Quite often you would have heard or seen that one of your relatives or friends, who was admitted in hospital for any medical reason and was going on well, suddenly developed breathing problems and died.
At that time you would not have clearly understood why and how this mishap happened.
Sometimes you would have observed one of your acquaintances or family members had developed sudden pain and swelling in the leg and got treated with massage and application of cream for two to three days and then after he developed breathlessness and within a few hours he died.
It was beyond people’s imagination to comprehend why this unfortunate mishap happened when the problem was not that big in magnitude.
Many times you would have observed that a pregnant lady once developed breathlessness suddenly and she died. In a few cases, women died all of sudden within a few days of delivery. In our country, it has become customary for the people to label due to ignorance, the cause of sudden death as heart attack.
This is a well known fact that a person’s death is declared only after his heart beat has stopped. In other words, death means the stopping of the heart beat.
After all there must be a reason for the heart beat. As a matter of fact, in our country quite often in hospital or at home the cause of sudden death is a medical condition called a “Pulmonary Embolism”.
A pulmonary embolism means in a simple language choking of blood pipes of lungs. The reason for this choke is the accumulation of either large blood clots or other substances in the blood pipes of lungs.
Who are the majority victims of Pulmonary Embolism?
There are some conditions which cause sudden death due to pulmonary embolism. The risk of pulmonary embolism always looms large either after surgery or after injury. The women who are on contraceptive medicines or in menopausal stage or her monthly periods have stopped due to any reason or on hormone therapy are always at the risk of developing pulmonary embolism.
Pregnant ladies during their pregnancy period or within 3 to 4 weeks after delivery are always at risk of developing pulmonary embolism. Cancer patients who are especially on anticancer medication are always in the danger zone of pulmonary embolism.
If you are overweight and obese (fatty) and at the same time, you are not a regular walker, believe me you will eventually fall victim to an onslaught of pulmonary embolism. People who due to any reason are confined to bed for a long period either at home or in the ICU of any hospital, more often develop pulmonary embolism.
In a few patients, some elements which prevent rapid clotting of blood are found absent in blood since birth. These substances are Protein ‘C’, Protein ‘S’, and Antithrombin 3.
If these three substances are deficient in the blood of anybody, his blood will have a tendency to become thick and clot formation will occur early. If anybody is put under stressful conditions and or any body’s blood is deficient in a substance called ‘Factor V Leyden’ since birth, such persons after any surgery or injury, are likely to develop pulmonary embolism.
How does Pulmonary Embolism start?
If ever blood clots get accumulated in blood pipes of legs that carry impure Oxygen deficient blood due to injury or lack of regular habit of walking, this leads to a medical condition called deep vein thrombosis (D.V.T).
The presence of this condition in the leg predicts the future probability of pulmonary embolism. If these leg veins already choked with blood clots are not treated promptly & effectively, the accumulated blood clots will prove fatal, as these clots will slip upwards from legs to lung and choke the blood pipes of lung.
With the result, the impure blood going to the lung for purification will stop. This will lead to overloading of heart and exert stress on the heart which can be fatal.
Road traffic Accident is also responsible
In an accident, if a person has sustained physical injury or a bone fracture of long bone of leg or arm, he is always at risk of developing pulmonary embolism.
It has been observed that a person who got injured in a traffic accident and admitted in a hospital, remain stable for a few days, then suddenly a news comes about his death.
Reportedly he had breathlessness first to start with, then sudden death. In such conditions, generally, the blood clots are not the culprit but fat substance or particles are responsible for blockage of blood pipes of lung. This is called fat embolism in medical term.
Other Reasons of Pulmonary Embolism
These are substances other than blood clots & fat pieces which are responsible for blocking the blood pipes of the lung.
For example fragile & small pieces of tumour mass in a cancer patient reach the lung & choke the blood pipes.
This condition is called in medical terms “Tumour Embolism”. Cancer patients always must be aware of the danger of pulmonary embolism.
Narcotics & substances of abuse are also Responsible
Drug addicts & narcotic users are very susceptible to danger of pulmonary embolism.
These drug addicts keep on injecting themselves drugs & other substances of abuse into their own veins and these substances reach the blood pipes of lungs through veins & choke them.
With the results these addicts wittingly or unwittingly fall prey to pulmonary embolism. You would have observed that drug addicts are often found dead on road side pavements & majority of these deaths occur during night time suddenly & only to be discovered the next morning by police personnel.
Pulmonary Embolism In Newly born babies
Sometimes this pulmonary embolism becomes the reason for death of newly born babies. This is called, in the medical term “Amniotic fluid embolism” (AFE).
In a mother’s womb, the baby remains protected in a bag which is called an amniotic sac. This contains amniotic fluid like substance which provides food & protection to growing foctus (babies).
When to suspect Pulmonary Embolism
If your legs have developed sudden swelling or you have been feeling pain and stretching in your leg for the last two to three days and you suddenly develop breathing problems you must understand that the PE has started unfolding.
If you had a past history of an episode of Deep veins Thrombosis of leg and got treated then, and now if you develop breathlessness, the possibility of PE cannot be denied.
If you are suffering from cancer and you are undergoing chemotherapy or radiotherapy and one fine morning you develop sudden mild breathing difficulty, pulmonary embolism is strongly suspected.
If you are confined to bed for many days due to a chronic illness (e.g. Paralysis, stroke and bone fracture) and you develop all of a sudden breathing problem, possibility of developing PE must be thought of.
What to do
If you have developed sudden swelling in leg and at the sometime you have breathing difficulty, immediately you must consult an experienced Vascular Surgeon so that the incidence of total pulmonary embolism may be pre-empted, as prevention of pulmonary embolism is better than its cure.
Always go to a hospital without wasting time where there is an availability of a full time vascular surgeon and Department of a Cardio vascular surgery exist and there is a facility of special investigation like angiography, ventilation perfusion scan.
Remember a modern intensive care unit (I.C.U) is very much essential for effective treatment of pulmonary embolism.
The author is Senior Consultant Cardiothoracic & Vascular Surgeon Indraprasta Apollo Hospitals
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.