Pulmonary embolism awareness

Overview

A pulmonary embolism (PE) is a sudden blockage in a blood vessel in the lungs. It usually happens when a blood clot from a vein in the leg (deep vein thrombosis, or DVT) travels through the bloodstream and gets stuck in a lung artery. This can make it hard for the lungs to get oxygen to the body and is a serious medical emergency.

Pulmonary embolism is not extremely common, but it happens more often than many people think. It affects about 1 in 1,000 people each year. It is the third most common cause of death from heart or blood vessel problems.

Pulmonary embolism can happen to anyone, but it is more common in adults over 60, people who are very inactive (such as after surgery or a long flight), those with a history of blood clots, people with cancer, and those who are pregnant or have recently given birth.

Symptoms

Common symptoms

• Sudden shortness of breath
• Sharp chest pain that may get worse when you breathe deeply or cough
• Coughing up blood
• Fast or irregular heartbeat
• Feeling lightheaded or dizzy
• Fainting

Symptoms in children

• Children with a pulmonary embolism may complain of chest pain, trouble breathing, or feel very tired. They might also have a fast heart rate or feel faint. Symptoms can be less clear in young children, so any sudden breathing difficulty should be checked urgently.

Symptoms in older adults

• Older adults may have less obvious symptoms, such as only mild breathlessness or confusion. They might not feel sharp chest pain. Instead, they could have a fast heart rate, low blood pressure, or just feel generally unwell. Any sudden change in breathing or mental state needs immediate medical attention.

Causes

Main causes

• A blood clot that forms in a deep vein, usually in the leg or pelvis, and then breaks loose and travels to the lungs.

Risk factors

• Being immobile for long periods (long flights, bed rest after surgery)
• Having surgery, especially hip or knee replacement
• Having a history of blood clots or a family history of clots
• Having cancer or receiving cancer treatment
• Pregnancy and the 6 weeks after giving birth
• Using hormone therapy or birth control pills containing estrogen
• Being over age 60
• Being overweight or obese
• Smoking
• Certain genetic conditions that make blood clot more easily

When to see a doctor

See a doctor urgently if:

• If you have sudden severe chest pain, trouble breathing, or cough up blood, call your local emergency number right away.
• If you have swelling or pain in one leg that comes on suddenly, especially if you also have shortness of breath, see a doctor urgently.

Book a routine appointment if:

• If you have had a blood clot before and are worried about getting another one, talk to your doctor during a routine visit.
• If you are planning to fly long distances or have surgery and think you might be at risk, ask your doctor about prevention.

Diagnosis

Doctors use a combination of your symptoms, medical history, physical exam, and tests to diagnose a pulmonary embolism. They will want to rule out other conditions that can cause similar symptoms, like a heart attack or pneumonia.

Tests that may be done

• D-dimer blood test — measures a substance that increases when there is a clot; a normal result makes PE less likely.
• CT pulmonary angiogram (CTPA) — a special X-ray that looks for clots in the lung arteries.
• Ventilation-perfusion (V/Q) scan — a test that checks how air and blood flow through your lungs.
• Ultrasound of the legs — to look for a deep vein thrombosis (DVT).
• Blood tests to check for oxygen levels and other things.
• Electrocardiogram (ECG) — to check the heart's rhythm.

What to expect at your appointment

If a pulmonary embolism is suspected, you will likely be seen in an emergency department. You will have blood tests and imaging. The process is usually quick because early treatment is important. You may need to stay in the hospital for several days. Your doctor will explain each step.

Treatment

Treatment for pulmonary embolism aims to stop the clot from getting bigger, prevent new clots, and help your body break down the existing clot. Most people are treated with blood-thinning medicines (anticoagulants). You may need to stay in the hospital for initial treatment.

Self-care at home

• Follow your healthcare provider's advice about activity — you may need to rest at first, then gradually move more.
• Take all prescribed medicines exactly as directed.
• Avoid alcohol while on blood thinners unless your doctor says it is okay, as alcohol can affect how the medicine works.
• Ask your doctor before taking any over-the-counter medicines or supplements, especially aspirin or ibuprofen, as they can raise the risk of bleeding.

Medical treatments

The main treatment is with medicines that thin the blood (anticoagulants). These are given as an injection or a pill. Treatment usually lasts at least 3 to 6 months, sometimes longer if the clot was linked to a lasting risk factor. In some severe cases, a medicine called a thrombolytic (clot-dissolving medicine) may be given through a vein to break up the clot quickly. This is used only when the embolism is life-threatening, because it increases the risk of serious bleeding.

When is surgery considered?

In rare cases where blood-thinning medicines cannot be used or are not working, a procedure to remove the clot may be done. This can include a catheter (a thin tube) inserted into the lung artery to break up or remove the clot, or surgery to remove it. These options are for emergencies when the blockage is very large.

Living with this condition

After a pulmonary embolism, most people recover fully with treatment. You will likely take blood-thinning medicine for several months. You will need regular blood tests or check-ups to make sure the medicine is working and that you are safe. It can take a few weeks to months to feel back to normal. Some people have lingering shortness of breath or chest pain; let your doctor know if this happens.

Lifestyle tips

• Stay active but avoid strenuous exercise until your doctor says it is safe.
• Wear compression stockings if your doctor recommends them to prevent leg swelling and clots.
• Avoid sitting for long periods — get up and walk every hour when traveling or at your desk.
• Stay hydrated, especially on long flights.
• Do not smoke — smoking increases the risk of blood clots.

Diet and exercise

A heart-healthy diet rich in fruits, vegetables, whole grains, and lean protein can help you maintain a healthy weight and reduce inflammation. If you are on blood thinners, it is important to keep your vitamin K intake consistent (found in green leafy vegetables) because vitamin K can affect how the medicine works. Ask your doctor or a dietitian for advice. Regular gentle exercise, like walking, is good once you have recovered, but check with your care team first.

Mental health and emotional wellbeing

Having a pulmonary embolism can be frightening and stressful. You may worry about another clot or about taking blood thinners. It is normal to feel anxious or down during recovery. Talk to your doctor if your mood is affecting your daily life. Connecting with others who have been through it can help.

Prevention

Yes, many pulmonary embolisms can be prevented, especially after surgery or during long travel. Staying active, keeping a healthy weight, not smoking, and using blood-thinning medicines when at high risk are key prevention strategies. If you are at risk, your doctor may recommend compression stockings or a short course of blood thinners.

Screening programmes

There is no routine screening for pulmonary embolism in the general population. However, if you have a family history of blood clots or a genetic condition that increases clotting, your doctor may discuss screening or preventive measures.

Complications

If left untreated

• A pulmonary embolism can cause severe damage to the lungs, making it hard to get oxygen.
• It can lead to heart strain and heart failure.
• It can be fatal if not treated quickly.

Long-term outlook

For most people who get prompt treatment, the outlook for pulmonary embolism is very good. The body can break down small clots over time. With blood-thinning medicines, the risk of death drops dramatically. Most people recover fully within a few months. Some may have long-term issues such as shortness of breath or chronic blood clots in the lungs (a condition called chronic thromboembolic pulmonary hypertension), but this is not common. Staying on top of your treatment and follow-up care helps ensure the best outcome.

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