Pulmonary Embolism

A pulmonary embolism (PE) is a blood clot that travels to your lungs from somewhere else in your body and blocks blood flow. Usually, the clot starts in a vein in your leg or pelvis. It breaks free and moves through your bloodstream until it reaches your lungs, where it gets stuck in a blood vessel and obstructs the passage of blood.

Pulmonary embolisms are common. Experts estimate they lead to at least 100,000 deaths per year in the U.S.

Seek medical care immediately if you think you have a PE. Quick treatment can save your life. About 1 in 3 people with a PE die within a few hours of when symptoms begin — often before they can get a diagnosis or treatment.

The most common treatment for a PE is blood thinner medication to get rid of the clot and prevent new ones from forming. In severe cases, you may have a procedure or surgery. You may need to take medication for months or years to prevent future clots. Your healthcare provider will explain the plan that’s best for you.

Symptoms of a pulmonary embolism

PE symptoms range from mild to severe and may include:

• Sharp chest pain that gets worse if you move around or take a deep breath
• Sudden shortness of breath, even if you’re at rest
• Fast breathing
• Cough (you may cough up blood)
• Wheezing
• Pale, clammy or bluish skin
• Fast heartbeat
• Dizziness
• Fainting

Call 911 or your local emergency number if you have these symptoms.

PE symptoms usually come on suddenly. However, symptoms of a blood clot waiting to dislodge and travel to the lungs may include leg pain, swelling and warmth. Take those signs just as seriously and seek medical care right away.

Pulmonary embolism causes

A pulmonary embolism happens when a blood clot travels to your lungs. In most cases, the clot starts as deep vein thrombosis (DVT). This is when you have a blood clot in a vein that’s deep inside your body, typically in your leg.

About half of all DVT or PE episodes happen after surgery or a hospital stay. These are times when you can’t move around for several days. So, blood can “pool” in your blood vessels. This makes it more likely to form abnormal clots.

Risk factors

Many conditions and situations raise your risk for a pulmonary embolism. What they share in common is that they make your blood more likely to clot when it shouldn’t. Examples include:

• Surgery: Major surgery, especially on your hips or legs, raises your risk for a PE. Bed rest as you recover makes blood more likely to pool. Plus, other factors, like general anesthesia and trauma to blood vessels, can raise the risk of clots forming.
• Hospital stay: Even if you don’t have surgery, a hospital stay for any reason raises your PE risk, especially if it’s for longer than three days. This is because you’re not moving around as much. Your care team will take steps to lower your risk.
• Thrombophilia (blood clotting disorders): This is a group of conditions that cause your body to make too many clots or have trouble breaking down old ones. Factor V Leiden, prothrombin mutations and antiphospholipid syndrome are common risk factors for PE.
• Pregnancy: Your risk for DVT or PE goes up while you’re pregnant and for a few months after you give birth. This is partly due to hormone changes.
• Hormone-based medications: Certain forms of oral contraception and hormone-replacement therapy can raise your risk for blood clots that lead to PE. If you’re on these meds, it’s important to talk to your provider about the risks and how to manage them.
• Long periods of sitting still: This includes everything from sitting at your work desk all day to taking a long car or plane ride. You’re more likely to get blood clots if you sit for a long time without moving your legs.
• Cancer: Having cancer or receiving cancer treatment raises your risk for PE. Together, DVT and PE are the second leading cause of death among people with cancer, behind cancer itself.
• Other medical conditions: Any condition that makes your blood more likely to clot raises your risk of PE. Some of these are temporary, like a severe COVID-19 infection. Others last longer, like kidney disease, heart failure, autoimmune diseases and atrial fibrillation.

Complications of this condition

A pulmonary embolism disrupts normal blood flow through your lungs. It’s a medical emergency because it can lead to:

• Sudden stopping of your heart (cardiac arrest)
• Dangerous drop in blood flow to your body (obstructive shock)
• Lung tissue death from lack of blood flow (pulmonary infarction)

PE is more likely to cause death if you don’t get treatment soon enough. But it can also be fatal despite treatment.

