Embolism

Overview

An embolism happens when something that should be flowing freely through your blood gets loose and blocks a blood vessel. Most often that 'something' is a blood clot. It can also be a bubble of air, a drop of fat, or a small piece of fatty plaque that has broken away from a vessel wall. Once a blood vessel is blocked, blood and oxygen cannot reach the part of the body it supplies. That is why an embolism is a medical emergency. It can affect the lungs (called a pulmonary embolism), the brain (which can cause a stroke), an arm or a leg, the bowel, or another organ. The warning signs depend on where the blockage lands.

Clots in the veins and lungs are fairly common, especially in people who have been in hospital or cannot move around easily. Other kinds of embolism, such as air, fat, or amniotic fluid, are much rarer.

Anyone can have an embolism, but it is more likely in people who have been lying still for a long time, such as after surgery or during a long hospital stay. It is also more common in people with cancer, in pregnancy and the weeks after birth, in people with certain heart conditions, in smokers, and in people with obesity. Some families carry genes that make clots more likely.

Symptoms

Common symptoms

• Lungs: sudden shortness of breath, chest pain that gets worse when you breathe in, a fast heartbeat, coughing up blood, or feeling faint.
• Brain: sudden weakness or drooping on one side of the face, weakness in an arm or leg, slurred speech, or sudden loss of vision.
• Arm or leg: sudden severe pain, pale or bluish skin, coldness, numbness, or weakness in the limb.
• Bowel: sudden severe belly pain, vomiting, or blood in the stool.
• Many people also feel anxious or have a sense that something is badly wrong.

Symptoms in children

• Embolism is rare in children. When it happens, it is usually linked to a long hospital stay, a thin tube placed in a vein, heart problems present from birth, or a blood condition such as sickle cell disease.
• Babies and young children may not be able to explain what is wrong. Signs can include irritability, poor feeding, fast or difficult breathing, a swollen limb, or a change in alertness.
• A child with any of these signs needs to be seen urgently.

Symptoms in older adults

• Older adults may not have the classic signs. Confusion, sudden falls, or a general 'not right' feeling can be the main clue.
• Breathlessness may be put down to age or a chest infection, so a new or worsening shortness of breath should always be checked.
• Pain in a limb may be less obvious, so swelling, colour change, or cool skin matter just as much as pain.

Causes

Main causes

• A blood clot forming in a deep leg vein (deep vein thrombosis) and then breaking loose and travelling to the lungs.
• A clot forming in the heart, often linked to an irregular heartbeat, and then travelling to the brain, arm, leg, or bowel.
• Fatty plaque breaking away from the wall of a hardened artery.
• Air entering a vein, for example during some medical procedures or after a chest injury.
• Fat droplets entering the blood after a broken bone or major surgery.
• Amniotic fluid entering the bloodstream during or shortly after childbirth, which is very rare.
• A medical device, such as a thin tube in a vein, that a clot can form around.

Risk factors

• Being unable to move for a long time, such as during a hospital stay, after surgery, or on a long journey.
• Recent surgery, especially of the hip, knee, or abdomen.
• Cancer and its treatments.
• Pregnancy and the first weeks after giving birth.
• Oestrogen-containing contraception or hormone replacement therapy.
• Smoking, obesity, and older age.
• A previous blood clot, or a close family member who has had one.
• Inherited conditions that make the blood clot more easily.
• Heart failure, an irregular heartbeat, or damage to a heart valve.
• Dehydration, and varicose veins or a leg injury.
• A leg cast or brace that keeps you still.

When to see a doctor

See a doctor urgently if:

• You have new swelling, pain, or colour change in one leg or arm.
• You feel short of breath, even mildly, and it is new for you.
• You have chest discomfort or a cough you cannot explain.
• You have recently had surgery, a long hospital stay, or a long flight and you notice any of the above.

Book a routine appointment if:

• You want to understand your personal risk before starting hormone treatment or before planned surgery.
• You have had a clot before and have questions about your follow-up or travel plans.
• You are worried about a family history of blood clots.
• You have varicose veins that are becoming sore or swollen.

Diagnosis

A doctor will ask about your symptoms, when they started, and your risk factors, and will examine you. Which tests you need depends on where the problem is thought to be. Because an embolism can be serious, tests are usually done the same day, and some are done in an emergency department.

Tests that may be done

• A blood test called a D-dimer, which can help rule out a new clot in some situations.
• An ultrasound scan of the leg veins to look for a deep vein clot.
• A CT scan of the chest with a dye, called a CT pulmonary angiogram, to look for clots in the lungs.
• A heart tracing (ECG) and a chest X-ray, which help rule out other causes of chest pain and breathlessness.
• An echocardiogram (ultrasound of the heart) if the heart's strain needs checking.
• A scan of the arteries, such as a CT or magnetic resonance angiogram, for a suspected blockage in an arm, leg, or the bowel.
• Blood tests to check how your kidneys work and, later, to look for underlying clotting conditions.

