division of pulmonary critical care at the University of Miami Miller School of Medicine.
Shafazand has not examined Williams and has not seen her medical records. She commented on publicly available details of Williams' condition and on her extensive experience treating patients with pulmonary embolisms.
What happened to Serena Williams?
Shortly after winning her fourth Wimbledon title last July, Williams cut her foot on a shard of glass. The severe cut required surgery and 18 stitches. Although she played an exhibition match shortly thereafter, continuing problems with the foot has kept her out of competition since then.
According to a statement from her representative in People magazine, Williams was in New York last week undergoing further treatment for her foot injury. She flew back to Los Angeles and apparently suffered a pulmonary embolism during or shortly after the flight.
On Feb. 28, she "underwent emergency treatment" for a hematoma she suffered as a result of her treatment for pulmonary embolism.
Williams is reported to be recovering.
What is a pulmonary embolism?
These clots usually arise in the leg, usually in a deep vein. Doctors call such a clot a thrombosis. A clot arising in a deep leg vein is called a deep venous thrombosis or DVT. DVTs often arise after a period of inactivity and are particularly common after long airplane flights. A clot originating in a deep leg vein in some cases will break free and travel to the lungs, causing a pulmonary embolism.
Williams may have been relatively inactive because of the foot injury. The risk of DVT is increased with inactivity.
"Her injury could have led to a clot in the leg," Shafazand suggests. "And New York to California is quite a long trip -- and that could increase risk of the slowing down of blood flow in the leg, which could lead to a DVT."
Some people with very small pulmonary embolisms never notice them. But larger clots block blood flow to significant portions of the lungs.
"A large pulmonary embolism cuts blood circulation to the lungs and decreases oxygen levels in the body. A patient can very quickly deteriorate and die," Shafazand says. "And the heart, which is supposed to pump the blood through the arteries, can fail because it cannot stand the pressure buildup from the blockage."
What are the symptoms of pulmonary embolism?
The most common symptoms are:
- Sudden shortness of breath
- Sharp chest pain that is worse when you cough or take a deep breath
- A cough that brings up pink, foamy mucus
Pulmonary embolism can also cause more general symptoms, such as feeling anxious or unwell, heavy sweating, feeling lightheaded or faint, or having a rapid heartbeat or palpitations. Such symptoms, particularly if sudden and severe, require immediate medical attention.
What is the treatment for pulmonary embolism?
Treatment for pulmonary embolism depends on the size of the clot blocking the lung artery and on the degree of blockage.
"When someone comes into the hospital with a suspected pulmonary embolism, we give oxygen. Then we start with blood thinner, heparin, to thin the blood enough to allow it to pass through the blockage," Shafazand says. "Then we do some testing, a CT angiogram, to look for the pulmonary embolism. We may also look at the veins in the leg through Doppler ultrasound."
If a severe pulmonary embolism is confirmed, more urgent treatment may be necessary.
"If the embolism is very severe and the patient is at risk of dying, with blood pressure dropping, there is a procedure called pulmonary embolectomy, where we go in through a vein [with a catheter] and make attempt at removal of the clot. This is done rarely," Shafazand says.
Another emergency treatment for pulmonary embolism -- also rarely done -- is to use the clot-busting drug tPA to open the clogged artery.
Did Williams undergo an embolectomy? That isn't yet known, but it's unlikely.
Williams did undergo a procedure. This may have been simply a diagnostic procedure to take a close look at her pulmonary embolism.
Another typical procedure in patients who have suffered a pulmonary embolism is to insert a filter into the major vein leading to the heart -- an inferior vena cava (IVC) filter -- to catch any future clots that come along.
Why did Serena Williams have a hematoma? What is a hematoma?
People magazine reports that Williams suffered a hematoma from her treatment for pulmonary embolism.
A hematoma is a bruise -- a collection of blood beneath the skin from a leaky blood vessel.
"A hematoma could happen with any procedure where they have to enter vein or artery," Shafazand says. "If it is a large enough hematoma, it would be drained and if the artery beneath it is still leaking, it would be repaired."
Will Serena Williams ever play tennis again?
Pulmonary embolisms usually are not removed because the body eventually reabsorbs the clot over time. Some people fully recover, others do not.
"For most patients, the recommendation is they go on some form of anticoagulant [blood thinner] for at least three to six months, Shafazand says. "For a subset of patients, their pulmonary embolism may lead to pulmonary hypertension -- meaning there has been damage to the pulmonary arteries. In these cases, the blood pressure in the pulmonary artery is high and this has many implications down the road for the patient's health."
WebMD asked Shafazand whether Williams is likely to return to competition.
"It all depends on how her heart and lungs respond in the future in terms of recovery," she said. "In three to four months, her doctors will have to see if her pulmonary embolism is completely resolved and her heart has the proper response to exercise."
What are the risk factors for pulmonary embolism?
Risk factors for pulmonary embolism include:
- Birth control pills
- Hormone replacement therapy with estrogen and progesterone
- Recent surgery, especially on the legs or belly
- A long hospital stay involving bed rest
- Some cancers
- Pregnancy and childbirth, particularly with C-section
- Age over 70
Another risk factor is hereditary. Some people who suffer pulmonary embolisms are predisposed to abnormal blood clotting.