PULMONARY EMBOLISM

Understanding Pulmonary Embolism: Symptoms, Causes, Treatment & Prevention

A pulmonary embolism (PE) occurs when there is a blockage in a pulmonary artery. This artery carries blood from the heart to the lungs. Oxygen is diffused into the blood while in the lungs then travels back to the heart, where the oxygenated blood is pumped throughout the body. A pulmonary embolism—which is often caused by a blood clot (thrombus)—is a serious condition that blocks this normal flow of blood.

If not treated promptly, the heart will have to work harder to push blood through the vessels, which can increase blood pressure in the heart and the lungs. This is known as pulmonary hypertension. Eventually, a pulmonary embolism can weaken the heart and may lead to a heart attack or irregular heartbeat. In addition, PE can result in permanent damage to the lungs and low blood oxygen levels for other organs. When the organs don’t receive proper amounts of oxygen, they can be damaged as well. Finally, death may also occur when there a large clot or multiple smaller clots block a pulmonary artery.

What are the Types of Pulmonary Embolism?

There are three main types of pulmonary embolism: acute, subacute and chronic:

Acute pulmonary embolism – occurs when the symptoms come on quickly and requires immediate treatment
Subacute pulmonary embolism – occurs over the course of two to 12 weeks; as a result, symptoms arise more subtly than acute PE so subacute PE has a higher risk of death
Chronic pulmonary embolism – occurs when a residual clot remains in the lung after an acute PE and symptoms get progressively worse over time; heart failure may result.

The location of the clot in the pulmonary artery will also determine how a PE is categorized, as saddle, lobar or distal. In this order, these categorizations indicate progressively smaller branches of the pulmonary artery in which a clot may occur:

Saddle pulmonary embolism – a rare occurrence when a large clot lodges where the main pulmonary artery bifurcates or branches off into a Y-shape to feed into each lung
Lobar pulmonary embolism – occurs when a clot lodges in one or more of the big branches of the left or right main pulmonary artery
Distal pulmonary embolism – occurs when a clot lodges in one or more of the small branches of the left or right main pulmonary artery

What are the Causes and Risk Factors of Pulmonary Embolism?

In the majority of cases, a pulmonary embolism is caused by deep vein thrombosis (DVT). This condition is the formation of a blood clot in one of the deep veins of the leg. When a clot breaks free in the leg and travels to the lungs, a pulmonary embolism can occur.

The underlying causes and risk factors of DVT, other forms of thrombosis and potentially pulmonary embolism are known as Virchow’s triad. These three factors are known to contribute to the formation of blood clots and include:

Hypercoagulable blood, which is a hereditary disorder involving blood with a higher-than-normal tendency to clot; also known as thrombophilia
Abnormal blood flow or venous stasis, which can occur with long periods of inactivity or immobility, such as during a bed-bound hospital stay or a long flight
Endothelial injury, or damage to the inner lining of the blood vessels

Additional Causes of Pulmonary Embolism

A pulmonary embolism may also be caused by:

Air bubbles – Known as a gas embolism or air embolism, the condition occurs when one or more air bubbles enter and block blood flow in a vein or artery.
Parts of a tumor – Called a tumor embolism, the condition occurs when cancer cells break away from a primary tumor somewhere in the body, travel through the bloodstream and become lodged inside a pulmonary artery.
Fat – A fat embolism occurs when particles or droplets of fat escape from a major broken bone, such a femur or pelvis, and lodge in the arteries of the lungs.

Certain coexisting medical conditions can also increase one’s risk for pulmonary embolism, including:

Other risk factors for PE include being 60 years or older, obesity and smoking. Women who are pregnant, have given birth in the last six weeks or are taking birth control pills or hormone replacement therapy are also at increased risk.

What are the Symptoms and Warning Signs of Pulmonary Embolism?

The most common symptoms of pulmonary embolism are shortness of breath or wheezing that occurs suddenly and sharp chest pain that gets worse with breathing or exertion. If you are experiencing these symptoms, it’s important to see a doctor right away. The condition is treatable but not seeking medical attention can increase the risk of death.

PE symptoms vary in severity and from person to person, based on the size of the clot, how much of the lung is affected and an individual’s overall health. But in some cases, someone with pulmonary embolism may not experience any symptoms at all.