What to expect at your appointment

Some tests involve a small needle or a dye given into a vein. You may need to wait for results, and you may be given treatment to thin your blood before every result is back. This is normal and is done to keep you safe. Ask your team to explain anything that is unclear.

Treatment

Treatment aims to stop the blockage getting bigger, stop new clots forming, and get blood flowing again. Most people are treated in hospital at first, and some can then continue treatment at home. Your team will also look for the reason the embolism happened, so it can be managed too.

Self-care at home

• Take any prescribed medicine exactly as directed, and do not stop it on your own.
• Keep moving as your team advises. Gentle walking is usually encouraged once you are stable.
• Wear compression stockings if you have been fitted with them.
• Drink enough fluid, especially in hot weather or when you are unwell.
• During long journeys, get up and walk regularly and move your ankles and legs while seated.
• Know the emergency warning signs and act quickly if they return.
• Keep your follow-up appointments and tell your doctor about any new bruising or bleeding.

Medical treatments

The main treatment is medicine that makes the blood less likely to clot. These are often called blood thinners or anticoagulants. They come as tablets or injections, and the choice depends on your situation. For a serious blockage, you may be given clot-dissolving medicine in hospital through a drip. Supportive care such as oxygen, pain relief, and fluids may also be needed. Some people need medicine for a few months, and others for longer, depending on why the embolism happened. Your team will also treat the underlying cause, such as an irregular heartbeat.

When is surgery considered?

Surgery or a procedure is needed in some cases, for example to remove a large clot from the lungs or from an arm or leg when medicines are not enough or not safe. This can sometimes be done through a thin tube passed into the blood vessel rather than with open surgery. Occasionally a small filter is placed in a large vein to catch clots before they reach the lungs. These options are used only when there is a clear reason.

Living with this condition

Most people get back to their usual routine after treatment. You may need follow-up appointments and blood tests, and you may be given a card or letter explaining your diagnosis in case you need medical care elsewhere. Bruising more easily is common with blood-thinning medicine, so take care with sharp objects and contact sports. Tell any dentist, surgeon, or pharmacist about your treatment before procedures.

Lifestyle tips

• Stay active. Regular walking helps blood flow in the legs.
• Avoid sitting or standing still for very long stretches. Set a reminder to move every hour or so.
• If you smoke, getting support to stop is one of the most useful things you can do.
• Aim for a healthy weight, with steady changes rather than strict diets.
• Keep alcohol within sensible limits and stay well hydrated.
• Plan long journeys: aisle seat if possible, regular walks, and ankle exercises.

Diet and exercise

There is no special diet that treats an embolism, but eating a balanced diet with plenty of vegetables, fruit, whole grains, and lean protein supports your heart and circulation. If you take blood-thinning tablets, keep your intake of leafy green vegetables steady rather than suddenly changing it, and ask your team whether any foods matter for your particular medicine. Build activity back gradually. Walking, swimming, and cycling are good choices. Ask your doctor before returning to heavy lifting, contact sports, or very strenuous exercise.

Mental health and emotional wellbeing

It is very common to feel frightened or on edge after an embolism. Some people find themselves checking every twinge, or feeling low for a while. These feelings usually settle, but they deserve attention. Talk to your doctor if worry, low mood, or poor sleep is affecting your daily life, as talking therapies and support are available.

Prevention

Not every embolism can be prevented, but many can. The biggest steps are keeping your blood moving and lowering your clot risk. If you are going into hospital, ask whether you need clot prevention. Hospitals often give short-term blood-thinning medicine, compression stockings, or leg pumps after surgery. Getting out of bed and walking as soon as it is safe is also important.

Screening programmes

There is no routine screening test for embolism for the general public. Screening for inherited clotting conditions is only offered in specific situations, such as a strong family history or an unusual clot at a young age. Ask your doctor whether testing is right for you.

Complications

If left untreated

• The blocked vessel can starve an organ of oxygen, which can cause lasting damage.
• A large clot in the lungs can be life-threatening.
• A blockage in the brain can cause a stroke, with lasting weakness, speech, or memory problems.
• A blocked limb can, rarely, lead to loss of the limb.
• Some people develop long-term breathlessness or tiredness after a lung clot.
• Leg swelling and skin changes can persist after a deep vein clot, known as post-thrombotic syndrome.
• There is a higher chance of another clot, which is why follow-up and sometimes longer treatment matter.

Long-term outlook

The outlook is good for most people who are treated quickly. Many make a full recovery and return to work, exercise, and normal life. Some notice breathlessness or tiredness for a while, and this often improves over months. Keeping your follow-up appointments and knowing the warning signs gives you the best chance of staying well.

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