Pulmonary Embolism

Pulmonary embolism (PE) is a sudden blockage of a lung artery, usually by a blood clot that travelled from a deep vein in the leg (deep vein thrombosis, DVT). It can be fatal within hours and is under-diagnosed in India — the symptoms are often blamed on other causes.

Red flag symptoms — dial 112

• Sudden breathlessness at rest or on exertion.
• Sharp chest pain worsened by deep breath (pleuritic pain).
• Coughing up blood.
• Fast heart rate, sweating, light-headedness, collapse.
• Swollen, painful, warm calf or thigh (DVT) — often on one side only.
• In severe PE — sudden collapse and cardiac arrest.

Who is at higher risk

• Recent hospitalisation, major surgery (especially orthopaedic and cancer surgery).
• Long-distance travel (flights or road journeys over 4–6 hours) — stand, walk, stretch calves every 1–2 hours.
• Pregnancy and up to 6 weeks postpartum.
• Combined oral contraceptive pill, hormone replacement therapy.
• Active cancer and chemotherapy.
• Obesity, smoking, immobilisation (plaster cast, prolonged bed rest).
• Personal or family history of clots, inherited thrombophilia, antiphospholipid syndrome.
• COVID-19 and other serious acute infections.

Diagnosis

• D-dimer blood test (helps rule out low-risk cases).
• CT pulmonary angiogram (CTPA) — the main diagnostic test.
• Leg ultrasound for DVT.
• ECG, troponin, echocardiogram to assess severity and strain on the heart.

Treatment

• Anticoagulation (blood thinners) — the mainstay. Modern direct-oral-anticoagulant (DOAC) class — widely used in India — is simpler than older vitamin-K-antagonist options for most patients.
• Thrombolysis (clot-busting drugs) or surgery/thrombectomy for severe, life-threatening PE.
• Compression stockings are no longer routinely prescribed for all DVT — check current recommendation with your doctor.
• Duration of anticoagulation depends on whether the clot was provoked (surgery, trauma, pregnancy) or unprovoked — usually 3–6 months, or longer.

Prevention in hospital and travel

• Early mobilisation after surgery; calf-compression devices; prophylactic low-dose anticoagulation when appropriate.
• On long journeys — move calves every hour, hydrate, avoid heavy alcohol/sedatives, consider compression stockings if high-risk.
• Stop smoking; manage weight.