Pulmonary Embolism

Issue

Vol. 2 No. 1 (2025)

Date Log

Submitted
September 11, 2024
Accepted
February 12, 2025
Published
February 12, 2025

Pulmonary Embolism (PE) - Risk Factors, Symptoms, Diagnosis and Treatment

https://doi.org/10.69512/ajphi.v2i1.70
Aakriti Karki, MD
Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh
https://orcid.org/0009-0007-4024-1617
Lumanti Manandhar
Rajiv Gandhi University of Health Sciences, Bangalore, India
Sahira Shrestha, MD
Nepal Medical College, Kathmandu, Nepal
https://orcid.org/0009-0002-2356-3204

Corresponding Author(s) : Aakriti Karki, MD

iamaakritikarki@gmail.com

The American Journal of Patient Health Info, Vol. 2 No. 1 (2025)

Abstract

Pulmonary embolism (PE) is a severe cardiovascular disorder marked by the obstruction of the pulmonary arteries by blood clots, frequently developed after deep vein thrombosis (DVT). Affecting over 900,000 individuals per year in the United States, pulmonary embolism ranks as the third most common cause of cardiovascular mortality worldwide. Potential risk factors include extended periods of immobility, surgical procedures, specific medical disorders, such as cancer, and the utilization of contraception or hormone medication. Manifestations such as abrupt dyspnea, angina, and vertigo require urgent medical intervention. The diagnosis of pulmonary embolism includes imaging studies, such as CT pulmonary angiography (CTPA) and bloodwork. The usual treatment protocol involves using anticoagulants, thrombolytics, and occasionally surgical procedures, such as catheter-assisted thrombus removal or inferior vena cava filters. Preventive measures predominantly target the reduction of blood clot risk by using anticoagulants, prompt postoperative mobility, and elevation of the legs. Considering its seriousness, timely identification and therapy significantly decrease mortality associated with pulmonary embolism.

Keywords

Deep vein thrombosis DVT Pulmonary Embolism PE Venousthromboembolism VTE
Karki, MD, A., Manandhar, L., & Shrestha, MD, S. (2025). Pulmonary Embolism (PE) - Risk Factors, Symptoms, Diagnosis and Treatment. The American Journal of Patient Health Info, 2(1). https://doi.org/10.69512/ajphi.v2i1.70
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References
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Aakriti Karkia, Lumanti Manandharb, Sahira Shresthac

a Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh

b Rajiv Gandhi University of Health Sciences, Bangalore, India

c Nepal Medical College, Kathmandu, Nepal

Background

A pulmonary embolism (PE) occurs when a blood clot blocks an artery in the lung, stopping the blood flow. While most PEs originate from Deep vein thrombus (DVT) in the leg veins, PEs can also come from clots in other deep veins in the body. It affects around 900,000 people in the US annually and is the third most common cause of cardiovascular death worldwide after stroke and heart attack, with 10 -30% of individuals dying within one month of diagnosis. [1]

Pulmonary embolism can be very dangerous as it hinders blood flow to the lungs. However, quick treatment can significantly reduce the risk of death. Preventing blood clots in your legs is essential to protect yourself from a pulmonary embolism. [2]

Risk Factors of Pulmonary Embolism

PE can affect anyone, but several factors can increase the likelihood of developing blood clots. [3]

Figure 1.

  • Inherited Blood Disorder: If you or your close blood relatives, such as parents or siblings, have experienced venous blood clots or PE in the past, you may have an elevated risk. Common inherited conditions, like factor V Leiden, Protein C and S deficiencies, and antiphospholipid syndrome (APS), increase blood clotting (hypercoagulability) and, therefore, the risk of PE. [4,5]
  • Surgery: Surgery, especially on your abdomen, hips, or legs, can damage blood vessels and slow your circulation, increasing the chance of clots. Major injuries like fractures can also raise the risk. [5]
  • Cancer: Cancer is known as a hypercoagulable state, increasing your blood clot risk. The treatment of cancer, like chemotherapy, is also further known to increase this risk. [6]
  • Coronavirus Disease 2019 (COVID-19): People with severe symptoms of COVID-19 are at an increased risk of developing pulmonary embolism due to the viral infection's impact on the body. [7]
  • Extended Periods of Inactivity: Long periods of inactivity can lead to blood clot formation, especially during bed rest after surgery, a heart attack, leg fracture, trauma, or a severe illness. Blood flow in the legs slows down when lying flat for extended periods, increasing the risk of clot development. Similarly, sitting for extended periods during long-distance plane trips or car trips can also slow blood flow in the legs, raising the risk of clots [8]
  • Smoking: Too much of smoking can increase the risk of PE by causing coagulation abnormalities, inflammation, and elevated plasma fibrinogen levels, especially when combined with other risk factors. [9]
  • Being Overweight: Carrying excess weight puts extra pressure on your veins, particularly in your legs. This slows blood flow and raises the likelihood of clots forming. [10]
  • Pregnancy: During pregnancy, your blood naturally clots more easily to protect you from bleeding during childbirth. However, this also raises the risk of clots forming in your legs or pelvis.
  • Hormonal Medications: Birth control pills and hormone replacement therapy can increase blood clotting ability. If you take these medications, especially if you’re over 35 or smoke, your risk of having PE is high. [11]

