Pulmonary Embolism Explained: Symptoms, Diagnosis, Treatment

Every year, 900,000 Americans are caught by surprise by the symptoms of a pulmonary embolism: a sudden shortness of breath, chest pain and a rapid heartbeat.

Described by Dr. Talal Dahhan, Division Chief for Pulmonary & Critical Care, Baystate Pulmonary, pulmonary embolism (PE) is a serious and potentially life-threatening condition. “But with prompt diagnosis, 92% of PE patients survive and, with proper management, go on to live healthy and full lives.”

What is a Pulmonary Embolism?

As Dr. Dahhan explains, “A PE is a blood clot that forms in the body—most often the legs—that breaks loose and travels to the blood vessels in the lungs where it blocks the normal flow of blood in the lungs. Many PEs—70-80%—end up getting stuck and blocking small blood vessels.

When the supply of blood that carries oxygen to other parts of the body gets restricted by the clot, it leads to a very sudden shortness of breath. In some cases, a small clot may be pushed or moved so that normal blood and oxygen flow resumes quickly, and the person will feel fine. But in the case of big clots, a large restriction of blood and oxygen can lead to cardiac arrest and loss of consciousness.

Regardless of the size of the clot, PE is very serious and can lead to lung damage and, in some cases, death.”

Symptoms of Pulmonary Embolism

It’s critical to seek medical attention if you experience any symptoms of PE, including:

• Sudden shortness of breath
• Panting
• Stabbing chest pain, may increase in intensity when breathing deeply
• A cough that may or may not produce blood
• Rapid heartbeat

“Even if the shortness of breath or chest pain passes quickly, it’s important to see your doctor,” urges Dr. Dahhan. “While the blood clot may have moved on, it’s still in your blood stream and poses a threat to your health and life.”

What Causes Pulmonary Embolism?

The root cause of PE is the formation of clots in the body. “Under normal circumstances,” says Dr. Dahhan, “the body forms clots to stop bleeding from damaged blood vessels and allow the body to heal. Damage typically stems from an injury, trauma or even medical procedures including device implantation, invasive screenings and surgery. For most people, clots dissolve naturally and are taken up by the body.” But as he notes, certain factors can increase the likelihood a clot may remain persistent and potentially break free.

“As we age, our blood naturally thickens,” he says. “This increases the tendency for blood to clot and, thus, increases the chance of developing a clot that can lead to PE.”

Complicating the issue for older adults is that fact that many conditions that develop as one ages often lead to people becoming less active, which can increase the risk of clotting.

Risk Factors for Pulmonary Embolism

“Conditions including congestive heart failure, chronic obstructive pulmonary disease (COPD), and interstitial lung disease, can all lead to a shortness of breath,” Dr. Dahhan explains. “The response of many is to become less active. But this lack of activity allows blood to pool in the lower extremities, which can increase the risk of clotting.”

“Even when there aren’t underlying health issues, simply being stationary—say, driving or flying for six hours or more—can increase the risk of clotting. The same is true post-surgery when the body is actively creating clots. This is why surgical patients, especially those undergoing joint replacement, are made to get up and walk even just a few hours after surgery. Movement helps stimulates circulation, which reduces clot risk.”

Other factors that can increase PE risk include:

• A history of vein diseases
• Smoking, as certain chemicals contained in tobacco products are known to make blood stickier and increase the risk of clotting
• Having thrombophilia or a family history of thrombophilia, a condition that increases the risk of blood clotting even without injury
• Certain gene mutations, including prothrombin gene mutation and Factor V Leiden

Diagnosing Pulmonary Embolism

The symptoms of PE are similar to those associated with other serious conditions affecting the heart and lungs, so getting a quick diagnosis is critical.

When assessing patients experiencing symptoms of PE, the Baystate Pulmonary team relies on a clinical prediction tool called the Well’s Score. Dr. Dahhan explains, “The Well’s Score allows us to consider symptoms and clinical risk factors to determine the probability of PE versus another condition. Different symptoms and factors are assigned point values. The more points you have on the Score, the more likely it is that you have PE. The Score also guides what steps we’ll take next to confirm a PE diagnosis if the score is leaning that way.”

Common next steps for confirming a diagnosis include:

• A CT pulmonary angiography: Also called a CT scan, this imaging uses a dye to create a 3D image of the arteries and blood vessels of the lungs and reveal a PE
• Kidney function assessment: PE can significantly impact kidney function, specifically glomerular filtration rate (GFR). A decrease in GFR can be a strong indicator of PE.
• Ultrasound: Performed on the leg, an ultrasound can reveal clots in the veins and help evaluate blood flow

Treatment for Pulmonary Embolism

While PE can be mild or severe, the focus of treatment remains the same: keeping a clot from getting bigger, restoring blood flow, and preventing new clots from developing.

Dr. Dahhan notes that common treatment options include:

Blood thinners: Also referred to as anticoagulants, blood thinners are often the first line of treatment for patients with PE. Given intravenously or taken orally, blood thinners help to break up existing clots and keep new clots from forming.

Depending upon the patient’s condition and history, they may be required to take blood thinners even after the initial clot has been resolved. In some cases, patients remain on thinners for several months while others take them for the remainder of their lives.

Systemic thrombolysis: Often called “clot busters,” thrombolytic medications are used for severe cases of PE and administered by IV or by a catheter that’s positioned near the site of the clot.

Surgical embolectomy: Performed only in the most severe cases or when other treatments are not resolving the clot or are not an option for a patient, an embolectomy is a minimally invasive procedure that involves surgically removing the clot.

Managing and Preventing PE

Once you’ve experienced PE, managing it becomes a lifetime commitment.

Dr. Dahhan says, “Most patients with PE are able to live successfully with PE provided they stay on top of their condition and takes steps to reduce risks.”

In addition to consistently taking any medication prescribed for PE, patients need to make sure all their healthcare providers—including dentists or oral surgeons—are aware of their PE history and current treatment regimen.

“Here at Baystate, providers actively work across disciplines and collaborate to provide the best care based on the patient's specific needs and severity of their condition,” he notes. “Together we’re able to create an optimal care plan and make adjustments based on patient’s response to treatment and in advance of any required procedures that may be impacted by the care plan.”

Patients of Dr. Dahhan and other members of the Baystate Pulmonary team also encourage patients to:

• Adhere to any recommended treatments, follow-up screenings or evaluations related to PE or other conditions
• Quit smoking
• Remain active, 15-20 minutes of daily walking will do
• Stay hydrated to help keep blood flowing
• Eat a healthy diet
• Lose weight if your weight is keeping you from engaging in regular exercise