Pulmonary embolism: Death in minutes

Are you one of those people whose jobs require you to spend hours sitting? Or are you fond of spending the weekend lying on the couch watching television?

If you answered Yes to one or both of these questions, then you are at risk of developing pulmonary embolism, a serious condition that can cause death in minutes.

Doctors say it is common and can be caused by every day habits we assume are harmless, such as sitting at your desk for a long period without stretching or standing.

VICTIMS

Pulmonary embolism affects thousands of Kenyans each year and quite a number die, especially if they fail to receive prompt medical help.

Boniface Shitambasi and Gathiri Kihuria survived to tell their stories. They hope that their experiences will shed light on this condition which can, in some cases, be prevented by living an active life and spotting the symptoms fast enough.

When Boniface Shitambasi, a 54-year-old laboratory technologist at the Aga Khan University Hospital in Nairobi, took his annual leave in June this year, he had no doubt about how he would spend it.

The soccer fraternity’s most prestigious tournament was going on. The World Cup. Being an ardent football fan, he planned to watch every game in the comfort of his rural home in Kakamega.

“My job requires me to stand for long, so I looked forward to relaxing and taking it easy during my leave,” he says.

While he spent other breaks visiting old friends and neighbours and making trips to Kakamega town, this time round, he decided to stay indoors throughout.

“I wanted complete rest during my leave. For three weeks, I remained glued to my television, not wanting to miss any of the soccer action. I rested very well,” he confesses.

OUT OF BREATH

At the end of his leave, Shitambasi began his journey back to Nairobi. Even though it is a journey he had made hundreds of times before with no notable incident, this time round, something strange happened when he arrived in Nairobi.

“Immediately I alighted from the bus, I had barely taken three steps when I ran out of breath,” he remembers.

After pausing for a few minutes, he resumed walking, but had to stop again due to laboured breathing. This time round, it was accompanied by a dizzy feeling and sweating.

“I had to sit down for about 10 minutes before I could walk again.”

He had to take several more breaks before he finally got to the matatu terminus, where he boarded a vehicle to his home in Umoja Estate.

When he alighted, the walk home was agonising.

“A journey that normally takes me just 10 minutes took me one hour. By the time I got home, exhausted and out of breath, I knew I had to go to hospital. I drank some water, showered, then took a taxi to hospital.”

MALIGN BLOODCLOT
At the hospital, after explaining his symptoms, Shitambasi was immediately put on oxygen before undergoing various tests.

“The tests showed that I had a large blood clot that had travelled to my lungs. When I heard this, I was surprised that I was still alive because I know how dangerous blood clots can be.”

Still struggling to breathe, Shitambasi was taken to the intensive care unit (ICU) where he stayed for four days. Had he not sought medical help when he did, he most likely would not have lived to tell his story.

According to Dr Mzee Ngunga, an interventional cardiologist at Aga Khan University Hospital, Shitambasi happens to be one of the few cases that survived such a life-threatening episode.

“Blood clots to the lungs are dangerous, and the size of Shitambasi’s clot was enough to be fatal. He may have been saved by his decision to seek immediate medical attention and in a facility that was able to offer him the appropriate intervention,” he explains.

CAUSES
Pulmonary embolism is caused by a sudden blockage of a major blood vessel — the artery.

The blockage is usually caused by a large blood clot, which in most cases emanates from the deep veins in the leg, commonly known as deep vein thrombosis (DVT).

When the clot travels to the lungs, it blocks the lung artery, stopping blood flow to the lungs. The pulmonary artery is the blood vessel that carries blood from the heart to the lungs.
RISK FACTORS
While some people are born with blood that clots too quickly, there are other risk factors for pulmonary embolism, the greatest being prolonged immobility.

Dr Ngunga explains that people who remain sedentary for long periods risk developing blood clots.

“The vulnerable include those who stay at home all day, lying down without engaging in any physical activity, those who sit for a long period when travelling without stretching and walking at regular intervals, as well as patients recovering from surgical procedures that require them to lie down for long periods.”

In some cases, the clots take time to build up and may take days or weeks. However, once they join together and travel up to the lungs as one big clot, they can be fatal.

The sudden blocking of the pulmonary arteries by a blood clot can cause death in minutes, says Dr Ngunga. This can explain why someone, after being immobile for long, can simply stand up, collapse, and die.

“When one is lying down or sitting, the clot is either lodged in the leg or pelvic area, but once he stands up, the clot, in a matter of seconds, travels to the lungs, causing sudden blockage, which causes death.”

Other risk factors for fatal blood clots include cancer, where certain treatments can cause the blood to clot more easily.

People who are overweight, smokers, those with heart disease, as well as those who have a close family member with a history of blood clotting are also at a higher risk of pulmonary embolism.

SIGNIFICANT RISK FACTORS
People who have had previous blood clots as well as people above 60 years are also at higher risk.

One other significant risk factor for pulmonary embolism is pregnancy. This is due to changes in hormonal levels as well as reduced blood flow in the legs due to the pressing weight of the foetus on the veins.

“That is why pregnant women are advised to take regular walks and exercises to prevent blood clots in their legs. This should continue even after she has delivered, especially if she gives birth via caesarean section,” advises Dr Ngunga.

Still on women, one other significant risk factor is contraceptives. This is because hormones contained in birth control pills can increase clotting factors. This is an experience that 30-year-old Gathiri Kihuria, a Nairobi-based advocate, knows only too well.

“I had irregular periods and to normalise them, my doctor put me on a daily birth control pill for three months,” she says.

One of the side effects was weight gain. In just two months, she had jumped from 65 to 80kgs. However, her periods returned to normal by the third month.

Aside from the weight gain, she made an observation towards the end of the third month.

“I noticed that I would have chest pains, especially in the evening. I attributed this to work-related fatigue and my weight. One day, I experienced shortness of breath as I walked home. I could hardly manage three steps due to laboured breathing,” she remembers.

UNPROPOTION HEART
Alarmed, Gathiri immediately went to the nearest health facility in her neighbourhood. There, she was told she was suffering an anxiety attack.

However, the doctor also decided to do a chest X-ray, whose results showed that one side of the heart was bigger than the other.

Puzzled at these results, she decided to seek a second opinion from a bigger hospital — the results remained the same. One side of her heart was bigger.

In a panic, she called her father, who has a heart condition, and informed him of the test results. He asked her to immediately travel home to Nyeri for a third opinion by their family doctor.

As the doctor performed a series of tests, he at one point asked her if there was anything “out of the ordinary” she had done in the past three months.

“I told him I had been taking birth control pills. This prompted him to do a scan on my legs and arms. When he saw the results, he organised immediate admission to a private hospital in Nyeri.”

AN AWAKENING

Once there, she was shocked at the manner she was received at the casualty.

“The nurses were moving swiftly and urgently, as though in panic. By then, I could barely speak due to difficulty in breathing.”

Gathiri remained at the hospital for 14 days as the doctors monitored her condition. She later came to learn that she had suffered pulmonary embolism and that she was lucky to have survived.

Gathiri now carefully watches what she eats and exercises regularly. So does Shitambasi, who has since stopped taking alcohol and takes a brisk walk for an hour daily. He is still on medication, which he will take for another three months.

Obviously, to decrease the risk of developing pulmonary embolism, you need to lead an active life.

Diagnosis for pulmonary embolism involves a series of tests that include an electrocardiogram (ECG), MRI, ultrasound, chest X-ray, and blood tests.

Unfortunately, notes Dr Ngunga, many of these services are not available in many public health facilities.