17400 Pulmonary Embolism

Overview

A pulmonary embolism (PE) is a sudden blockage in a blood vessel in the lungs. It usually happens when a blood clot travels from a vein in your leg (called deep vein thrombosis, or DVT) up to your lungs. The clot can block blood flow and make it hard for your lungs to send oxygen to the rest of your body. This is a serious condition that needs prompt medical care.

Pulmonary embolism is fairly common. It is one of the most serious heart and lung conditions and affects many people each year. It requires urgent medical attention.

PE can affect adults of any age, though the risk increases with age. It can also happen in younger people, especially those with certain risk factors like long periods of immobility, recent surgery, pregnancy, or a genetic tendency to clot. Children are rarely affected but can be at higher risk if they have certain medical conditions.

Symptoms

Common symptoms

• Sudden shortness of breath at rest or with activity
• Sharp, stabbing chest pain that may feel worse when breathing in deeply
• Cough that may bring up blood mixed with sputum
• A fast heartbeat
• Feeling lightheaded, dizzy, or faint
• Anxiety or a sense of dread
• Low blood pressure

Symptoms in children

• In children, PE can be harder to spot. They may have chest pain, fast breathing, or a fast heartbeat.
• They may look very tired, fussy, or have a low fever.
• They might also have swelling or pain in one leg, which could mean a blood clot.

Symptoms in older adults

• Older adults may not have typical chest pain. Instead, they might feel confused, extremely tired, or have trouble breathing.
• They may have a sudden fall or a feeling of weakness.
• Because these signs can be subtle, it is important to seek medical help quickly if you notice any sudden change.

Causes

Main causes

• A blood clot forms in a deep vein, most often in the legs (deep vein thrombosis or DVT).
• The clot breaks free and travels through the bloodstream to the lungs, where it blocks an artery.
• In rare cases, a clot can form directly in the lung's blood vessels.
• Other less common causes include fat, air bubbles, or amniotic fluid entering the blood, though these are very rare.

Risk factors

• Being immobile for a long time, such as long flights, bed rest, or a leg in a cast
• Recent surgery, especially hip, knee, or abdominal surgery
• Cancer or cancer treatment
• Pregnancy and the first 6 weeks after giving birth
• Using birth control pills or hormone replacement therapy
• Inherited blood-clotting disorders
• Being overweight or obese
• Smoking
• A previous clot or a family history of blood clots
• Heart failure or chronic lung disease

When to see a doctor

See a doctor urgently if:

• If you have sudden shortness of breath at rest
• If you have chest pain that feels like pressure or a sharp sting and is worse with deep breaths
• If you cough up blood or notice blood in your sputum
• If you feel faint, lightheaded, or dizzy
• If you have swelling and pain in one leg along with any breathing symptom

Book a routine appointment if:

• If you have had a recent surgery or long period of immobility and are worried about clot risk
• If you have unexplained breathlessness that is getting worse over time
• If you experience leg pain and swelling that does not improve after a few days
• If you have a family history of blood clots and are planning to start birth control or hormone therapy

Diagnosis

A doctor will first ask about your symptoms, medical history, and risk factors. They will examine you and may order tests. Diagnosis usually involves a blood test called D-dimer, and if that suggests a clot, an imaging scan of your lungs and legs.

Tests that may be done

• Physical exam: The doctor listens to your heart and lungs, and checks your legs for swelling, warmth, or tenderness.
• D-dimer blood test: Measures a substance released when blood clots break down. A normal result makes PE less likely, but can also be high with other conditions.
• CT pulmonary angiogram (CTPA): A special X-ray machine takes detailed images of the arteries in your lungs after injecting a contrast dye.
• Ventilation-perfusion scan (V/Q scan): Looks at air flow and blood flow in the lungs to see if there are any blockages.
• Ultrasound of the legs: Checks for blood clots in the deep veins of your legs.

What to expect at your appointment

The diagnosis process can move quickly, especially in an emergency setting. You may have blood tests taken from your arm, and you may be asked to lie still for a scan. If you are diagnosed with PE, treatment usually starts soon after. Your healthcare team will explain each step and answer your questions.

Treatment

The goals of treatment are to stop the clot from getting bigger, prevent new clots, and help your body dissolve the clot. For small or medium clots, medications that thin the blood are often enough. For severe cases, more aggressive treatments may be needed in the hospital.

