Symptoms of Pulmonary Embolism

Show Article Table of Contents

When somebody has a pulmonary embolus, it is the symptoms they experience that usually causes them to seek medical help. And the symptoms they describe often tip off the doctor that a pulmonary embolus may be the problem.

If a pulmonary embolus is producing a reasonably “classic” set of symptoms, most doctors will think of the right diagnosis immediately and will quickly go about confirming their suspicion. 

Sometimes, however, people having a pulmonary embolus will not have the classic symptoms. Instead, many may have mild symptoms or no symptoms at all. On the other hand, some will immediately experience cardiovascular collapse, possibly with sudden death, and will never have the chance to describe any symptoms to anybody.

So, while the symptoms of a pulmonary embolus are important, it is also important for doctors to have a high index of suspicion whenever a person who has an increased risk of pulmonary embolus complains of even mild symptoms that might conceivably be caused by one. A pulmonary embolus that does not produce impressive symptoms may soon be followed by another pulmonary embolus (one that might have been prevented) that causes a severe complication.

pulmonary embolus symptoms
© Verywell, 2018 

Common Symptoms

The classic symptoms of a pulmonary embolus, the ones described in the medical textbooks, are:

  • sudden, unexplained dyspnea (shortness of breath), followed by
  • dull chest pain that is often pleuritic in nature (that is, it gets worse with a deep breath), and
  • cough.

Other symptoms that people often have with a pulmonary embolus include:

Any of these symptoms should place pulmonary high on the doctor’s list of medical problems that should be considered right away.

For most people, experiencing very sudden, very severe dyspnea, apparently for no reason at all, is very alarming. So people who have this symptom usually try to get medical help immediately. Doctors too are usually impressed by this symptom, and they should be. So even if their patient does not have accompanying symptoms like chest pain or cough, a description of sudden unexplained dyspnea should be enough to alert most doctors to the possibility of a pulmonary embolus.

But a pulmonary embolus does not always cause this kind of dramatic symptom; sometimes symptoms are quite mild. Doctors need to be suspicious of this possibility in any person who has risk factors for pulmonary embolism, and complains of any symptom (however mild) related to their breathing.

Signs

Doctors will often see objective findings (referred to as “signs”), in people who have had a pulmonary embolus. These signs include:

  • tachycardia (rapid heart beat)
  • tachypnea (rapid breathing)
  • hypotension (low blood pressure)
  • decreased breath sounds over a portion of a lung, indicating that air is not flowing to that area
  • rales (crackles over the lungs), indicating fluid in the air sacks
  • elevated pressure in the neck veins, suggesting an obstruction in the pulmonary artery
  • swelling or tenderness over the thigh or calf, indicating a DVT

If any of these objective findings are present, along with any of the symptoms commonly produced by a pulmonary embolus, testing should be done right away to confirm or disprove that diagnosis. Even without objective findings, and even if symptoms seem pretty mild, as long as the doctor thinks there is a possibility that a pulmonary embolus may have occurred, diagnostic testing should be done.

In some people, the signs of a pulmonary embolus are not subtle. In some, a pulmonary embolus will cause severe, immediate, cardiovascular instability, and even frank shock. Unexplained cardiovascular collapse should itself be a strong clue that a pulmonary embolus might have occurred.

In fact, if the clinical circumstances are highly suspicious of a pulmonary embolus and the patient is likely to die without immediate treatment, doctors may begin treatment for a pulmonary embolus even before the diagnosis is confirmed.

Complications

A pulmonary embolus can have dire consequences, especially if the diagnosis is delayed or missed. To avoid these consequences, doctors should always be suspicious of a pulmonary embolus if there is any reason to think one might have occurred. 

The major complications of a pulmonary embolus are:

  • Recurrent pulmonary embolus. Unless the diagnosis is made and effective treatment is given, people who have a pulmonary embolus have a greatly elevated risk of having another one.
  • Pulmonary infarction. A pulmonary infarction is the death of a portion of lung tissue, which can be caused by a pulmonary embolus if an artery supplying lung tissue is completely blocked by the embolus. If large enough, a pulmonary infarction may be life-threatening.
  • Pulmonary hypertension. Pulmonary hypertension is a very serious medical disorder that can result from a large pulmonary embolus—or from recurrent pulmonary emboli—if the clot or clots produce a permanent, partial obstruction of the pulmonary artery.
  • Death. The mortality rate for untreated pulmonary embolus is quite high and has been reported as high as 30 percent. A large acute pulmonary embolus can cause sudden death, but more commonly death occurs within a few days of the diagnosis if treatment is insufficient to stop recurrent pulmonary emboli.
What Can Cause a Pulmonary Embolus?
Was this page helpful?
Article Sources
  • Keller K, Beule J, Balzer JO, Dippold W. Syncope and collapse in acute pulmonary embolism. Am J Emerg Med 2016; 34:1251. doi: 10.1016/j.ajem.2016.03.061.
  • Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35:3033. doi: 10.1093/eurheartj/ehu283.
  • Lucassen W, Geersing GJ, Erkens PM, et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 2011; 155:448. doi: 10.7326/0003-4819-155-7-201110040-00007.
  • Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120:871.