15802 Pulmonary Embolism Who Is At Risk

Overview

A pulmonary embolism (PE) is a blood clot that blocks a blood vessel in your lungs. It usually starts as a clot in a deep vein in your leg or thigh, called deep vein thrombosis (DVT). Part of that clot can break loose, travel through your bloodstream, and get stuck in your lung. This can make it hard to breathe and put strain on your heart, but quick treatment saves lives.

Pulmonary embolism is fairly common. It affects people of all ages, but becomes more likely as you get older. Hospitals and emergency departments are well prepared to diagnose and treat it quickly.

Anyone can get a pulmonary embolism, but your risk is higher if you are less mobile, have had surgery, have cancer, or have a personal or family history of blood clots. It can happen at any age, but risk increases after age 40 and is higher during pregnancy and after childbirth.

Symptoms

Common symptoms

• Sudden shortness of breath
• Chest pain that gets worse when you breathe in or cough
• Coughing up blood
• Fast or irregular heartbeat
• Feeling lightheaded, dizzy, or faint
• A sense of anxiety or dread

Causes

Main causes

• A blood clot from a deep vein, usually in the leg or thigh, that breaks loose and travels to the lungs.
• This is called deep vein thrombosis (DVT), and a pulmonary embolism is its most serious complication.

Risk factors

• Being immobile for long periods — long flights, bed rest, or hospital stays
• Recent surgery, especially hip or knee replacement
• Previous blood clot or a family history of blood clots
• Cancer and some cancer treatments
• Pregnancy and the six weeks after giving birth
• Certain hormonal contraceptives or hormone replacement therapy
• Smoking, obesity, and heart or lung disease
• Older age, especially over 60

When to see a doctor

See a doctor urgently if:

• If you have swelling, pain, or tenderness in one leg that is not from an everyday injury, especially after long travel or surgery.
• If you are short of breath without a clear cause.
• If you have chest pain that gets worse when you breathe in.

Book a routine appointment if:

• If you have a family history of blood clots and are planning surgery, pregnancy, or hormone treatment.
• If you have had a blood clot before and want to know how to lower your risk in the future.

Diagnosis

Doctors diagnose a pulmonary embolism using a few steps. They first ask about your symptoms and risk factors, then might arrange blood tests, scans, and sometimes an ultrasound of your legs.

Tests that may be done

• D-dimer blood test — a simple blood test that can suggest whether a blood clot may be present.
• CTPA scan (computed tomography pulmonary angiography) — a special CT scan of the chest that looks for clots in the lung arteries.
• V/Q scan (ventilation-perfusion scan) — a scan that compares airflow and blood flow in the lungs.
• Ultrasound of the leg — checks for blood clots in the deep veins of your leg.

What to expect at your appointment

You may be asked to wait for results while in hospital. If tests confirm a pulmonary embolism, treatment usually starts right away. You may need to stay in hospital for a few days, or you may be treated at home depending on how small the clot is and how well you feel.

Treatment

Treatment aims to stop the clot growing, break it down, and prevent new clots. Most people need blood-thinning medicines, and some may need oxygen, monitoring, or a procedure to remove the clot.

Self-care at home

• Take all medicines exactly as prescribed, and do not stop without talking to your doctor.
• Move around as soon as your healthcare team says it is safe.
• During long journeys, move your legs, flex your ankles, and take short walks every couple of hours.
• Wear compression stockings if advised — they help prevent leg swelling and blood clots.
• Tell your doctor promptly about any unusual bleeding, bruising, or dark stools while taking blood thinners.

Medical treatments

Blood-thinning medicines, also called anticoagulants, are the main treatment for most people. They may be given by injection or as tablets. These medicines stop the clot growing and let your body dissolve it slowly over time. For a large or life-threatening clot, doctors may use a clot-dissolving medicine through a drip in hospital. The exact type and length of treatment depend on your situation, and you may need to take blood thinners for at least three to six months.

When is surgery considered?

Surgery is usually reserved for very large or dangerous clots. Options include using a thin tube called a catheter to break up or remove the clot, placing a filter in a large vein to catch future clots, or occasionally open surgery. Your specialist will explain the risks and benefits if this is needed.

Living with this condition

Recovery from a pulmonary embolism takes time. You may feel tired and short of breath for weeks or months. Keep all follow-up appointments, take your medicines as directed, and give your body rest when it needs it. Most people can return to normal life, but pace yourself and build up gradually.

Lifestyle tips

• Stay active with gentle walking once your doctor says it is safe.
• Stop smoking if you smoke.
• Move your legs regularly on long flights or journeys.
• Keep a healthy weight.
• Wear compression stockings if prescribed.
• Stay well hydrated, especially when travelling.

Diet and exercise

Eat a balanced diet with plenty of fruit, vegetables, and whole grains. Drinking enough water is helpful, especially on long trips. If you take blood thinners, try to keep foods containing vitamin K, such as leafy green vegetables, steady in your diet. Some herbal remedies and supplements can affect blood clotting, so always ask your pharmacist or doctor before taking anything new. Gentle exercise like walking is usually encouraged, but check with your healthcare team before starting a new routine.

Mental health and emotional wellbeing

It is completely normal to feel anxious, tearful, or worried about another clot after a pulmonary embolism. These feelings usually improve with time. Talk to people you trust, and if low mood or anxiety last for more than a few weeks, speak with your GP or a mental health professional. If you ever feel unable to keep yourself safe or have thoughts of harming yourself, contact your local emergency number right away.

Prevention

Not all pulmonary embolisms can be prevented, but many can. The most important steps are staying active, avoiding long periods of sitting, and receiving preventive treatment after surgery or during hospital stays. If you are at high risk, your doctor may recommend blood-thinning medicine or compression devices.

Vaccines

There is no vaccine that prevents pulmonary embolism.

Screening programmes

There is no routine screening test for everyone. Doctors assess risk during pregnancy, before surgery, or after a previous blood clot, and may recommend prevention based on that assessment.

Complications

If left untreated

• The clot can grow and block blood flow to the lungs, making breathing dangerously difficult.
• It can put severe strain on the heart, leading to a sudden collapse or cardiac arrest.
• It can cause long-term damage such as chronic thromboembolic pulmonary hypertension, a type of high blood pressure in the lungs.
• Without treatment, a pulmonary embolism can be life-threatening.

Long-term outlook

With quick treatment, the outlook is good. Most people survive a pulmonary embolism and recover their energy over weeks or months. Your doctor will follow up with you to check for any long-term effects. Following your treatment plan and reaching out for support when you need it gives you the best chance of a full recovery.

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