Pulmonary embolism

Also called PE, Blood clot on the lung

A clot that has travelled to the lungs. Sudden breathlessness with chest pain that is worse on breathing in is a 999 call.

What it is

A blood clot, usually formed in a leg vein as a deep vein thrombosis, that breaks away and lodges in the lung's blood supply.

It is common, it is frequently missed, and it kills people who would have survived with earlier treatment. The reason it is missed is that the presentation is often unimpressive: mild breathlessness, a bit of chest pain, feeling more tired than usual.

Risk rises sharply after surgery, after a hospital admission, with immobility, with cancer, in pregnancy and the weeks after birth, with the combined pill or HRT, and with long-haul travel. In hospital it is one of the most preventable causes of death, which is why every admission includes a clot risk assessment.

Treated with anticoagulation, usually for at least three months, and sometimes for life.

Signs you might notice

Breathlessness, often sudden.

Chest pain that is sharp and worse on breathing in.

Coughing, sometimes with blood.

A fast heart rate, light-headedness, or collapse.

A swollen, painful, warm calf, which is the clot that started it.

999 immediately for sudden breathlessness, chest pain, or collapse. Do not drive the person; do not wait for a GP appointment.

In an older person, the only sign may be unexplained breathlessness, new confusion, or a fall.

How it can affect day-to-day life

Life on anticoagulants is mostly ordinary, with three things that change: bleeding risk, the need to tell any dentist, surgeon or clinician, and the need not to stop the medication without advice.

Many people are frightened for months afterwards, and breathlessness that is really anxiety is common and treatable. Being told this happens, and that it is not a sign of another clot, helps more than reassurance without explanation.

A proportion of people are left with long-term breathlessness and reduced exercise tolerance. That deserves review rather than acceptance.

Anybody having surgery, going into hospital, or becoming immobile after a previous clot needs their risk raising explicitly. It should be assessed anyway and it is worth checking that it was.

Supporting someone well

Call 999 rather than arranging a lift. Deterioration is sudden.

Say the words pulmonary embolism, and mention any recent surgery, immobility, cancer, pregnancy, long flight, or previous clot. Those details drive the decision.

Never stop anticoagulation without medical advice, and tell every clinician, including the dentist, that the person is on it.

Ask what to do about a missed dose before it happens, not after.

Get the calf checked. An untreated DVT is the next PE.

Report bleeding that does not stop, black stools, or a significant knock to the head while anticoagulated.

Where to get help

999 for sudden breathlessness, chest pain or collapse.

A GP or NHS 111 for a swollen painful calf, which should be assessed the same day.

The anticoagulation clinic for anything about dosing or bleeding.

Thrombosis UK have clear patient information and a support network.