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Pulmonary Embolism Symptoms in Women: Warning Signs

Pulmonary embolism in women: recognize symptoms early, understand causes, and act fast. Overview of typical and atypical warning signs.

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Things worth knowing about "Pulmonary Embolism Symptoms in Women"

Pulmonary embolism in women: recognize symptoms early, understand causes, and act fast. Overview of typical and atypical warning signs.

What Is a Pulmonary Embolism?

A pulmonary embolism occurs when a blood clot (thrombus) blocks one or more arteries in the lungs. The clot usually travels from the deep veins of the legs (deep vein thrombosis) through the bloodstream to the lungs. Without immediate treatment, a pulmonary embolism can be life-threatening. Women often present with different and less typical symptoms compared to men, which can make early diagnosis more challenging.

Typical Symptoms of Pulmonary Embolism in Women

Symptoms of a pulmonary embolism can vary greatly depending on the size and location of the clot. Women most commonly experience the following:

Sudden shortness of breath: Difficulty breathing that appears without an obvious cause is one of the most common signs of a pulmonary embolism.
Chest pain: Often described as sharp or pressure-like, chest pain may worsen when breathing deeply (called pleuritic chest pain).
Rapid heart rate (tachycardia): The heart beats faster as it tries to compensate for the lack of oxygen.
Coughing: Sometimes accompanied by blood-tinged sputum (haemoptysis), though a dry, persistent cough is also possible.
Dizziness and fainting: Loss of consciousness or feeling as though one might faint can indicate a severe embolism.
Blue lips or fingernails (cyanosis): A sign of severe oxygen deficiency in the blood.

Atypical and Female-Specific Symptoms

Research indicates that women more frequently report atypical symptoms compared to men, which can lead to delayed diagnosis. Less classic symptoms include:

General weakness and fatigue: Extreme tiredness without an explainable cause.
Nausea and vomiting: Gastrointestinal complaints that can be easily mistaken for other conditions.
Anxiety and restlessness: An intense sense of fear or a feeling that something is seriously wrong.
Upper abdominal or back pain: These may be incorrectly attributed to digestive problems.
Swelling and pain in one leg: Indicating a preceding deep vein thrombosis from which the clot originated.

Causes and Risk Factors in Women

Women face a heightened risk of pulmonary embolism due to specific biological and hormonal factors. Key risk factors include:

Hormonal contraceptives: Taking the contraceptive pill or other oestrogen-containing contraceptives significantly increases the risk of thrombosis.
Pregnancy and the postpartum period: Blood clotting is naturally increased during pregnancy and the weeks following childbirth, raising the risk of embolism.
Hormone replacement therapy: Taking oestrogens during menopause can increase risk.
Immobility: Prolonged sitting, such as on long-haul flights, or bed rest after surgery.
Obesity: Increases pressure on leg veins and promotes clot formation.
Genetic clotting disorders: Hereditary conditions such as Factor V Leiden mutation or prothrombin mutation.
Cancer or chemotherapy: Certain cancers and their treatments increase thrombosis risk.

Diagnosis

When a pulmonary embolism is suspected, several investigations are carried out in the emergency department:

D-dimer blood test: Checks for breakdown products of blood clots. An elevated level may indicate an embolism.
CT pulmonary angiography (CTPA): A CT scan with contrast dye is the gold standard for diagnosing pulmonary embolism.
Echocardiography: An ultrasound of the heart to assess cardiac function.
ECG (electrocardiogram): Shows changes in heart activity caused by increased strain.
Arterial blood gas analysis: Measures oxygen levels in the blood.

Treatment

Treatment for a pulmonary embolism must begin immediately. Depending on severity, the following approaches may be used:

Anticoagulants (blood thinners): Medications such as heparin, rivaroxaban, or apixaban prevent further clot formation and are administered immediately.
Thrombolysis (clot-busting therapy): In life-threatening cases, drugs such as alteplase are used to dissolve the clot.
Catheter-based therapy: Mechanical removal of the clot using a catheter inserted into the blood vessel.
Surgery (embolectomy): In rare, very severe cases, surgical removal of the clot may be necessary.
Oxygen therapy: To treat oxygen deficiency.

When to Call Emergency Services Immediately

Call emergency services immediately if you experience any of the following:

Sudden, severe difficulty breathing
Intense chest pain
Loss of consciousness or sudden collapse
Blue colouration of lips or fingernails

A pulmonary embolism is a life-threatening emergency. Rapid action can save lives.

References

Konstantinides SV et al. - 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. European Heart Journal. 2020;41(4):543-603.
World Health Organization (WHO) - Cardiovascular diseases: Thromboembolism. Available at: https://www.who.int
National Heart, Lung, and Blood Institute (NHLBI) - Pulmonary Embolism: Diagnosis, Treatment and Prevention. Bethesda, 2023.

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