The Clot Thickens

It was easy to sympathise with doctors treating Vivek Oberoi when dad Suresh turned on the tearworks. But though the doctors denied that Viv...

It was easy to sympathise with doctors treating Vivek Oberoi when dad Suresh turned on the tearworks. But though the doctors denied that Vivek was in any danger, they underplayed the fact that he had developed pulmonary embolism, the same condition that affects up to 5 out of 10,000 Americans annually and kills 30 per cent of patients when undiagnosed. With treatment, the mortality rate drops to 3 per cent.

When the condition originates due to blood clots in the lower half of the body as in Vivek8217;s case, it is known as deep vein thrombosis, or Economy Class Syndrome.

What is pulmonary embolism?
It is the condition caused by a pulmonary embolus, the medical name for the blockage of a lung artery through fat, air, tumour tissue or blood clots, thus affecting blood flow. When pulmonary embolism is severe, it causes the lungs to collapse; heart failure and death follow.

8216;8216;In most cases, the blood clots originate in the lower extremities due to prolonged periods of inactivity,8217;8217; explains Dr Nishith Chandra, senior cardiologist at Escorts Heart Institute, New Delhi. That8217;s why deep vein thrombosis is called the Economy Class Syndrome, since the cramped seats and insufficient leg room are perfect for triggering PE.

Who are at risk?
Anyone who is inactive for a long period of time due to injury or while travelling. The risk multiplies in people over 40 with a personal/ family history of blood clots. Besides, the following groups are vulnerable:

Those who have had treatment for cancer, certain blood diseases, heart and circulation problems.

Those who have just had surgery, especially for the hips or knees. And those who have fractured hips or the femur, which releases bone marrow into the circulation system.
People with an inherent tendency towards blood-clotting.
Women who are pregnant, have just had a baby, are on contraceptives or on the hormone replacement therapy.

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And the symptoms?
Blood-streaked sputum
Shortness of breath, so much so the person has to bend over or hold his chest to breathe
Lightheadedness or dizziness
Rapid heartbeat and low BP
Sharp chest pain under the breastbone or on one side. The pain may worsen at night or radiate to the shoulder, arm, neck, jaw. It may worsen also on breathing deeply, coughing, eating, bending, stooping, sweating or with anxiety.
l Skin discolouration,
weak pulse
Pelvic and leg pain; swelling in the legs; lump near a vein close to the skin surface

What are the preventive measures?
If you8217;re in the risk group, try to resume walking as soon as possible after surgery. Leg exercises and elastic support stockings also help. If long bedrest is inevitable, subcutaneous heparin therapy low doses of heparin injected under the skin, an anticoagulant, may be prescribed.

How is pulmonary embolism treated?
8216;8216;When a patient in the risk group suffers from breathlessness, he needs to be hospitalised immediately and subjected to chest X-rays and lung scans to detect the location and extent of embolism,8217;8217; says Dr Chandra. Definitive treatment consists of dissolving the clot by thrombolytic therapy. The patient also needs to be put on ventilator.