A pulmonary embolism (PE) happens when a blood clot disrupts blood flow. in your lungs. While its exact prevalence is unknown, studies estimate that PE impacts 39 to 115 per 100,000 people each year.

Pulmonary embolisms are categorized based on risk. A submassive PE is at an intermediate risk level.

It’s difficult to define exactly what a submassive PE is because doctors must consider many factors when assessing risk. Groups like the American Heart Association, American College of Chest Physicians, and European Society of Cardiology all have different definitions and guidelines.

We will detail what causes submassive PEs, how doctors diagnose and treat them, and how they are treated.

“A submassive PE is an intermediate risk type of PE. Let’s explore what that means.”

Hemodynamic stability

A submassive PE is hemodynamically stable. This means that a person’s The heart rate is related to the amount of blood in the body. and blood pressure remain steady.

“Hemodynamic instability is the main cause of more severe PEs. A person’s heartbeat can be irregular and their blood pressure can go down.”

Right ventricular dysfunction

Another feature of submassive PE is right ventricular dysfunction (RVD). The right ventricle is the chamber of the heart that sends blood with low. oxygen into the lungs to receive fresh oxygen.

While the right ventricle can accommodate large amounts of blood, it’s not built to deal with high levels of pressure. When a PE disrupts blood flow. in the lungs, it can lead to an increase in pressure.

When this happens, the right ventricle has to work harder to pump blood into the lungs. This can lead to the right ventricle not functioning as it should, causing serious problems for the heart and its ability to pump blood.

High troponins

Elevated troponin levels are another potential finding in submassive PE. Troponins are proteins that are released when damage to the heart has occurred.

Comparison chart

The table compares the characteristics of PE.

Low risk (mild) Intermediate risk (submassive) High risk (massive)
Hemodynamic instability No No Yes
Right ventricular dysfunction No Maybe* N/A
Elevated troponins No Maybe* N/A

*According to the American Heart Association’s definition, in addition to being hemodynamically stable, a submassive PE has either RVD or high troponin levels. It’s also possible for both of these findings to be present.

A PE happens when a blood clot disrupts blood flow. in your lungs. Clots typically form in response to an injury, although other risk factors play an important role.

Most PEs develop from a blood clot that forms in the deep veins, typically in the leg. In some cases, part of this clot can break off and travel to the lungs, where it ends up blocking an artery.

The symptoms of a sub massive PE can be found.

Seek emergency care

All PEs are medical emergencies that require prompt treatment. Call emergency services or go to the emergency room if you have unexplained The breath was very thin. or sudden chest pain.

In addition to getting your medical history and doing a physical examination, your doctor can use the follow.ing tests to help make a diagnosis of submassive PE:

  • Chest X-ray. Your doctor may initially take a chest X-ray to look at your heart and lungs to see if there are any obvious explanations for your symptoms. However, with PE, most chest X-rays appear typical.
  • Electrocardiogram (EKG). An EKG measures the electrical activity in your heart. Certain EKG changes can show how much strain a PE is putting on your heart. It can also help your doctor rule out other conditions that can cause chest pain.
  • D-dimer test. The D-dimer test looks for a protein that’s made when a blood clot dissolves in your body. High levels can indicate a problem with blood clots.
  • Troponin test. The troponin test looks for increased troponin levels in a sample of blood.
  • Arterial blood gas (ABG). The ABG test uses a blood sample from an artery. It measures oxygen and carbon dioxide levels in the blood to give your doctor an idea of how well your lungs are working.
  • CT angiography. CT angiography uses a special dye and CT scan technology to generate pictures of the blood vessels in your chest. This can help your doctor see if a blood clot is present.
  • Ventilation-perfusion (VQ) scan. A VQ scan uses radioactive material to assess both the airflow. and blood flow. in your lungs.
  • Echocardiogram. An echocardiogram uses ultrasound technology to visualize the chambers of your heart. Your doctor can use it to check for signs of RVD.

There are different treatment options for PE. Depending on the severity of your PE, you can receive a variety of treatments.

PE severity is usually estimated using the Pulmonary Embolism Severity Index (PESI). This is a points-based system in which a higher score suggests a higher PE severity and less favorable outlook. It takes the follow.ing factors into account:

“Let’s look at treatment options for PE.”


One of the main treatments for submassive PE is anticoagulant therapy. Anticoagulant drugs are also called blood thinners.

These drugs interfere with proteins that are important for clotting. Heparin is an example of an anticoagulant drug that doctors may use to treat submassive PE.

