By Dr. Phillip Gould
BlackDoctor
https://blackdoctor.org/
Legendary rapper Heavy D was 44 when he struggled to breathe and collapsed outside his Beverly Hills home. Serena Williams knew something was wrong when she suddenly became short of breath the day after giving birth. And for NBA champion Chris Bosh, blood clots cut short two seasons and ultimately ended his playing career. All three faced a pulmonary embolism, a potentially life-threatening blockage in an artery in the lung.
Their stories show how differently a pulmonary embolism can unfold. It can strike after a long trip, during recovery from surgery or childbirth, or in the middle of an elite athletic career. In the United States, Black Americans also face a disproportionate burden of pulmonary embolism, including higher rates of diagnosis and death documented in national research.
Heavy D died after a clot traveled from his leg to his lung
Dwight Arrington Myers, better known as Heavy D, helped bring hip-hop to a wider audience with Heavy D & the Boyz and hits such as “Now That We Found Love.” On November 8, 2011, he had trouble breathing and collapsed outside his home. He died that day at a Los Angeles hospital.
The Los Angeles County coroner determined that a clot from a deep vein in his leg had traveled to his lung, causing a fatal pulmonary embolism. The coroner’s office said the clot likely formed during an extended flight back from Europe. The autopsy also documented heart disease.
Long stretches of sitting can slow blood flow in the legs. The CDC says travel lasting more than four hours can raise clot risk whether you’re on a plane, in a car, or on a bus or train. The overall risk for most travelers is small. It rises when other risk factors are present, such as recent surgery, a previous clot, or limited mobility.
Serena Williams recognized the symptoms after childbirth
Williams first made headlines for a pulmonary embolism in 2011. She later said doctors found several clots in both lungs. That experience mattered six years later, when she suddenly had trouble breathing while recovering from an emergency C-section after the birth of her daughter Olympia in September 2017.
Williams told Vogue that she had temporarily stopped taking her usual blood thinner around the time of surgery. With her history of clots, she suspected another pulmonary embolism and asked for a CT scan and heparin, an anticoagulant. A nurse initially thought pain medication might be confusing her, according to Williams’ account. An ultrasound of her legs found no clot. A subsequent CT scan revealed several small clots in her lungs.
Her recovery grew more complicated. Her C-section incision reopened, and doctors found a large collection of blood in her abdomen. She underwent additional procedures, including placement of a filter in a large vein to help keep more clots from reaching her lungs. Williams said she spent six weeks in bed after returning home.
Pregnancy makes blood clot more readily, which helps limit blood loss during delivery. That same change increases the risk of dangerous clots. A C-section adds risk, and the CDC says clot risk remains elevated for up to three months after delivery, with the highest risk in the first six weeks. Anyone with a history of clots can discuss a prevention plan with their maternity care team before delivery, including how to manage blood thinners around childbirth and what symptoms require emergency care.
Blood clots cut short Chris Bosh’s NBA career
Miami Heat star Chris Bosh’s 2014–15 season ended after doctors found a blood clot in his lung. He returned the following season and played 53 games before another clot was discovered around the 2016 All-Star break. He never played another NBA game. Bosh has since spoken publicly about his experience with pulmonary embolism and the danger of blood clots.
What happens during a pulmonary embolism?
A pulmonary embolism, or PE, usually starts when a clot forms in a deep vein, most often in the leg or pelvis. That first clot is called a deep vein thrombosis, or DVT. If part of it breaks loose, it can travel through the bloodstream, pass through the right side of the heart, and lodge in an artery that carries blood to the lungs. Doctors use the term venous thromboembolism, or VTE, to refer to DVT and PE.
The blockage reduces blood flow through part of the lung and can lower the amount of oxygen in the blood. It also forces the right side of the heart to work harder to pump blood past the blockage. A severe PE can cause a sudden drop in blood pressure, shock, or cardiac arrest. How serious it becomes depends in part on how much blood flow is blocked and how well the heart and lungs can handle the strain.
