Pulmonary embolism (PE)
Get urgent help for possible PE
A pulmonary embolism can be life-threatening. Sudden breathlessness or coughing up blood needs urgent GP or NHS 111 assessment. Call 999 or attend A&E for severe breathing difficulty, chest or upper-back pain, a very fast heartbeat or collapse. Do not drive yourself or wait for a routine private appointment.
What is a pulmonary embolism?
PE is a blood clot blocking an artery in the lungs. It often starts as a clot in a deep leg vein and travels to the chest. Symptoms may include sudden breathlessness, pain on breathing and coughing up blood. A painful, swollen leg may occur, but is not always present.
How is it diagnosed?
Clinicians assess the likelihood of a clot using your symptoms, examination and risk factors. Depending on that assessment, a D-dimer blood test and imaging may be needed. CT pulmonary angiography is commonly used; a ventilation-perfusion scan is an alternative in selected circumstances. A normal chest X-ray alone cannot rule out PE. Anticoagulant treatment may be started while urgent tests are arranged when clinically appropriate.
Treatment
Anticoagulants reduce further clot formation while the body clears the existing clot. The medicine is chosen around kidney function, bleeding risk, other medicines and individual circumstances. Treatment is usually needed for at least three months. A review weighs the risk of another clot against bleeding risk to decide whether treatment should continue. Some severe cases need emergency treatment to remove or break down the clot.
Recovery and follow-up
Breathlessness and tiredness can take weeks or months to improve. Follow your discharge plan and increase activity as advised. Persistent breathlessness needs reassessment, particularly at the three-month review, to look for complications and other causes.
Take anticoagulants exactly as prescribed and seek advice before stopping them or starting new medicines. Carry your anticoagulant alert information. Significant bleeding, a head injury or new severe symptoms require urgent medical advice. Your team can advise about travel, exercise and future clot prevention.
Routine follow-up appointment contacts
Sources and further information
NICE NG158: diagnosis and anticoagulant treatment
General information for adults; suspected PE needs urgent assessment.