Systemic thrombolytic therapy

Another potential treatment option is systemic thrombolytic therapy. Thrombolytic drugs work to dissolve clots quickly. However, their use with submassive PE is controversial, according to a 2019 consensus paper.

A 2014 study investigated systemic thrombolytic therapy in submassive PE. Overall, it found that while systemic thrombolytic therapy helped keep participants’ conditions from worsening, it also increased the risk of serious bleeding and stroke.

A doctor must carefully consider the risks and benefits of systemic thrombolytic therapy for submassive PE.

People with sub-massive PE who are at low. risk of bleeding and have their condition worsening may be candidates for low. dose thrombolytic therapy.

Catheter-directed thrombolysis

A catheter is a tube that is inserted into the body. Doctors use a catheter to deliver drugs to the location of the PE.


An emboloectomy is the removal of a blood clot. Doctors can use a catheter or perform a surgical procedure.

Submassive PE treatment in children

“The treatment of children may be different from that of adults. There aren’t detailed guidelines to assess risk and treatment options because PE is rare in children.”

A 2020 study of 24 children with submassive PE found that more children were treated with systemic thrombolytics than anticoagulation. This is different from adult submassive PE, in which anticoagulation is typically the main treatment.

Submassive PE can lead to a variety of problems.

  • Repeat events. If you’ve had a PE, you may be at risk of another serious blood clot event. In fact, 1 in 3 people with PE or deep vein thrombosis (DVT) has a repeat event within the next 10 years.
  • Post-PE syndrome. Post-PE syndrome refers to persistent symptoms like The breath was very thin., difficulty exercising, and reduced quality of life after PE.
  • Pulmonary hypertension. Your pulmonary arteries lead from your heart to your lungs. Pulmonary hypertension is when the blood pressure in your pulmonary arteries is too high. It can lead to heart failure.
  • Chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a specific type of pulmonary hypertension. It happens when the blood pressure in your pulmonary arteries is too high due to the presence of blood clots.

As you recover from a submassive PE, your doctor will want to regularly monitor your condition. This can help prevent a repeat event and detect and address other complications, like pulmonary hypertension.

The overall mortality rate for PE can be up to 30 percent if it’s left untreated. However, with timely medical treatment, the mortality rate drops to 8 percent. The exact mortality rate for submassive PE is still unclear.

A 2016 study divided people with PE into four risk categories:

  • high
  • It is intermediate-high.
  • The low..
  • low.

The researchers found that the mortality rate for It is intermediate-high. and The low.. PE was 7.7 and 6.0 percent, respectively.

RVD and troponin levels can be used to forecast sub-massive PE. RVD, high troponin levels, and both point toward a less favorable outlook.

Studies have also looked into the rate of complications after a submassive PE. For example, a 2017 study looked at the long-term outlook in people with submassive PE treated with systemic thrombolytic therapy.

The researchers found that 36 percent of the participants had persistent symptoms like The breath was very thin.. CTEPH was also seen, but only in 2.1 percent of participants.

There are a number of things that can increase your risk of PE. These include:

It is not a guarantee that you will experience one in the future if you have risk factors for sub massive PE. It just means that you are more at risk than people without any risk factors.

There are things you can do to help low.er your risk of experiencing a PE:

  • Move around. Try to avoid being immobile for long periods of time. For example:
    • Be as active as is appropriate follow.ing a period of bed rest, such as after an injury, surgery, or illness.
    • When you are on a long trip, stop and walk around every couple of hours.
    • If you’re sitting for a long period of time and cannot get up, exercise your legs by tightening and relaxing your leg muscles or raising and low.ering your heels off the floor.
  • Make health-promoting lifestyle choices. Aiming to live a balanced lifestyle can reduce your risk of blood clots and other health conditions. Try to:
    • A balanced diet is important.
    • Exercise frequently.
    • When possible, reduce your stress levels.
    • Get enough sleep.
    • If you smoke, quit.
  • Manage other health conditions. If you have health conditions, such as “It’s obese.” or heart disease, that increase your risk of blood clots, make sure you’re taking steps to manage them.
  • Ask a doctor about preventive measures. If you’re at a higher risk of blood clots, talk with a doctor about preventive options like compression stockings or blood-thinning medications.

A submassive PE is an intermediate risk PE. People with this type of PE have stable blood pressure and The heart rate is related to the amount of blood in the body. but have RVD, high troponin levels, or both.

Any type of PE is a medical emergency, and outlook greatly improves with timely treatment. Seek care immediately if you have unexplained The breath was very thin. or chest pain that comes on suddenly.