What is Pulmonary Embolism (PE)

Pulmonary embolism is a sudden blockage or decrease of blood flow in one lung or both lungs. Most blockages come from a blood clot that forms in a lower leg, thigh, or arm vein (deep vein thrombosis, DVT) and travels to the lungs.

A clot is blood that has thickened into a gel or solid. PE is a dangerous and life-threatening condition that needs to be treated right away.

What are the causes?

This condition is usually caused by a blood clot that forms in a vein and moves to the lungs. In rare cases, it may be caused by air, fat, part of a tumor, or other tissue that moves through the veins and into the lungs.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Traumatic injury, such as breaking a hip or leg.
• Spinal cord injury.
• Orthopedic surgery, especially hip or knee replacement.
• Any major surgery.
• Stroke.
• Having DVT.
• Blood clots or blood clotting disease.
• Long-term (chronic) lung or heart disease.
• Taking medicines that contain estrogen. These include birth control pills and hormone replacement therapy.
• Cancer and chemotherapy.
• Having a central venous catheter.
• Pregnancy and the period of time after delivery (postpartum).
• Being older than age 60.
• Being overweight.
• Smoking.

What are the signs or symptoms?

Symptoms of this condition usually start suddenly and include:

• Shortness of breath during activity or at rest.
• Coughing or coughing up blood or blood-tinged mucus.
• Chest pain that is often worse with deep breaths.
• Rapid or irregular heartbeat.
• Feeling light-headed or dizzy.
• Fainting.
• Feeling anxious.
• Fever.
• Sweating.
• Pain and swelling in a leg. This is a symptom of DVT, which can lead to PE.

How is this diagnosed?

This condition may be diagnosed based on:

• Your medical history.
• A physical exam.
• Blood tests.
• CT pulmonary angiogram. This test checks blood flow in and around your lungs.
• Ventilation-perfusion scan, also called a lung VQ scan. This test measures air flow and blood flow to the lungs.
• Ultrasound of the legs.

How is this treated?

Treatment for this condition depends on many factors, such as the cause of your PE, your risk for bleeding or developing more clots, and other medical conditions you have. Treatment aims to remove, dissolve, or stop blood clots from forming or growing larger. Treatment may include:

• Medicines, such as:
  • Blood thinning medicines (anticoagulants) to stop clots from forming or growing.
  • Medicines that dissolve clots (thrombolytics).
• Procedures, such as:
  • Using a flexible tube to remove a blood clot (embolectomy) or deliver medicine to destroy it (catheter-directed thrombolysis).
  • Inserting a filter into a large vein that carries blood to the heart (inferior vena cava). This filter (vena cava filter) catches blood clots before they reach the lungs.
  • Surgery to remove the clot (surgical embolectomy). This is rare.

You may need a combination of immediate, long-term (up to 3 months after diagnosis), and extended (more than 3 months after diagnosis) treatments. Your treatment may continue for several months (maintenance therapy). You and your health care provider will work together to choose the treatment program that is best for you.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you are taking an anticoagulant medicine:
  • Take the medicine every day at the same time each day.
  • Understand what foods and drugs interact with your medicine.
  • Understand the side effects of this medicine, including excessive bruising or bleeding. Ask your health care provider or pharmacist about other side effects.

General instructions

• Wear a medical alert bracelet or carry a medical alert card that says you have had a PE and lists what medicines you take.
• Ask your health care provider when you may return to your normal activities. Avoid sitting or lying for a long time without moving.
• Maintain a healthy weight. Ask your health care provider what weight is healthy for you.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Talk with your health care provider about any travel plans. It is important to make sure that you are still able to take your medicine while on trips.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You missed a dose of your blood thinner medicine.

Get help right away if:

• You have:
  • New or increased pain, swelling, warmth, or redness in an arm or leg.
  • Numbness or tingling in an arm or leg.
  • Shortness of breath during activity or at rest.
  • A fever.
  • Chest pain.
  • A rapid or irregular heartbeat.
  • A severe headache.
  • Vision changes.
  • A serious fall or accident, or you hit your head.
  • Stomach (abdominal) pain.
  • Blood in your vomit, stool, or urine.
  • A cut that will not stop bleeding.
• You cough up blood.
• You feel light-headed or dizzy.
• You cannot move your arms or legs.
• You are confused or have memory loss.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• A pulmonary embolism (PE) is a sudden blockage or decrease of blood flow in one lung or both lungs. PE is a dangerous and life-threatening condition that needs to be treated right away.
• Treatments for this condition usually include medicines to thin your blood (anticoagulants) or medicines to break apart blood clots (thrombolytics).
• If you are given blood thinners, it is important to take the medicine every single day at the same time each day.
• If you have signs of PE or DVT, call your local emergency services (911 in the U.S.).