What does a pulmonary embolism feel like? 

A pulmonary embolism (PE) most commonly feels like a sudden, unexplained onset of shortness of breath accompanied by a sharp, stabbing chest pain that intensifies when you take a deep breath. Because the symptoms vary based on the size of the blood clot and its location in the lung, the sensation can range from a mild ‘stitch’ in the side to a crushing feeling of suffocation or an overwhelming sense of impending doom. 

What We’ll Discuss in This Article 

• The primary sensations of pleuritic chest pain and sudden breathlessness 

• How the size of a clot dictates the intensity of physical symptoms 

• Atypical sensations: Back pain, rib cramps, and localized shoulder aches 

• Distinguishing PE pain from a heart attack, anxiety, or pneumonia 

• Biological reasons for the ‘air hunger’ and racing heart rate 

• Silent pulmonary embolisms: When the sensation is minimal or absent 

• Emergency red flags that indicate a massive embolic event 

The Core Sensation: Pleuritic Pain and Air Hunger 

The hallmark sensation of a pulmonary embolism is pleuritic chest pain. Unlike the dull, heavy pressure often associated with a heart attack, pleuritic pain is typically described as sharp or ‘knife-like’. It is directly tied to the mechanics of breathing; you may feel a sudden jolt of pain every time you inhale, cough, or sneeze. This happens because the clot causes a lack of blood flow to a segment of the lung, irritating the sensitive lining (the pleura) that rubs against the chest wall. 

Alongside this pain is the sensation of ‘air hunger’ or sudden dyspnoea. This is not the gradual breathlessness you might feel after a long walk, but a sudden feeling that you cannot get enough oxygen despite gasping for air. Your body’s internal sensors detect the drop in oxygen and the backup of carbon dioxide, triggering an urgent, reflexive need to breathe faster (tachypnoea). This can lead to a racing heart rate (tachycardia) as your heart tries to compensate for the reduced efficiency of your lungs. 

• Sudden Onset: The feeling of being ‘winded’ happens instantly, often while at rest. 

• Sharp Intensity: The pain is localized and becomes agonizing during deep inspiration. 

• Racing Pulse: You may feel your heart thumping hard against your ribs (palpitations). 

• Coughing: You might develop a dry, hacking cough or notice blood-streaked phlegm. 

How Clot Size Changes the Sensation 

The physical experience of a PE is highly dependent on the ‘clot burden’ the total amount of blood vessel area blocked. Well-rounded clinical data shows that different sizes of clots create vastly different sensory profiles. 

Clot Category	Common Sensation	Physiological Impact
Small (Peripheral)	A sharp ‘stitch’ in the side or ribcage.	Localized inflammation with minimal breathing impact.
Medium (Segmental)	Significant breathlessness and persistent sharp pain.	V/Q mismatch where lung areas receive air but no blood.
Large (Saddle)	Crushing chest pressure, fainting, and severe suffocation.	Sudden blockage of the main pulmonary artery; life-threatening.

A ‘saddle embolus’ is a large clot that straddles the fork where the main pulmonary artery splits into the left and right lungs. This sensation is often less about ‘stabbing’ pain and more about a sudden, catastrophic failure of circulation. Patients may feel intense lightheadedness, a cold sweat, and a total loss of strength as their blood pressure plummets. In these cases, the feeling of ‘fainting’ is actually a sign of the heart struggling to push blood past the massive obstruction. 

Atypical and ‘Silent’ Sensations 

Mainstream data often focuses on chest pain, but amazing clinical data from the PIOPED II study suggests that many patients experience atypical sensations. For some, the only sign of a PE is a deep, persistent ache in the upper back or shoulder blade, which is often misdiagnosed as a muscle pull. Others describe a ‘burning’ feeling in the chest that mimics acid reflux or a ‘cramp’ in the lower ribcage that only appears during physical exertion. 

Interestingly, nearly 10% of pulmonary embolisms are ‘silent’ or asymptomatic. These are often incidental findings on CT scans performed for other reasons. In these cases, the body’s natural fibrinolytic system may be breaking down small clots as they arrive, or the clots are small enough that the lung’s dual blood supply prevents tissue damage and pain. However, even a ‘silent’ PE can cause long-term fatigue and a gradual loss of stamina. 

Differentiation: PE vs. Heart Attack vs. Anxiety 

Because the heart and lungs are so closely linked, it can be difficult to tell where the pain is originating. Distinguishing the sensations is vital for seeking the correct emergency care. 

1. PE vs. Heart Attack: PE pain is usually sharp and worsens with breathing. Heart attack pain (angina) is typically a heavy, crushing pressure that may radiate to the jaw, neck, or left arm and does not change when you take a breath. 

2. PE vs. Anxiety/Panic: An anxiety attack causes a racing heart and breathlessness, but the chest pain is often described as a ‘tight band’ around the chest rather than a sharp, localized stab. Anxiety also tends to improve with slow, deliberate breathing, whereas PE pain remains constant or worsens. 

3. PE vs. Pleurisy/Pneumonia: Pleurisy feels almost identical to a PE (sharp pain when breathing). However, pneumonia is usually accompanied by a high fever, a productive cough with thick mucus, and a slower onset of symptoms. 

My final conclusion 

A pulmonary embolism is a varied and complex sensation that primarily manifests as sudden breathlessness and sharp, pleuritic chest pain. Whether it feels like a minor rib cramp or a catastrophic loss of air, the sensation is a warning that the critical exchange of oxygen in your lungs has been compromised. Recognising that ‘off-and-on’ symptoms or atypical back pain can still be a blood clot is essential for early diagnosis and life-saving treatment. 

If you experience severe, sudden, or worsening symptoms, call 999 immediately. This is an absolute priority if you feel sudden chest pain, gasping for breath, or if you feel like you are going to pass out. 

Authority Snapshot 

This article provides an in-depth analysis of the sensory experience of pulmonary embolism, incorporating both typical and atypical presentations. The content is reviewed by Dr. Rebecca Fernandez to ensure it provides accurate, non-alarmist information that helps the public recognise the urgent signs of a lung blood clot.Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.