How doctors diagnose this condition

A healthcare provider will look at your symptoms and medical history. They’ll run tests to diagnose or rule out PE, including:

• D-dimer test: This is a blood test. It’s usually the first test providers use when looking for PE. It can show if your body is making and breaking down clots — a key sign of pulmonary embolism.
• CT pulmonary angiogram (CTPA): This is an imaging test that looks at your lungs. It can show blockages from blood clots. You’ll need it if the D-dimer test says PE is possible.
• VQ scan: This is another test that takes pictures of your lungs. You may need it if you can’t have a CTPA or your provider needs more information.

You may also need other tests, like a chest X-ray or echocardiogram. These can rule out other conditions and diagnose complications.

How is a pulmonary embolism treated?

The goal of treatment is to get rid of the blood clot in your lungs and prevent new ones. This involves medications and, in some cases, a procedure. You may need to stay in the hospital so healthcare providers can keep a close eye on your condition.

Possible treatments include:

• Anticoagulants: Blood thinners serve as the first line of PE care. They keep the clot from growing and help your body break it down. They also reduce your risk of new clots. You may take them as pills or receive them through an IV.
• Thrombolysis: Providers give medications through an IV or a catheter to dissolve the blood clot. They typically use this treatment when blood thinners aren’t enough or when the PE is severe.
• Embolectomy: Providers do this procedure to remove a clot. They usually consider it when other treatments don’t help or aren’t possible.
• Inferior vena cava filter (IVC): A surgeon places a small device in a large vein in your belly. The device catches blood clots before they reach your lungs. Most people don’t need one, but your provider may recommend it if you can’t take blood thinners.

When should I see my healthcare provider?

Your provider will tell you when to come back for follow-up visits. These are crucial for making sure the treatment is working and that you don’t have more blood clots.

Seek medical care right away if you have any signs of internal bleeding (a risk of taking blood thinners). These include:

• Sudden, severe headache or stomach pain
• Vomiting or coughing up blood
• Orange, red or brown pee
• Red or black poop

What can I expect if I have a pulmonary embolism?

Treatment doesn’t stop when you leave the hospital. You’ll need to take blood thinners for at least three months. Some people need to take them for many months or years to prevent another PE. Your healthcare provider will tell you what’s best based on your risk factors and overall health.

A pulmonary embolism is a major life event. Recovery can take a while. Even after treatment, it’s possible to develop long-term issues like:

• CTEPH: This is high blood pressure in your lungs due to chronic accumulation of blood clots. It affects about 2 to 3 out of every 100 PE survivors. The most common symptom is trouble breathing when you’re moving around. You may also have chest discomfort, dizziness or heart palpitations.
• Post-PE syndrome: This is more common than CTEPH. It involves fatigue and shortness of breath that persist after PE treatment. Many things combine to cause it, including lack of movement during recovery, anxiety, and heart or lung damage from the PE.

It’s important to tell your healthcare provider about any new or changing symptoms as you recover.

Life expectancy

It’s hard to say how long you might live after a pulmonary embolism. Research shows that about 1 in 20 people die within 30 days of a PE diagnosis. About 4 in 20 people die within six months. Survival at one year varies greatly based on what caused the PE.

Remember, these numbers don’t predict your future. They simply show how serious a pulmonary embolism can be. Your healthcare provider will give you the most accurate sense of what to expect. Following your treatment plan and going to all of your follow-up visits gives you the best possible chance of surviving and regaining your strength.

Can I prevent a pulmonary embolism?

It’s not always possible to prevent PE. But there’s a lot you can do to lower your risk:

• Don’t sit still for too long at once. Whether you’re working a desk job or taking a long flight, keep moving. Flex your ankles or stand up and stretch every 30 minutes. This helps keep blood from pooling in your leg veins, which can lead to blood clots or PE.
• Get moving (safely) after surgery. Your care team will take action to prevent DVT and pulmonary embolisms. This involves helping you stand up and move around as soon as possible after surgery. Never attempt any movement without your provider’s OK.
• Follow other post-surgery advice. Your care team may tell you to stay hydrated, elevate your legs, wear loose (not tight) pants and do foot exercises. Follow their guidance, and ask if you’re not sure about something.
• Take your medicines as prescribed. Your provider may prescribe low-dose blood thinners if you have certain risk factors, like cancer or a hospital stay. These help prevent dangerous blood clots that can lead to PE.