Pulmonary Embolism: Symptoms, Causes, and What to Do

Having trouble breathing—especially when active—could be a sign of a blood clot in the lungs.

What it is

Pro Tip

The most common misconception is that blood clots only occur in the elderly or sick. But even young, healthy, and active people can develop blood clots. Particularly in those with undiagnosed underlying medical conditions that increase your risk of forming blood clots. —Dr. Chandra Manuelpillai

Pulmonary embolism (PE) is a blood clot in a blood vessel in the lungs. The blood clot prevents blood flow to that area of the lung. Though it can come from anywhere in the body, the blood clot most typically originates in the lower legs.

The clot may lead to difficulty breathing or a sharp chest pain that worsens when breathing deeply. In severe cases, the heart is strained.

If you think you have a pulmonary embolism, go to the ER immediately. It can be life-threatening.

What is causing your symptoms?

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What are the warning signs of a pulmonary embolism?

The most common sign is difficulty breathing. It usually worsens when you are active. You may also feel sharp chest pain when breathing deeply.

The embolism can cause low oxygen levels, which can elevate heart rate and increase your breathing rate. You may also cough up blood.

In severe cases, this may lead to decreased blood pressure, dizziness, passing out, and even death.

You may also have symptoms of a deep vein thrombosis (DVT). Most blood clots that cause pulmonary embolism originate in the calf. Generally one leg may be swollen and hurt.

Main symptoms

  • Difficulty breathing, which often gets worse with activity
  • Sharp chest pain that’s worse when taking deep breaths (pleuritic chest pain)

Other symptoms you may have

  • Coughing up blood
  • Elevated heart rate/palpitations
  • Dizziness or passing out
  • Increased breathing rate
  • Pain and swelling in leg or calf (deep vein thrombosis)

What are the main causes of a pulmonary embolism?

Pulmonary embolisms are caused by blood clots. Sometimes it’s because an underlying medical issue makes you prone to clotting. Other times, blood clots form because of damage to the inner wall of a blood vessel.

The pulmonary embolism forms when a piece of the blood clot breaks off and travels to the lung, where it gets wedged. The embolism blocks blood flow to your lungs and can reduce oxygen throughout your body.

Dr. Rx

Genetic testing is important. If it is determined that you have an underlying clotting medical condition, it becomes even more important to avoid other things that increase your risk of PE. Also, you may want to encourage family members to be tested. —Dr. Manuelpillai

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Treatment for a pulmonary embolism

Treatment depends on the cause, size, and locations of the blood clot. And symptoms. The goal of treatment is to break up the clot, keep it from worsening, and prevent new ones.

After being diagnosed with a pulmonary embolism, further imaging may be needed, including an ultrasound of your legs to look for a blood clot. And possibly a heart ultrasound (ECHO) to determine if the blood clot is causing strain on the heart. You may need to repeat imaging after treatment to confirm there aren’t any blood clots.

Once you have had a pulmonary embolism, you are at increased risk for it happening again. It is important to have additional testing—including genetic testing—to determine your future risk for blood clots and pulmonary embolisms.

You may need to take blood thinners (anticoagulation medications) like warfarin, rivaroxaban, or apixaban for about three months. These medications help prevent new clots.

Pro Tip

Blood clots cannot be treated or prevented without thinning out the blood, which decreases your body’s ability to form clots and prevent bleeding when injured.  This is not usually a problem with simple cuts or injuries. But it is very important to contact your doctor or go to the ER if you have any traumas or falls while on blood thinners. You want to make sure you are not having internal bleeding. —Dr. Manuelpillai

If symptoms are more severe, you may be prescribed stronger medications such as a thrombolytic, which breaks up or dissolves a clot. You may need a procedure where a medication is given intravenously or injected directly at the site of your clot. Or have surgery to remove the clot (thrombectomy/embolectomy).

If you are not able to be on blood-thinning medications, you may need a filter surgically placed in your large vein (inferior vena cava) next to the heart. The filter catches any clots to prevent them from traveling to your lungs and causing a pulmonary embolism.

Risk factors for pulmonary embolism

  • Certain medical conditions increase your risk of forming blood clots. These include cancer (both the disease and the treatment can increase risk), stroke, and pregnancy and the postpartum period (up to 6 weeks after giving birth).
  • Clotting syndromes including Factor V Leiden, lupus, and antiphospholipid syndrome.
  • Previous blood clot or pulmonary embolism.
  • Certain medications including hormone replacement treatment, birth control pills, chemotherapy, or palliative care (because of limited mobility and other risk factors).
  • Being in a wheelchair.
  • Recent travel with long periods of sitting within the last three days (like driving a truck and long flights).
  • Surgery within the last month, particularly if it required general anesthesia.
  • Having a cast on the long bone of the leg (tibia).
  • Certain lifestyle conditions, including smoking and obesity.
  • Being age 50 or older.
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Take a thorough self-assessment on what you may have

How serious is a pulmonary embolism?

If you think you may have a pulmonary embolism, go to the ER. Call 911 if you are having significant difficulty breathing, chest pain, or dizziness.

If a pulmonary embolism is suspected, you will probably have a computed tomography (CT) scan of the chest and/or nuclear lung (VQ) scan. You may need to be hospitalized. But if symptoms seem mild, you can be treated at home.

Can a pulmonary embolism be prevented?

If a medication increases your risk for PE, ask your doctor about other possible options.

Increase activity during long stretches of traveling or sitting—take walking breaks, even if just pacing the aisle on a plane.

Compression socks can increase blood flow and reduce leg swelling.

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