Pulmonary Embolism (PE)

Common PE symptoms include:

• Shortness of breath
• Rapid breathing
• Pain with deep breathing
• Higher heart rate

Less common symptoms of PE include:

• Coughing, with or without blood
• Feelings of anxiety or dread
• Lightheadedness or fainting
• Sweating

PE occurs when an embolus (blood clot) from a deep vein blood clot breaks loose, travels to the lungs and blocks an artery within the lung. PE can also develop directly in the small blood vessels of the lungs, even if there are no clots in the arms or legs. Blood clots can develop in veins damaged by surgery or trauma, prolonged inactivity, or from inflammation caused by an infection or injury. Patients with cancer and with specific genetic disorders affecting the blood clotting system have a higher risk of blood clots and PE.

Your healthcare provider will diagnose a PE based on your symptoms, medical history, physical exam and various imaging or blood test results.  

Blood tests measure substances in the blood that may be signs of a blood clot. D-dimer is a substance in the blood that is released when the fibrin protein (proteins that help stop bleeding) in a clot dissolves. High d-dimer levels can lead to the diagnosis of PE. A normal d-dimer effectively excludes the diagnosis of a PE. Your provider can also check the oxygen levels in your blood. Low blood oxygen can be a sign of a blood clot. These tests, taken together, are a common first step to detect signs of a blood clot in the lungs, particularly in individuals who are otherwise healthy.  

Computed tomography pulmonary angiography (CTPA) provides detailed pictures of the blood vessels to detect blood clots in the lungs. It is the primary test used to diagnose PE.

Ventilation perfusion (V/Q) scan is a non-invasive test that measures airflow (ventilation) and blood flow (perfusion) in the lungs. If your lungs do not get the right amount of air or blood as evaluated in this test, you may have PE.

Pulmonary angiography requires inserting a tube into your blood vessel and injecting contrast dye into the pulmonary arteries. X-rays create video of the blood flow to your lung so your provider can identify any blood clots to confirm or rule out PE.  

Additional imaging tests may be used to assess the heart and lungs’ structure and function if initial tests are inconclusive or to evaluate the effects of a confirmed PE. 

Make healthy lifestyle changes. Talk to your provider about changes you may need to make, including choosing heart-healthy foods, getting physically active, aiming for a healthy weight, and quitting smoking.

Prevent a repeat DVT and PE. Talk with your provider about your risk, get regular checkups, and take all medicines as prescribed to help lower your chance of having repeat blood clots. This can include blood testing for clotting disorders or even some screening for unrecognized cancers or other major medical problems.

Be aware of possible complications. PE can cause pulmonary hypertension, which means elevated blood pressure in the vessels leading to your lungs and can result in heart failure. Signs of pulmonary hypertension include difficulty breathing (especially after exercise), chest pains, swelling, coughing up blood, and fainting. You may feel tired or like your heart is beating too hard or too fast. Pulmonary hypertension can be difficult to treat effectively.  Some medications have recently been shown to help lower pulmonary artery pressures.  If you have severe pulmonary hypertension after initial PE treatment due to large amounts of residual blood clots, your provider may refer you to a surgeon to consider removing them surgically. This surgery is very rarely considered or performed.

Take care of your mental health. Anxiety, fear and stress can be common after a blood clot. Reach out to your healthcare provider if you need support.