A pulmonary embolism (PE) is a sudden, life-threatening blockage in one of the pulmonary arteries, typically caused by a blood clot (embolus) that travels from a deep vein, often in the legs (deep vein thrombosis or DVT). When the embolus lodges in the lung, it impairs oxygen absorption and places strain on the heart. Because PE requires immediate diagnosis and complex, rapid decision-making, its management involves a coordinated team of medical professionals from various specialties.
Emergency and Acute Care Specialists
The initial point of contact for a suspected pulmonary embolism is the Emergency Medicine Physician, who handles immediate triage and stabilization. They quickly assess the patient’s hemodynamic stability, checking blood pressure and oxygen levels. This phase involves ordering rapid diagnostic tests, such as a D-dimer blood test and computed tomography pulmonary angiography (CTPA), the primary imaging test used to visualize the clot.
If the patient is unstable or requires intensive monitoring, they are transferred to Critical Care or Intensive Care Unit (ICU) Physicians. These specialists manage life support, including mechanical ventilation or vasopressors to maintain blood pressure. Hospitalists coordinate the initial treatment plan for admitted patients not in the ICU. They initiate anticoagulation and consult with other specialists based on the patient’s risk profile.
Primary Medical Management of Pulmonary Embolism
The primary treatment for most PE patients is the immediate initiation of anticoagulation therapy (blood thinners), which prevents the existing clot from growing and stops new clots from forming. Long-term medical management is co-led by specialists focusing on the lungs and the heart.
Pulmonologists oversee how the clot impacts gas exchange and overall lung function. They focus on the long-term risk of the clot leading to pulmonary hypertension (high blood pressure in the lung arteries). Their expertise ensures optimal oxygenation strategies and follow-up care for respiratory symptoms.
Cardiologists focus on the right ventricle of the heart, which strains against the resistance caused by the clot. Right ventricle strain predicts poor outcomes, so cardiologists use echocardiograms to monitor heart function and guide treatment intensity. These specialists are often part of a Pulmonary Embolism Response Team (PERT) to ensure fast, consensus-driven treatment decisions.
Interventional and Surgical Treatment Teams
If a patient’s PE is high-risk (hemodynamically unstable or extensive clot burden), standard anticoagulation may be insufficient, necessitating physical removal or dissolution of the clot. Interventional and surgical teams then become involved, performing procedures in the catheterization lab or operating room.
Minimally Invasive Procedures
Interventional Cardiologists and Interventional Radiologists perform minimally invasive, catheter-directed treatments. They can thread a thin tube to the clot to deliver high-dose, clot-dissolving medication (thrombolytics), known as catheter-directed thrombolysis. Alternatively, they may use specialized devices to physically break up and aspirate the clot (percutaneous embolectomy), or place an inferior vena cava (IVC) filter to catch future clots.
Surgical Intervention
For the highest-risk cases, such as massive PE where the patient is in shock and cannot receive thrombolytics due to bleeding risk, Cardiothoracic Surgeons or Vascular Surgeons may be called upon. These surgeons perform a surgical pulmonary embolectomy, an open-heart procedure to manually remove the large clot from the main pulmonary artery. This procedure is reserved for patients failing other therapies, as it carries significant risks but offers the fastest path to clot removal.
Long-Term Monitoring and Prevention
Once the immediate threat is resolved, the focus shifts to preventing recurrence and managing long-term complications.
Hematologists, who specialize in blood disorders, identify any underlying hereditary or acquired clotting disorders (thrombophilias) that may have predisposed the patient to the PE. They manage complex anticoagulation regimens, especially for patients requiring indefinite blood thinner use, ensuring the medication is effective while minimizing bleeding risk.
Primary Care Physicians (PCPs) anchor the long-term follow-up care, coordinating the transition from specialty treatment back to routine health management. The PCP monitors the patient for side effects from long-term anticoagulation and encourages adherence to preventative measures. They also screen for chronic complications, particularly Post-PE Syndrome, which includes chronic thromboembolic pulmonary hypertension (CTEPH), a severe condition requiring lifelong specialized care.