Pulmonary Embolism (PE) in Singapore

A pulmonary embolism, or PE, occurs when a blood clot blocks an artery in the lungs. It often starts as a deep vein thrombosis (DVT) in the leg or pelvis. A piece can break away, pass through the right side of the heart and lodge in the pulmonary circulation.

PE can interfere with oxygen transfer and strain the heart. Its severity varies, so assessment considers the person’s circulation, oxygen levels and overall condition. Dr Andrew Choong introduces the condition in his video article, What Is a Pulmonary Embolism?

When should you seek emergency help?

Possible symptoms include sudden or unexplained breathlessness, chest pain that may worsen with breathing, coughing blood, a rapid heartbeat, marked light-headedness or fainting. Some people also have a swollen or painful leg; others do not.

These symptoms can signal a medical emergency. Call 995 in Singapore for life-threatening symptoms such as severe breathlessness, chest pain with breathlessness, fainting or collapse. Do not wait for a routine clinic appointment or an online reply.

Other symptoms suggesting PE also need prompt emergency assessment. You cannot judge the severity safely from symptoms alone, and the absence of leg swelling does not rule it out.

How are DVT and PE connected?

DVT and PE are different presentations of venous thromboembolism. A deep-vein clot may remain in place, grow or release material that travels to the lungs. Read what a DVT is to understand the connection.

The DVT treatment guide explains how related leg-vein clots are managed, including medicines and selected procedures.

Risk can increase with surgery, immobility, active cancer, pregnancy or the period after childbirth, certain hormone medicines and a previous clot. Sometimes no clear cause is found. Knowing the circumstances helps guide decisions about preventing another event; it does not replace urgent investigation of new symptoms. The article on why blood clots form explains the main mechanisms.

How is pulmonary embolism diagnosed?

The emergency assessment combines symptoms, examination and the likelihood of a clot. Blood tests can help within a clinical pathway, but an abnormal D-dimer alone does not diagnose PE.

CT pulmonary angiography is commonly used to examine the lung arteries. A ventilation–perfusion scan may be an alternative in selected circumstances. The team may also assess the heart, oxygen levels and leg veins. Test selection takes account of factors such as pregnancy, kidney function and contrast allergy.

Does every PE need clot removal?

Anticoagulation is central to treatment

For many patients, treatment uses anticoagulant medicines. These reduce further clotting while the body gradually deals with the existing clot. They do not physically extract it. The medicine and care setting depend on the severity of PE, other illnesses and bleeding risk. Only an appropriately assessed patient should enter an outpatient treatment pathway.

Additional treatment is reserved for selected situations

When PE causes serious circulatory problems or a person deteriorates, an urgent specialist team may consider clot-dissolving medication, catheter-based treatment or surgical clot removal. The potential benefit must be weighed against risks, including major bleeding and procedure-related complications.

A catheter procedure is not automatically better than anticoagulation. Dr Choong’s article on modern clot-removal techniques discusses why selection matters and distinguishes treatment in leg veins from treatment in the lung arteries.

How long are blood thinners needed?

An initial treatment phase commonly lasts three to six months, followed by a decision about longer-term prevention. The plan considers whether a temporary trigger has resolved, previous clots, persistent risk factors and bleeding risk. Some people need extended treatment.

Do not stop medication because breathing has improved. Keep the agreed review appointments, discuss side effects and check before taking new medicines or supplements. Significant bleeding needs urgent advice; heavy bleeding or collapse requires emergency assistance.

What follow-up matters after PE?

Follow-up reviews medication safety, symptoms, activity and the likely cause of the clot. An early review after discharge and a further assessment by around three months help establish the next steps. Return to exercise, work and travel should follow individual advice.

Persistent breathlessness or reduced exercise tolerance deserves assessment, particularly beyond three months. There are several possible causes. One is chronic thromboembolic pulmonary disease, involving persistent obstruction in the lung vessels; some affected patients develop raised pressure in those vessels, called chronic thromboembolic pulmonary hypertension (CTEPH). Specialist investigation may be needed.

New or worsening breathlessness should be assessed sooner. Do not wait for a scheduled follow-up if symptoms suggest another emergency.

Planning non-emergency vascular follow-up in Singapore

After emergency assessment and treatment, contact Andrew Choong Vascular Surgery for a non-emergency discussion of DVT, clot risk or ongoing vascular care at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring discharge letters, scan reports and your medication list. You can read about Dr Andrew Choong. Acute PE symptoms need emergency care first.

Pulmonary embolism videos

Watch Dr Andrew Choong explain how a blood clot can reach the lungs. The DVT and pulmonary embolism video collection provides further background on blood clots, warning signs and treatment discussions.