Self-care at home

• Follow your healthcare provider's instructions exactly, including taking any prescribed medications as directed.
• Attend all follow-up appointments and blood tests to monitor your treatment.
• Stay well hydrated unless your doctor tells you otherwise.
• Move your legs regularly while resting and avoid sitting still for long periods.
• Watch for signs of bleeding (like unusual bruising, blood in urine or stools) and report them immediately to your doctor.
• Do not stop or change any medication without talking to your healthcare provider first.

Medical treatments

Treatment usually involves medications called anticoagulants, which help prevent new blood clots from forming and give your body time to break up the existing clot. These are often given as an injection or as tablets, and the dose is based on your individual needs. In some situations, clot-dissolving medications may be given through an IV to quickly break down a large or dangerous clot. Another option is a catheter-based procedure where a thin tube is placed into the blood vessel to remove or break up the clot. Your doctor will choose the best approach based on the size of the clot, your overall health, and how well your body is responding.

When is surgery considered?

Surgery is rarely needed but may be used if a clot is very large or if other treatments cannot be used. A surgeon can remove the clot through a small tube inserted into a blood vessel, or in extremely severe cases, open surgery may be performed to clear the blockage. This is usually reserved for life-threatening situations.

Living with this condition

After a pulmonary embolism, most people need to take blood-thinning medication for several months or longer. During this time, you may need to make some adjustments. You should rest when you feel tired, but also move as much as your healthcare team advises. Avoid heavy lifting or contact sports that could cause bleeding. Your doctor will tell you when it is safe to return to work, exercise, and normal activities.

Lifestyle tips

• Stay active with light activities like walking, as advised by your healthcare team.
• Do not sit for longer than 1–2 hours without getting up and moving your legs.
• Wear compression stockings if your doctor recommends them to help prevent swelling in your legs.
• Quit smoking to reduce your risk of further blood clots.
• Keep a healthy weight to lower the strain on your heart and circulation.

Diet and exercise

Eating a balanced diet helps your heart and blood vessels stay healthy. Try to include fruits, vegetables, whole grains, lean proteins, and healthy fats. If you take certain blood thinners, your doctor may advise you about foods that may affect the medication. Regular exercise like walking or swimming is often encouraged, but start gradually and follow your care team's advice. Always ask before starting a new exercise routine.

Mental health and emotional wellbeing

Going through a pulmonary embolism can be frightening and stressful. Many people feel anxious about having another clot, and some may have symptoms of post-traumatic stress. It is common to feel sad, worried, or overwhelmed. These feelings usually improve with time, but it is important to talk to your doctor if you are struggling. Ask about support groups or speaking with a mental health professional.

Prevention

Many cases of pulmonary embolism can be prevented. The most important steps are to keep your blood moving, especially during long journeys or after surgery, and to manage any underlying risks. If you are at high risk, your doctor may recommend blood-thinning medication temporarily. Staying active, drinking plenty of fluids, not smoking, and wearing compression stockings when advised all help lower your risk.

Vaccines

Vaccines are not used to prevent pulmonary embolism directly. However, staying up to date with recommended vaccines can help prevent infections that might lead to illness and immobility, which can raise your risk of blood clots. Always discuss any vaccine questions with your healthcare provider.

Screening programmes

Routine screening for clot risk is not done for everyone. If you are at high risk — for example, because of surgery, cancer, or a family history of blood clots — your doctor may assess your risk and recommend preventive measures. In some cases, a blood test or genetic testing may be offered after a clot to check for inherited clotting disorders.

Complications

If left untreated

• Without treatment, a PE can be life-threatening, and death can occur rapidly.
• The clot may grow larger, blocking more blood flow to the lungs.
• A large PE can cause a sudden drop in blood pressure and lead to a state of shock.
• Long-term damage to the lungs is possible, including a condition called chronic thromboembolic pulmonary hypertension, where high blood pressure in the lungs strains the heart.

Long-term outlook

Most people with a pulmonary embolism recover fully with prompt treatment. The outlook depends on how quickly treatment begins, the size of the clot, and your overall health. Even after the emergency passes, many people continue to feel breathless or tired for weeks or months, but this usually improves. With follow-up care and lifestyle changes, the risk of another clot can be significantly reduced. Hope and persistence are important — your body needs time to heal, and your healthcare team will guide you every step of the way.

Find support

International organisations

• World Thrombosis Day

Local organisations

• Your local health service or hospital patient support · Local

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