Additional Symptoms of Pulmonary Embolism

Other pulmonary embolism symptoms can include:

Coughing up bloody mucus
Leg pain or swelling
Pale, clammy skin
Rapid or irregular pulse
Excessive sweating
Dizziness or lightheadedness
Loss of consciousness

Diagnosis & Tests for Pulmonary Embolism

Because the symptoms of a pulmonary embolism mimic those of other conditions, such as heart attack or panic attack, it can be hard to diagnose. As the first step, a thorough medical history and symptom review is critical to ensuring the proper diagnosis and treatment.

At Tampa General Hospital’s Heart & Vascular Institute, our physicians have extensive experience treating patients with pulmonary embolisms and offer several diagnostic options to get to the bottom of your symptoms, including:

Blood tests, such as a D-dimer test – to check levels of the D-dimer protein fragment that may indicate a blood clotting disorder; other blood tests can check for oxygen and carbon dioxide levels in the blood and help rule out other conditions
Pulse oximetry – to test the levels of oxygen in your blood
Chest X-rays – to capture a visual representation of your heart and lungs to help rule out other medical conditions, such as pneumonia or fluid in the lungs (pleural effusion)
Electrocardiogram (ECG) – to measure the heart’s electrical activity to rule out a heart attack
Pulmonary angiograms – an X-ray that looks for blood clots in the lungs
Ultrasounds, such as duplex ultrasonography – to check for deep vein blood clots in the legs using a wand-shaped device called a transducer; it uses sound waves to reflect off surfaces in the body and create visual images on a screen
CT angiogram scans – to create 3D, cross-sectional images with X-rays that can find clots within the pulmonary arteries in your lungs; sometimes a contrast dye may be used
MRI scans – to create high-resolution and detailed images of the lungs using a magnetic field and radio waves; this test is often reserved for pregnant women and anyone with kidney disorders that make them sensitive to contrast dyes
Ventilation-perfusion scan (VQ scan) – to measure air flow and blood circulation in the lungs; this is another test often recommended for pregnant women or patients with kidney disease.

How do You Treat Pulmonary Embolism?

A pulmonary embolism can be treated with a combination of blood thinner medications, thrombolytic therapy and lifestyle changes, but a surgical procedure may be necessary to prevent medical complications and reduce the risk of death. For this reason, treatment often takes place in a hospital setting so that patients can be closely monitored.

TGH Heart & Vascular Institute offers prompt pulmonary embolism treatment for patients, and our physicians recommend a wide array of therapies, from nonsurgical options to advanced surgical procedures, including:

Medications

Medications can include anticoagulants such as warfarin and heparin to thin the blood and help prevent future clotting.

Thrombolysis, or thrombolytic therapy, may also be recommended. This involves guiding a catheter through the circulatory system intravenously to deliver clot-dissolving drugs.

Lifestyle Changes

A patient may be asked to make changes to their current lifestyle or certain habits. For example, wearing compression socks can help improve blood flow and prevent blood from pooling in the legs. Quitting smoking, maintaining a healthy weight and eating a balanced diet are other changes that may be recommended.

Surgical Procedures

In emergency situations, a surgeon may remove a large blood clot from the lung using a catheter inserted into the affected blood vessel. This procedure is called a pulmonary embolectomy and has a high success rate.

Another surgical option called inferior vena cava filter implantation involves an umbrella-shaped device implanted in the deep veins of the lower extremities to prevent clots from traveling to the lungs. Patients who can’t take blood thinners or continue to clot despite the use of anticoagulants are often candidates for this procedure. In general, this procedure has a high success rate of preventing clots from moving into the lungs. Implant retrieval procedures are generally highly successful as well.

What are the Complications and Long-Term Effects of Pulmonary Embolism?

The most common complication for PE is death, especially when not diagnosed and treated promptly. But the survival rate for pulmonary embolism improves drastically when patients are diagnosed and treated in a timely manner.

Other complications that can result from PE include:

Arrhythmia
Cyanosis
Heart attack
Pulmonary hypertension, which can become a chronic condition
Shock
Stroke
Tissue scarring in the pulmonary arteries

How do You Prevent and Reduce Your Risk of Pulmonary Embolism?

Reducing the risk of pulmonary embolism (PE) involves a series of proactive lifestyle changes and preventive strategies. Regular physical activity is essential—even if mobility is limited, frequent movement of arms and legs can encourage circulation. If sitting or standing for long periods is unavoidable, compression stockings can help. Maintaining hydration, limiting alcohol and caffeine and quitting tobacco products also support healthy blood flow. Avoid tight clothing, crossing legs and prolonged immobility, which can contribute to clot formation.