Development of Pulmonary Embolism from DVT

DVT can lead to Pulmonary Embolism through a process called embolization. Embolization occurs when a blood clot, known as a thrombus, breaks loose from its original location. The dislodged thrombus is now called an embolus. It travels through the bloodstream to another body part, where it becomes lodged and obstructs blood flow. Here's a simple way to understand how DVT can lead to PE: [12]

  • Formation of DVT: DVT occurs when a blood clot forms within a deep vein, usually in the leg. The clot wholly or partially obstructs the vein, causing blood flow to slow down or stop in that area.
  • Embolus Formation: If the DVT remains undetected or untreated, there is a risk that the blood clot can become dislodged from the vein wall.
  • Embolus Travel: Once dislodged, the blood clot, called an embolus, can travel through the bloodstream. It moves towards the heart through the large veins in the body.
  • Lodging in the Lung: The embolus eventually reaches the right side of the heart and then enters the pulmonary artery, the blood vessel that carries blood from the heart to the lungs. If the embolus is large enough, it can get stuck in one of the smaller arteries within the lungs, blocking blood flow to that area.
  • Pulmonary Embolism: When the embolus blocks blood flow to a portion of the lung, that is what we call a pulmonary embolism.

Symptoms of Pulmonary Embolism

The symptoms of pulmonary embolism can vary depending on how much of the lung is affected, the size of the blood clots, and any existing lung or heart conditions. Here are the symptoms you might experience if you have a pulmonary embolism:

Figure 2.

  • Sudden Shortness of Breath: You may feel breathless, as though you’re not getting enough air, even when you’re not exerting yourself. This happens because the blocked blood flow reduces oxygen exchange in your lungs, making breathing difficult. [13]
  • Chest pain: The pain may feel sharp, stabbing, or like heavy pressure in the chest. It often worsens when you take a deep breath, cough, or lie down. This discomfort is caused by reduced blood flow and inflammation in the lung tissue or the surrounding lining. [13]
  • Coughing: A cough may develop unexpectedly, either dry or producing mucus. In some cases, small amounts of blood appear in the coughed-up mucus. This symptom occurs when lung tissue is irritated or damaged by the clot. [13]
  • Rapid or Srregular Heartbeat: The heart may start beating faster or out of rhythm as it compensates for reduced blood flow in the lungs. This symptom reflects the strain on your cardiovascular system caused by the blocked blood vessels. [13]
  • Lightheadedness or Fainting: You may feel dizzy, weak, or even lose consciousness. These symptoms occur because the reduced blood flow from the lungs leads to a drop in oxygen levels reaching the brain and other vital organs. [13]
  • Swelling or Pain in one Leg: Often linked to DVT, this symptom occurs in the leg where the blood clot originally formed. Swelling, redness, warmth, or tenderness in the calf area is common, indicating poor blood flow in the affected vein. [13]
  • Blue or Pale Skin: A bluish tint to the skin, lips, or fingertips may develop. This symptom occurs when oxygen levels in the blood drop significantly, leading to visible changes in skin color. [13]

Diagnosis of Pulmonary Embolism

Diagnosing a pulmonary embolism can be challenging, mainly if underlying heart or lung issues exist. Here is the list of tests your doctor will use to diagnose pulmonary embolism: [14, 15]

Figure 3.

