A pulmonary embolism is the blockage of an artery in the lung what causes symptoms such as sudden shortness of breath, severe coughing, and chest pain that worsens when taking a deep breath, coughing, or eating.

A pulmonary embolism usually occurs due to a blood clot, thrombus, or embolus, that forms in other parts of the body and reaches the blood. This clot can interrupt blood flow and prevent oxygen from reaching the tissues of the affected area.

A pulmonary embolism embolism is a serious condition, and therefore if you suspect one is present, proceed immediately to the emergency room for assessment and treatment. Treatment typically involves the use of IV anticoagulants, oxygen therapy, and, in the more severe cases, surgery.

Common symptoms

The main symptoms of pulmonary embolism are:

Sudden feeling of shortness of breath;
Chest pain that worsens when taking a deep breath, coughing, or eating;
Constant coughing that may contain blood;
Swollen legs or pain when moving the legs;
Pale, cold and/or blue skin;
Feeling faint or fainting;
Mental confusion, especially in older adults;
Rapid and/or irregular heartbeat;
Dizziness that does not improve.

If you notice one or more of these symptoms, you are advised to proceed to an emergency room or call an ambulance for assessment and treatment, as prompt intervention can prevent complications.

Confirming a diagnosis

A pulmonary embolism diagnosis is made in the hospital by the general practitioner or pulmonologist through the assessment of the patient's symptoms, health history, use of contraceptives or hormonal medication, and other conditions, like pregnancy, deep vein thrombosis, cancer or fracture.

In addition, the doctor may order tests such as arterial blood gas analysis, blood clotting tests, brain natriuretic peptide (BNP), troponin and D-dimer, which assess the risk for clot formation.

To confirm the diagnosis, the doctor should request imaging tests, such as chest X-ray, computed tomography angiography, scintigraphy or pulmonary angiography, Doppler ultrasound, electrocardiogram (ECG) or echocardiogram, for example.

Possible causes

Although a pulmonary embolism can happen to anyone, there are factors that can increase the risk for developing one, such as:

1. Lack of physical activity

When you stay in the same position for a long time, such as lying down or sitting, blood begins to accumulate more in one part of the body, usually in the legs. Most of the time, this accumulation of blood does not cause any problems because when the person stands up, the blood returns to circulating normally.

However, spend several days lying down or sitting, which can happen after surgery or due to a serious illness such as a stroke, for example, can increase your risk for accumulated blood to form clots. These clots can be transported through the bloodstream until they block a pulmonary vessel, causing an embolism.

What to do: to prevent this risk, you should exercise all your limbs every day and change positions at least every 2 hours. Those who are on total bed rest and are immobilized are often prescribed anticoagulants and physiotherapy as necessary.

2. Surgeries

Post-operative recovery from a surgery generally reduces the patient's level of physical activity and increases the risk for clot formation. However, the surgery itself can also lead to a pulmonary embolism.

Incisions or cuts from the surgery can damage blood vessels, which can interfere with normal blood flow and increase the risk for clot formation.

What to do: It is important for recovery to first be monitored in a hospital setting, so that any abrupt changes can be caught and treated. At home, the doctor may prescribe anticoagulants, like warfarin or aspirin, to reduce the risk for clot formation.

3. Deep vein thrombosis

People who suffer from deep vein thrombosis (DVT) have a high risk of developing clots that travel to other organs, like the brain and lungs. Clots and blockages in blood flow can cause serious complications, such as embolism or stroke.

What to do: To prevent complications from DVT, you should follow treatment as guided by your doctor, which generally includes the use of anticoagulants.

4. Air travel

Taking any trip for more than 4 hours, whether by plane, car or boat, for example, can increase the risk for developing a blood clot. This is due to spending a prolonged amount of time in the same seated position. However, a risk for a blood clot is even higher when on a plane, as changes to pressure in the air can make the blood more viscous, leading to clot formation.

What to do: During long trips, especially when on a plane, you are advised to stand up or move your legs at least every 2 hours.

5. Fractures

Fractures are one of the main causes of pulmonary embolism. Broken bones can cause damage to the blood vessels surrounding them, and will usually require periods of immobilization after the injury.

Therefore, fracture can not only lead to the formation of blood clots, but also to the entry of air or fat into the bloodstream, increasing the risk of developing an embolism.

What to do: avoid dangerous activities, such as mountain climbing, and wear appropriate protection during high-impact sports to prevent fractures. If the fracture requires surgical repairs, patients should be encouraged to move the affected limb and mobilize as approved by their doctor or physiotherapist.

Risk factors

The main risk factors for a pulmonary embolism include:

Age over 60
Pregnancy or postpartum period
Previous history of blood clots or deep vein thrombosis (DVT)
Obesity or overweight
Smoking
History of heart or vascular disease
Hip or knee replacement
Cancer or chemotherapy treatment
Use of oral contraceptives or hormone replacement therapy
Infections, such as pneumonia, HIV or COVID-19

In addition, there are some reports of people who developed pulmonary embolism after vaccination against COVID-19, however, this risk is extremely low. Therefore, vaccination continues to be recommended and is considered to be safe. Learn more about the side effects of the COVID-19 vaccine.

Treatment options

Treatment for a pulmonary embolism should be guided by a general practitioner or lung specialist, and usually involves oxygen therapy, in which oxygen is provided to the patient through a mask.

In addition, medications are administered directly into the vein to dissolve the clot and ensure optimal blood flow. Analgesics can also be administered to manage pain.

Treatment for a pulmonary embolism generally requires hospitalization and may last weeks to months.

Surgery to remove the clot may be indicated in the most severe cases or when the obstruction of the blood flow is due to a foreign object or piece of bone.