Pulmonary Embolism in Black Adults: Signs You Cannot Ignore

A pulmonary embolism, or PE, happens when a blood clot blocks an artery in the lungs. Most of these clots start as a deep vein thrombosis (DVT) in a leg, then break loose and travel up to the lungs. When the clot lodges there, it cuts off blood flow, strains the heart, and can kill within hours. The catch is that PE is often blamed on anxiety, asthma, or a pulled muscle, and that delay is deadly. This guide covers what to watch for, why Black adults face higher risk, and exactly when to call 911.

Venous thromboembolism (VTE) is the umbrella term for two linked conditions. The first is deep vein thrombosis, a clot in a deep vein, usually in the calf or thigh. The second is pulmonary embolism, which is what happens when part of that clot breaks off, rides the bloodstream through the heart, and gets stuck in the lung arteries. About half of people with a DVT will develop a PE if the clot is not caught and treated. That is why leg symptoms matter: swelling, warmth, redness, or a deep ache in one calf can be the first warning of a clot that has not yet reached the lungs. If you want the full picture on leg clots, read our guide to DVT and blood clots in Black adults.

Black Americans carry the heaviest burden of blood clots in the country. In the Atherosclerosis Risk in Communities study, the lifetime risk of a first VTE between ages 45 and 85 was 11.5% in Black participants compared with 6.9% in white participants, and the incidence rate ran about 65% higher in Black adults across the full follow-up (Folsom and colleagues, American Journal of Medicine, 2019). The mortality gap is even wider. A national analysis of 109,992 pulmonary embolism deaths found Black Americans died at an age-adjusted rate of 5.26 per 100,000, against 2.91 for white Americans (Zghouzi and colleagues, Annals of the American Thoracic Society, 2023).

Several forces drive the gap. A 2025 American Heart Association scientific statement reports Black patients are about 1.9 times more likely than white patients to be hospitalized for PE and carry a nearly 50% higher rate of all-cause death after one (15.0% versus 10.7%). The same statement found Black patients are less likely to receive clot-busting interventional treatments such as catheter-directed therapy and surgical clot removal (Circulation, 2025). One inherited factor matters here. Sickle cell trait, carried by roughly 1 in 13 Black Americans, roughly doubles the risk of pulmonary embolism. In a prospective study it accounted for about 7% of clots among Black participants (Folsom and colleagues, American Journal of Hematology, 2015). Higher rates of obesity, clotting-protein differences, and gaps in timely care fill in much of the rest.

Pulmonary embolism symptoms come on fast. The most common are sudden shortness of breath that does not ease with rest, and sharp chest pain that gets worse when you breathe in deeply, cough, or bend. Other signs that point to PE include:

• A rapid or pounding heartbeat
• Coughing, sometimes coughing up blood or pink, foamy mucus
• Lightheadedness, dizziness, or fainting
• Unexplained anxiety or a sense of doom paired with breathlessness
• Bluish or gray skin, lips, or nail beds, which on brown and Black skin may show first inside the lips, on the gums, or under the nails rather than as obvious blue

A clot in the leg may show up at the same time as swelling, warmth, or pain in one calf. You do not need every symptom. Sudden breathlessness plus chest pain is enough to act on (CDC, 2024).

Pulmonary embolism is one of the most commonly missed life-threatening diagnoses. A systematic review found that roughly a third of PE cases are not recognized at the first medical contact, often mistaken for a chest infection, heart failure, or a heart attack (Kwok and colleagues, Health Sciences Review, 2022). Breathlessness and a racing heart are also the classic signs of a panic attack, and clinicians who reach for anxiety as the explanation are less likely to test for a clot. One review documents PE being mistaken for panic attacks and other psychiatric emergencies, with patients sent to mental health units instead of getting a scan (Sapota-Zareba and Nasierowski, Advances in Psychiatry and Neurology, 2023). For Black patients, whose pain and symptoms are already under-treated across medicine, this matters. If you are short of breath and someone tells you it is just anxiety or asthma without examining you, ask directly: "Could this be a blood clot, and can we rule it out?"

Anything that slows blood flow, injures a vein, or makes blood clot more easily raises your risk. The main risk factors are:

• Recent surgery or a hospital stay, especially orthopedic surgery or any procedure that keeps you off your feet
• Immobility: bed rest, a cast, or long travel of four or more hours by car or plane
• Pregnancy and the first six weeks after delivery, when clot risk is sharply elevated
• Estrogen-based birth control or hormone therapy
• Cancer and some cancer treatments
• Sickle cell trait or sickle cell disease
• Obesity, smoking, and increasing age
• A previous clot or a family history of clots
• Inherited clotting disorders such as factor V Leiden

The postpartum window deserves a flag. A systematic review found that in the first six weeks after delivery, a woman's risk of venous clots rises 21.5-fold to 84-fold above the baseline for a nonpregnant woman (Jackson and colleagues, Obstetrics and Gynecology, 2011). For Black women, who already face the highest maternal mortality in the country, new shortness of breath or chest pain in the weeks after birth is never something to wait out (CDC, 2024).

In the emergency department, the team weighs your symptoms and risk factors first. If the suspicion is low to moderate, a D-dimer blood test can help. D-dimer measures a substance left behind when a clot breaks down. A normal result in a lower-risk patient can rule PE out without imaging, though the test is not specific, since surgery, pregnancy, and infection also raise it. When suspicion is higher or the D-dimer is elevated, the gold-standard test is a CT pulmonary angiography (CTPA), a fast CT scan with contrast dye that shows the clot directly in the lung arteries. Pregnant patients may get a different scan, a ventilation-perfusion (V/Q) scan, to limit radiation. An ultrasound of the legs and an echocardiogram of the heart often round out the picture.

The main treatment for PE is anticoagulation, blood thinners that stop the clot from growing and let the body break it down over time. Most stable patients are now treated with direct oral anticoagulants such as apixaban or rivaroxaban, which do not require routine blood-test monitoring. Heparin and warfarin are still used in certain situations, including some pregnancies and cancers. For a severe, life-threatening PE that drops blood pressure, doctors use thrombolytics, clot-busting drugs given through a vein or through a catheter threaded to the clot, and in some cases surgery to remove it. Treatment usually runs at least three months and sometimes indefinitely if the clot was unprovoked or you have an ongoing risk (Ortel and colleagues, American Society of Hematology 2020 guidelines, Blood Advances). The AHA statement is blunt that Black patients receive advanced clot-removal therapies less often, so it is fair to ask your care team what the full menu of options is.

You can cut your risk, especially around the high-danger windows. Move your legs and walk regularly on long flights or drives, and stand up and stretch every couple of hours. After surgery or during a hospital stay, follow the plan for early walking, compression devices, or preventive blood thinners, and ask about it if no one brings it up. Stay hydrated, keep a healthy weight, and stop smoking. If you use estrogen birth control and have other risk factors such as a prior clot or sickle cell trait, talk with your clinician about whether a non-estrogen method fits you better. Anyone with a personal or family history of clots should discuss prevention before surgery, pregnancy, or long travel (CDC, 2024).

If you are having emergency symptoms, call 911 now. For follow-up after a clot, or to manage your risk if you have sickle cell trait, a prior clot, or a family history, you want a clinician who listens and takes your symptoms seriously the first time. You can find a Black or Black-serving clinician in our directory. Bring your risk factors to that visit in writing: recent surgery, pregnancy or recent birth, hormone use, travel, family history, and any sickle cell status. The clearer your history, the harder a clot is to miss.