  • CT Pulmonary Angiography (CTPA): CTPA is a gold standard diagnostic imaging test to detect pulmonary embolism. During a CTPA, X-rays create detailed cross-sectional 3D images of the blood vessels in the lungs, providing information about blood clots' presence, location, and size. The procedure involves injecting a contrast dye into a vein to enhance the visualization of the pulmonary arteries. As the dye circulates through the lungs, it highlights any areas of blood flow obstruction caused by clots. [15]
  • Blood Tests: The D dimer test is one of the most used blood tests to check for the presence of a blood clot. It measures the clot-dissolving substance in the blood. Elevated D dimer levels may indicate an increased likelihood of blood clots, but it’s not specific to PE and may require further testing. [15]
  • Chest X-ray: While a chest X-ray cannot directly diagnose PE, it helps rule out other conditions with similar symptoms. It provides images of the heart and lungs, which may appear normal or show signs of other lung or heart conditions. [16]
  • Ultrasound (Duplex Ultrasonography): This is a noninvasive test that uses sound waves to scan veins in the thigh, knee, calf, and arms for deep vein blood clots. The absence of clots reduces the likelihood of DVT, a common cause of PE. [15]
  • Ventilation-Perfusion (V/Q) Scan: A V/Q scan can avoid exposure to radiation or contrast material if necessary due to a medical condition. During this test, a small quantity of a radioactive substance known as a tracer is injected into a vein in the arm. The tracer maps the blood flow (perfusion) and compares it with the airflow (ventilation) in the lungs. It’s often used if you cannot have a CT scan, such as a dye allergy. [15, 17]
  • Pulmonary Angiogram: This test provides a clear picture of lung blood flow and is the most accurate method for diagnosing PE. It involves inserting a catheter into a large vein, guiding it to the pulmonary arteries directly, and injecting a special dye to visualize the blood vessels through X-rays. Pulmonary angiograms are reserved for cases where other tests are inconclusive due to the procedure's complexity and potential risks. [15]
  • MRI (Magnetic Resonance Imaging) of the Lungs: MRI is used in specific cases, such as pregnant individuals, to avoid exposing the baby to radiation or in people with kidney concerns about contrast dye used in other tests. It creates detailed images of organs and tissues using a magnetic field and radio waves. [18]

Treatment of Pulmonary Embolism

If you have a pulmonary embolism, you require immediate medical attention. Breaking up clots and preventing the formation of new ones are the two main objectives of treatment. Medications [19]and surgeries are available as treatments. [20,21]

Figure 4.

1. Anticoagulants: Anticoagulants are drugs often known as blood thinners, preventing blood clots from becoming more extensive and creating new clots. You might know them as heparin, Lovenox, coumadin, Eliquis, or Xarelto. They may be administered intravenously, as a tablet, or as an injection. The most important thing to remember is these drugs can result in bleeding, mainly if you take aspirin or other medications that thin the blood. [22]

2. Thrombolytics: They are clot busters used to dissolve blood clots. They can be prescribed if you have big clots that result in painful symptoms or other critical consequences. They help to reduce the embolic load quickly and enhance cardiorespiratory blood circulation. But thrombolytics are given only when your pulmonary embolism is severe and possibly life-threatening. The reason to use them only in such situations is thrombolytics can cause bleeding that can be fatal. [23

3. Surgery: Surgical management of pulmonary embolism is typically reserved for severe cases or situations where other treatment options are ineffective or contraindicated. [24,25]

  • Catheter-Assisted Thrombus Removal: This minimally invasive procedure involves inserting a catheter through a blood vessel, usually in the groin, and guiding it to the blood clot site in the lungs. The clot is carefully broken up or suctioned out using specialist equipment attached to the catheter, restoring blood flow to the damaged lung tissue. [20, 21]
  • Inferior Vena Cava (IVC) Filter: This is a small, cone-shaped medical device inserted into the inferior vena cava, a large vein that carries deoxygenated blood from the lower body to the heart. It is a minimally invasive procedure that uses a catheter to place the filter. The primary purpose of this filter is to prevent blood clots from traveling to the lungs and causing a potentially life-threatening condition known as pulmonary embolism. They are typically recommended for individuals at high risk of developing blood clots but cannot tolerate or respond to standard blood-thinning medications. The filter works by trapping large blood clots that may form in the lower extremities, preventing them from reaching the lungs. Over time, the filter may be removed if the risk of blood clots subsides or if there are concerns about potential long-term complications. [26]
  • Inferior Vena Cava (IVC) Filter: This is a small, cone-shaped medical device inserted into the inferior vena cava, a large vein that carries deoxygenated blood from the lower body to the heart. It is a minimally invasive procedure that uses a catheter to place the filter. The primary purpose of this filter is to prevent blood clots from traveling to the lungs and causing a potentially life-threatening condition known as pulmonary embolism. They are typically recommended for individuals at high risk of developing blood clots but cannot tolerate or respond to standard blood-thinning medications. The filter works by trapping large blood clots that may form in the lower extremities, preventing them from reaching the lungs. Over time, the filter may be removed if the risk of blood clots subsides or if there are concerns about potential long-term complications. [26]

    Complications of Pulmonary Embolism

    Approximately one-third of individuals with an undetected and untreated pulmonary embolism do not survive either due to complications or due to complications. The most common complications of pulmonary embolism are: [27,28]

    Figure 5.

