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Sudden breathlessness, stabbing on breathing in, a racing pulse — suspicion alone belongs in the emergency department, not in tomorrow’s appointment.
Also known as: pulmonary embolism · PE
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A clot blocking a lung artery — usually one that formed in the deep veins of the leg and broke loose. That is why leg and lung belong in one breath: the swelling you see and the breathlessness you feel are two stations of the same story. It nearly always starts suddenly. Typical are breathlessness for no apparent reason, a stabbing pain on breathing in, a racing heart, sometimes a cough with a little blood, sometimes only a brief faint. The treacherous part is that each of these signs alone also fits something harmless, and some people look astonishingly well — small emboli do little, large ones cause circulatory collapse. Triggers are everything that slows the flow or shifts clotting: immobility, an operation, a plaster cast, a long journey, pregnancy and the weeks after, hormonal contraception, cancer, an inherited tendency — and in a proportion of cases no reason is found. For what to do that is secondary: suspicion alone justifies going to the emergency department, because treated the situation is usually manageable and untreated it is not.
A second embolism or thrombosis without a recognisable cause shifts the question from the cause to the length of treatment — and the clotting workup helps with that.
Not the family doctor tomorrow morning and not waiting to see. With breathlessness that leaves no air, with loss of consciousness or bluish lips: call the emergency number.
A CT scan of the lung vessels shows the clot directly. In pregnancy and with contrast problems there are alternatives — the emergency department decides.
With strong suspicion treatment starts while the work-up continues. That is not haste but the balance between two unequal risks.
After a clear, temporary cause usually some months. With no identifiable cause or with recurrence often long term — this question belongs asked explicitly.
The origin of the same story — and the place where it will be noticed earlier next time.
With no apparent cause a clotting tendency and, appropriate to age, other causes are looked for. That is routine, not an accusation.
Blood thinners do not dissolve the clot — they prevent it from growing and new ones from forming; the body breaks down what is there over weeks to months. Thrombolysis is used only with circulatory failure, because the bleeding risk is high. The duration follows the trigger: three months after an operation or a leg in plaster, longer or lifelong if no trigger is found.
The D-dimer test rules it out reliably at low probability — but it is often raised in pregnancy, inflammation, after surgery and with age, which is why from fifty the threshold is adjusted for age. Treatment lasts at least three months; without a graspable trigger, longer. In about three to four in a hundred, raised pressure in the lung circulation remains at six to twenty-four months — hence the check if breathlessness persists.
The breathlessness comes out of nowhere, often while sitting. Something building over weeks is usually something else.
A sharp, one-sided pain that worsens on a deep breath — it arises when the affected piece of lung rubs against the pleura.
A resting pulse well over a hundred together with new breathlessness is one of the most telling combinations there is.
A one-sided swollen, warm, painful calf — sometimes already settled by the time the lung speaks up. It is asked about specifically.
In some people the blackout is all that shows. An unexplained faint with a fast pulse therefore needs taking seriously.
An operation, a cast, bed rest, a long journey, pregnancy and the weeks after, hormonal contraception, cancer, a family tendency — or none of these.
It serves to rule out, not to prove. A normal value with low suspicion makes embolism very unlikely; a raised one comes from a hundred other things and proves nothing.
Not for the diagnosis but for the severity: it shows whether the right side of the heart is suffering under the pressure — and treatment follows from that.
Part of the baseline before treatment, but says nothing about the embolism itself.
They lower the blood fats and act on the excitability of the heart muscle. Oily sea fish twice a week is the best-supported route; very high doses from capsules are not a harmless more.
Keeps the rhythm steady and lowers blood pressure. Water tablets drive it down, certain blood pressure drugs and a weak kidney drive it up — which is why it is checked under treatment.
A lack favours extra beats and at the same time keeps a potassium deficiency going. Anyone replacing only the potassium sees no success while the magnesium is missing.
Less salt lowers blood pressure measurably, and most of it is not in the salt cellar but in bread, cheese, cured meat and ready meals. With very low blood pressure the opposite applies.
Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
The same reckoning as with a leg vein thrombosis: the combined pill, pregnancy and above all the weeks after birth raise the readiness to clot. Breathlessness and chest pain in that time belong taken seriously, not blamed on the weight of the belly.
A large embolism strains the right heart chamber, and that then releases BNP. The value helps judge how far the heart is involved — it does not replace the imaging, but it places things.
Green vegetables need not be avoided — they should simply appear in similar amounts. Large swings upset the INR. With the newer blood thinners this does not matter.
On flights over four hours movement and fluid intake count; alcohol and low fluid slightly thicken the blood and one moves less.
After the acute phase the build-up is stepwise. With lasting breathlessness on exertion supervised rehabilitation programmes exist — some people need months.
AWMF 065-002 · S2k · 2023-09 — in force
Diagnostik und Therapie der Venenthrombose und der Lungenembolie
checked 2026-09