Major surgery, hospitalization, prolonged immobility, active cancer, pregnancy and the postpartum period, estrogen-containing medications, and a personal or family history of blood clots can raise the risk. Some people develop a clot with no obvious trigger.
Symptoms you should act on
A pulmonary embolism can happen without any warning symptoms in the leg. Signs to watch for include the following:
- Sudden or unexplained shortness of breath
- Chest pain that gets worse with a deep breath or cough
- A fast or irregular heartbeat
- Coughing up blood
- Lightheadedness, fainting, or collapse
Call 911 for possible pulmonary embolism symptoms. If you develop new swelling, warmth, or unexplained pain or tenderness in one leg, seek prompt medical evaluation for a possible DVT. Tell the care team if you’ve had a clot before, recently had surgery, or are pregnant or recently gave birth.
How doctors diagnose and treat it
Doctors assess your symptoms, medical history, and vital signs to estimate how likely a clot is. If the likelihood is low or intermediate, a blood test called a D-dimer can help rule out a PE. An elevated D-dimer can have several causes, so doctors may need imaging to confirm a clot. A CT pulmonary angiogram, a CT scan that uses contrast dye to show blood flow through the lung arteries, is a standard diagnostic test. A ventilation-perfusion scan, also called a V/Q scan, is an option in some situations. A leg ultrasound can look for a DVT. A person can still have a PE even if the ultrasound finds no clot in the leg.
Anticoagulants, commonly called blood thinners, are the main treatment. They help keep existing clots from growing and new ones from forming while the body breaks down the clot. Treatment usually lasts at least three months, and some people need it longer depending on what caused the clot, the chance it will recur, and the risk of bleeding. In severe cases, a medical team may use clot-dissolving medication or a procedure to remove the clot. Ongoing shortness of breath or reduced stamina after treatment deserves follow-up because some people develop lasting problems with blood flow through the lungs.
How pulmonary embolism affects Black Americans differently
Black Americans experience higher rates of PE and PE-related death. An American Heart Association scientific statement found that Black patients had the highest reported incidence of pulmonary embolism among the U.S. racial groups it reviewed. A national study using death records from 2006 through 2019 also documented higher PE-related mortality among Black Americans. These are population-level findings. The emergency warning signs are the same, and an individual’s risk depends on their medical history and circumstances.
Access to diagnosis and treatment can shape outcomes. The AHA identified disparities in the use of CT imaging to diagnose PE and cited research finding lower use of direct oral anticoagulants among Black patients even in a fully insured population. The statement also reported higher rates of readmission and a serious long-term complication called chronic thromboembolic pulmonary hypertension among Black patients. Income, insurance, and geography can influence access to imaging, medication, and follow-up care.
The disparity is visible in maternity care. Federal hospital data for 2020 recorded about 0.42 cases of VTE or PE per 1,000 delivery hospitalizations among non-Hispanic Black patients, compared with 0.30 per 1,000 among non-Hispanic White patients. That measure captures clots recorded during the delivery hospitalization. The risk continues after patients go home, so new breathing problems or chest pain after delivery still warrant emergency attention.
Sickle cell disease raises clot risk. For people living with sickle cell disease, an inherited condition that disproportionately affects Black Americans, sickled red blood cells can make clotting more likely. A person with sickle cell disease who develops sudden shortness of breath or chest pain needs urgent evaluation because several serious complications can cause those symptoms.
What you can do to reduce your risk
On trips lasting more than four hours, move your legs frequently and walk every one to two hours when it’s safe. If you’re seated, try raising and lowering your heels and toes to work your calf muscles. If you’ve had a blood clot, recently had surgery, or have another major risk factor, ask your clinician before traveling whether you need additional measures. After surgery or childbirth, make sure you know when you can safely start moving around, whether you need medication to prevent clots, and whom to call about new leg swelling or pain.
If you suddenly can’t catch your breath, have chest pain, cough up blood, or feel like you might pass out, call 911 right away. You can have a pulmonary embolism without leg swelling, without a recent flight, and even when you were feeling fine moments earlier.
