Signs and Symptoms of Pulmonary Embolism: What You Need to Know
Pulmonary embolism (PE) is a serious medical condition that occurs when a blood clot, often originating from the deep veins of the legs, travels to the lungs and blocks one or more pulmonary arteries. Despite its potentially life-threatening nature, the clinical presentation of PE can be subtle and non-specific, making early diagnosis challenging. In fact, only a small percentage of patients exhibit clear or classic symptoms, which often leads to delayed treatment.
Common Symptoms of Pulmonary Embolism
The most frequently reported symptoms include chest pain, shortness of breath, coughing (sometimes with blood), rapid breathing, and feelings of anxiety or impending doom. The intensity and combination of these symptoms can vary significantly depending on the size and location of the clot, as well as whether the condition develops acutely or progresses over time.
Chest Pain and Breathing Difficulties
Chest discomfort associated with PE is typically sharp and worsens with deep breaths—a condition known as pleuritic chest pain. This occurs when the clot causes inflammation in the lining of the lungs. Shortness of breath may appear suddenly and escalate quickly, especially during physical activity. In severe cases, individuals may experience dyspnea at rest, indicating significant blockage in the pulmonary circulation.
Cough and Hemoptysis
A dry cough is common, but some patients may cough up blood—a symptom referred to as hemoptysis. This usually happens when the affected area of the lung undergoes infarction due to lack of oxygenated blood flow. While not all patients will experience bleeding, its presence should raise immediate concern for possible pulmonary embolism.
Physical Signs and Clinical Findings
During a physical examination, healthcare providers may observe several key signs. These include tachypnea (rapid breathing), tachycardia (elevated heart rate), low-grade fever, cyanosis (bluish skin due to low oxygen levels), and distended neck veins, which suggest increased pressure in the right side of the heart.
Lung and Cardiovascular Abnormalities
In some cases, doctors may detect abnormal lung sounds such as crackles or wheezes, indicating fluid buildup or impaired airflow. A less common but telling sign is a pulmonary vascular bruit—an unusual sound heard over the lung fields caused by turbulent blood flow around the clot. These findings, while not always present, support the suspicion of PE when combined with other clinical indicators.
Chronic and Severe Forms of Pulmonary Embolism
Small or recurrent clots may go unnoticed initially but can accumulate over time, leading to chronic thromboembolic pulmonary hypertension (CTEPH). This progressive condition strains the right ventricle of the heart, resulting in right-sided heart enlargement, reduced cardiac output, and eventually right heart failure—a state often referred to as cor pulmonale.
On the other hand, massive pulmonary embolism—where a large clot obstructs the main pulmonary artery or major branches—can cause acute right heart strain, circulatory collapse, and sudden death. Patients may rapidly develop exertional dyspnea, hypotension, shock, or even cardiac arrest, requiring emergency intervention.
Early recognition of both mild and severe symptoms is crucial for timely diagnosis and effective management. Because the signs of pulmonary embolism overlap with many other cardiopulmonary conditions, clinicians must maintain a high index of suspicion, especially in high-risk individuals such as those with recent surgery, prolonged immobility, cancer, or a history of deep vein thrombosis.
If you or someone you know experiences unexplained shortness of breath, chest pain, or fainting spells, seek immediate medical attention. Prompt evaluation using imaging studies like CT pulmonary angiography can confirm the diagnosis and significantly improve outcomes.