    • Pulmonary Hypertension: When blood clots obstruct the pulmonary arteries for an extended period, it can increase lung pressure, causing pulmonary hypertension. This condition increases the work that your heart must do and can lead to heart failure if left untreated.
    • Right Ventricular Dysfunction: Severe pulmonary embolism can impair the function of the right ventricle, the heart chamber responsible for pumping blood to the lungs. This dysfunction can decrease the heart's output and potentially lead to shock.
    • Pulmonary Infarction: Large blood clots may completely block blood flow to a portion of the lung, causing lung tissue to become deprived of oxygen. It can result in pulmonary infarction, leading to localized lung tissue damage.
    • Pleural Effusion: Pulmonary embolism may cause inflammation in the lining of the lungs (pleura), accumulating fluid in the pleural space, which can cause pleural effusion. This can, in turn, cause chest pain and difficulty breathing.
    • Recurrence: There is always a chance that you have it again, primarily if the underlying risk factors are not adequately managed. Most commonly, recurrent PE is seen in people with inherited conditions that went undiagnosed.
    • Hemoptysis: In some instances, pulmonary embolism can cause lung bleeding, leading to coughing up blood, a condition known as hemoptysis.

    Prevention of Pulmonary Embolism

    Preventing blood clots in the deep veins of the legs is essential for avoiding pulmonary embolism. You can take the following measures to prevent pulmonary embolism: [29,30]

    Figure 6.

    • Blood Thinners: These medicines are administered before and after surgery and to hospitalized individuals with certain medical conditions, such as heart attack, stroke, or cancer complications. [31] Those who cannot mobilize immediately must be careful and take their blood thinners on time.
    • Early Mobilization: Early movement after surgery can prevent pulmonary embolism and expedite overall recovery. Thus, motivate yourself to move after your surgery. [32]
    • Pneumatic Compression Device: These devices are placed on the thighs or calf. They have a mechanism to automatically inflate and deflate that massages and squeezes leg veins, improving blood flow from the leg to the heart and reducing the risk of formation of DVT. [33]

    Questions to ask your Doctor

    1. What caused my PE, and do I have risk factors for another one?
    2. Should I consider any dietary considerations while on blood thinners?
    3. How long will I need to stay on anticoagulant therapy?
    4. What symptoms should prompt me to seek immediate medical attention?
    5. Can I travel by road, or can I fly safely?

    Conflict of Interest

    Aakriti Karki serves as a non-paid research assistant at eHealthyInfo. Lumanti Manandhar worked as a paid freelance medical journalist with eHealthyInfo from 2022 to 2023. Sahira Shrestha works as a non-paid research assistant at eHealthyInfo. There are no other conflicts of interest to declare.

    Peer Reviewed By

    Sumit Saurav Karna, MD

    Charleston Area Medical Center, WV, USA

    References

    1. Learn About Pulmonary Embolism | American Lung Association [Internet]. www.lung.org. 2023. Available from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/pulmonary-embolism/learn-about-pulmonary-embolism
    2. Mayo Clinic. Pulmonary Embolism [Internet]. Mayo Clinic. 2022. Available from: https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647
    3. Pastori D, Cormaci VM, Marucci S, Franchino G, Del Sole F, Capozza A, et al. A Comprehensive Review of Risk Factors for Venous Thromboembolism: From Epidemiology to Pathophysiology. International Journal of Molecular Sciences. 2023 Feb 5;24(4):3169. Available from: https://www.mdpi.com/1422-0067/24/4/3169
    4. Senst B, Tadi P, Basit H, Jan A. Hypercoagulability [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538251/
    5. Zöller B, Svensson PJ, Dahlbäck B, Lind-Hallden C, Hallden C, Elf J. Genetic risk factors for venous thromboembolism. Expert Review of Hematology. 2020 Aug 23;13(9):971–81. Available from: https://www.tandfonline.com/doi/full/10.1080/17474086.2020.1804354
    6. Caine GJ, Stonelake PS, Lip GYH, Kehoe ST. The Hypercoagulable State of Malignancy: Pathogenesis and Current Debate. Neoplasia. 2002;4(6):465–73. Available from:https://pmc.ncbi.nlm.nih.gov/articles/PMC1550339/
    7. Cui L, Cheng W, Mou Z, Xiao D, Li Y, Li Y, et al. Risk factors for pulmonary embolism in patients with COVID-19: a systematic review and meta-analysis. International Journal of Infectious Diseases. 2021 Oct;111:154–63. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8372457/
    8. Chandra D. Meta-analysis: Travel and Risk for Venous Thromboembolism. Annals of Internal Medicine. 2009 Aug 4;151(3):180. Available from: https://pubmed.ncbi.nlm.nih.gov/19581633/
    9. Tapson VF. The Role of Smoking in Coagulation and Thromboembolism in Chronic Obstructive Pulmonary Disease. Proceedings of the American Thoracic Society. 2005 Apr 1;2(1):71–7. Available from:https://pubmed.ncbi.nlm.nih.gov/16113472/
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