Additional steps include managing a healthy weight, elevating your feet regularly and discussing your risk factors with your healthcare provider. If needed, your provider may suggest options like a vena cava filter or specific precautions after surgery to prevent deep vein thrombosis (DVT), a major risk factor for PE.

Living with Pulmonary Embolism

Living with pulmonary embolism (PE) involves ongoing management and awareness to reduce the risk of recurrence and complications. Most individuals will need to take a blood thinner for at least three to six months, sometimes longer, depending on the underlying cause. It’s important to take these medications consistently and avoid activities that might lead to injuries, which could increase bleeding risk.

While anticoagulants are effective, they require careful management, including possible dietary restrictions (such as avoiding greens, broccoli and other foods rich in vitamin K) and avoiding certain over-the-counter medications. Some patients who have breathing issues six months after a PE may also undergo testing for chronic thromboembolic pulmonary hypertension (CTEPH), which can be caused by scar tissue that narrows the arteries. A hypercoagulability evaluation may also be performed to check for underlying risk factors.

Schedule regular appointments with your healthcare provider so your response to treatments can be monitored, adjustments to medications can be made and any side effects can be managed. If you are taking blood thinners, it’s especially important to alert your physician if you have black stool, bruises that are expanding and a headache. This could indicate internal bleeding and requires immediate treatment.

Your provider may also suggest lifestyle changes like quitting tobacco, increasing physical activity and making dietary adjustments to support overall health. If you develop anxiety or depression as a result of PE, know that this is common among pulmonary embolism patients and you are not alone. It’s best to find and speak to a counselor about what you’re experiencing.

Pulmonary Embolism Frequently Asked Questions (FAQs)

If you or a loved one are experiencing pulmonary embolism, you may have a lot of questions. Here are some FAQs for your reference but note that if you have a sharp pain in your chest or are having difficulty breathing, please seek medical attention immediately.

What is the life expectancy of a person with pulmonary embolism?

The life expectancy of a person with PE will vary depending on the type and severity of the condition, as well as time to treatment, age, sex and other factors. Doctors use a Pulmonary Embolism Severity Index (PESI) with 11 patient characteristic factors and a correlating point system to estimate and classify whether someone can survive a PE for 30 days or longer.

Points assignments are associated with the following risk classes:

≤ 65 points: Class I, Very Low Risk
66-85 points: Class II, Low Risk
86-105 points: Class III, Intermediate Risk
106-125 points: Class IV, High Risk
> 125 points: Class V, Very High Risk

Prompt medical treatment is essential to prevent serious complication and risk of mortality.

Can you recover from a pulmonary embolism?

There is a good chance that those who receive prompt medical treatment for a PE can recover. Many patients do recover, though they may experience chronic symptoms, such as shortness of breath.

How painful is a pulmonary embolism?

The pain caused by a PE can feel like a heart attack. You may experience sharp, stabbing pain when you breathe and a severe shortness of breath.

Can a healthy person get a pulmonary embolism?

Yes. Anyone can get a PE but there certain factors that increase the risk for some people. These factors can include surgical procedures, long periods of inactivity, age, obesity and others.

The TGH Difference for Pulmonary Embolism

A pulmonary embolism (PE) is a life-threatening condition that requires immediate medical intervention to prevent complications like heart strain, lung damage and even death. At Tampa General Hospital’s Heart & Vascular Institute, our medical staff expertly diagnoses, treats and manages PE for patients in and around the Tampa Bay area. Whether treatment involves blood thinners to prevent further clotting, thrombolytic therapy for breaking up existing clots or surgical intervention, our multidisciplinary team works tirelessly to achieve the best outcomes for patients.

Our commitment to providing world-class care has led U.S. News & World Report to recognize TGH as One of the Nation's Best Hospitals for Heart & Vascular Care and recognize us as a High Performing Hospital for Heart Attack and Heart Failure treatment for 2024-25, which places us in the top 10% of hospitals in the nation for treating those conditions. In addition, Newsweek has ranked TGH as one of America’s Best Specialized Hospitals for Cardiac Care in 2024, and we are the only hospital in the Tampa Bay region to earn a spot on the list of 100 Hospitals and Health Systems with Great Heart Programs developed by Becker's Hospital Review.

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