What Is a Saddle Pulmonary Embolism and How Is It Treated?

Written by Medicover Team and Medically Reviewed by Dr Alla Bhagyaraj , Pulmonologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Saddle pulmonary embolism (saddle PE) is a life-threatening form of pulmonary embolism in which a large blood clot becomes lodged at the bifurcation of the main pulmonary artery, blocking blood flow to both lungs. Most saddle pulmonary emboli originate from a deep vein thrombosis (DVT) in the legs that travels through the bloodstream to the lungs.

Although some people remain relatively stable, saddle pulmonary embolism can rapidly cause severe breathing problems, heart strain, shock, and sudden death. Immediate diagnosis and emergency treatment are essential to improve survival.

What Are the Types of Saddle Pulmonary Embolism?

Saddle pulmonary embolism is generally classified according to its severity and its effect on heart function rather than distinct anatomical subtypes.

Stable Saddle Pulmonary Embolism: Blood pressure remains normal despite the presence of a large clot.
Submassive Saddle Pulmonary Embolism: Right ventricular strain or heart dysfunction is present without persistent low blood pressure.
Massive Saddle Pulmonary Embolism: Causes severe obstruction leading to shock, sustained hypotension, cardiac arrest, or circulatory collapse.

What Are the Symptoms of Saddle Pulmonary Embolism?

Symptoms usually develop suddenly and require immediate emergency medical evaluation.

Sudden shortness of breath
Sharp chest pain, especially during deep breathing
Rapid breathing (tachypnea)
Rapid heartbeat (tachycardia)
Coughing up blood (hemoptysis)
Dizziness or lightheadedness
Fainting (syncope)
Low oxygen levels
Bluish discoloration of the lips or skin (cyanosis)
Sudden collapse or cardiac arrest in severe cases

What Causes Saddle Pulmonary Embolism?

Saddle pulmonary embolism occurs when a blood clot blocks the main pulmonary artery. The clot usually originates in the deep veins of the legs or pelvis.

Deep vein thrombosis (DVT)
Prolonged immobility or bed rest
Recent major surgery, especially orthopedic procedures
Major trauma or fractures
Cancer and certain cancer treatments
Inherited blood clotting disorders
Pregnancy and the postpartum period
Hormone replacement therapy or oral contraceptives

When to See a Doctor for Saddle Pulmonary Embolism?

Saddle pulmonary embolism is a medical emergency. Seek immediate medical attention from an Emergency Medicine Specialist or Pulmonologist if you develop sudden shortness of breath, severe chest pain, coughing up blood, fainting, or an unexplained rapid heartbeat, especially if you have risk factors such as recent surgery, prolonged immobility, or a history of deep vein thrombosis.

Go to the emergency department immediately if you experience:

Sudden severe shortness of breath
Chest pain that worsens with breathing
Fainting or collapse
Coughing up blood
Bluish lips or skin

Prompt emergency treatment can be lifesaving and significantly reduce the risk of permanent complications or death.

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How Is Saddle Pulmonary Embolism Diagnosed?

Rapid diagnosis combines clinical assessment with imaging and laboratory investigations.

Medical history and physical examination
CT pulmonary angiography (preferred imaging test)
D-dimer blood test
Echocardiography to assess right heart strain
Electrocardiogram (ECG)
Chest X-ray
Ventilation-perfusion (V/Q) scan when CT is unsuitable
Ultrasound of the legs to detect deep vein thrombosis
Arterial blood gas analysis

How Is Saddle Pulmonary Embolism Treated?

Saddle pulmonary embolism requires immediate hospital treatment to restore blood flow, stabilize circulation, and prevent further clot formation.

Emergency Medical Treatment

Oxygen therapy
Intravenous fluids when appropriate
Blood pressure support for unstable patients
Continuous cardiac and respiratory monitoring

Anticoagulation Therapy

Heparin or low-molecular-weight heparin
Direct oral anticoagulants (DOACs)
Warfarin for selected patients requiring long-term anticoagulation

Advanced Treatment

Thrombolytic (clot-busting) therapy for high-risk patients
Catheter-directed thrombectomy or thrombolysis
Surgical pulmonary embolectomy in selected severe cases
Inferior vena cava (IVC) filter when anticoagulation cannot be used

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What Are the Risk Factors for Saddle Pulmonary Embolism?

Several conditions increase the likelihood of developing blood clots that can lead to saddle pulmonary embolism.

Previous deep vein thrombosis or pulmonary embolism
Recent surgery or hospitalization
Prolonged immobility or long-distance travel
Cancer
Obesity
Pregnancy and postpartum period
Smoking
Inherited clotting disorders
Hormonal medications containing estrogen
Increasing age

What Are the Complications of Saddle Pulmonary Embolism?

Without prompt treatment, saddle pulmonary embolism can lead to life-threatening complications.

Sudden cardiac arrest
Shock
Respiratory failure
Right-sided heart failure
Chronic thromboembolic pulmonary hypertension (CTEPH)
Permanent lung damage
Recurrent pulmonary embolism
Death

Can Saddle Pulmonary Embolism Be Prevented?

Many cases can be prevented by reducing the risk of blood clot formation. Preventive measures include early mobilization after surgery, maintaining regular physical activity, staying hydrated, wearing compression stockings when recommended, taking prescribed anticoagulants if at high risk, and managing underlying conditions such as obesity or cancer.

Living With Saddle Pulmonary Embolism

Recovery requires regular follow-up with your healthcare provider, taking anticoagulant medications exactly as prescribed, attending scheduled blood tests when needed, staying physically active within medical advice, and recognizing warning signs of recurrent blood clots. Most patients can return to normal activities with appropriate treatment and long-term monitoring, although some may require lifelong anticoagulation depending on the underlying cause.

Frequently Asked Questions

1. What early signs should I look for with Saddle Pulmonary Embolism?

Look for sudden shortness of breath, chest pain, rapid heart rate, and coughing up blood. Immediate medical attention is crucial.

2. What are the recommended do's and don'ts for managing Saddle Pulmonary Embolism?

Do: Get immediate medical help. Don't delay seeking treatment or ignore symptoms to prevent serious complications of Saddle Pulmonary Embolism.

3. How can Saddle Pulmonary Embolism affect the body in the long term?

Saddle Pulmonary Embolism can lead to chronic pulmonary hypertension and heart strain if not treated promptly, affecting long-term heart and lung function.

4. What are the best ways to manage Saddle Pulmonary Embolism?

Treatment involves blood thinners, oxygen therapy, and possibly clot-dissolving medications or surgery. Close monitoring is essential for a good outcome, ensuring effective treatment and managing potential complications.