January 9, 2008, a 36 year old firefighter started walking on a treadmill: sanctioned activity on-duty. During the exercise, chest "tightness" began, radiating into the jaw and left arm. A paramedic at the station evaluated him, applying a cardiac monitor and ordering transport to a local hospital, where he was admitted.
A cardiac work up, including cardiac catheterization, revealed no evidence of heart disease. January 11 the firefighter was discharged and instructed to undergo a "return to work" evaluation, supervised by the Fire Department's health care provider.
January 12, he collapsed at his residence. An advanced life support unit responded and found the firefighter in respiratory failure, and cardiac arrest occurred in the emergency department. Resuscitation efforts were unsuccessful, and he was pronounced deceased. The postmortem exam revealed "occlusive bilateral pulmonary thromboembolism" as the cause of death. See, http://www.cdc.gov/niosh/fire/reports/face200914.html#appa
Pulmonary thromboembolism (PTE) is called a silent killer, because the diagnosis is often made after sudden death. Hospitals see this disorder in post-op patients, and efforts to reduce PTE include various forms of anticoagulation in the perioperative period, promotion of venous circulation by sequential leg pressure devices, gradient stockings, and early ambulation.
PTE usually results from sudden migration of thrombus (clot) formed in a deep leg vein through the right side of the heart, into the pulmonary artery (PA). It sends blood from the right ventricle to the lung. A large clot (saddle embolus) will completely block the PA, making circulation impossible, producing sudden death.
In this case study, the first episode of chest discomfort was probably due to movement of a smaller, "sentinel" clot into the PA, which blocked blood flow to to a region of one lung, causing it die, a process known as pulmonary infarction. A EKG done on the first admission was reported to show "incomplete right bundle branch block (IRBBB)" a conduction problem involving the right side of the heart.
With pulmonary infarction and PTE, complete right bundle branch block (RBBB) is observed in the resting EKG in 25 percent of cases. (See, Cecil Textbook of Internal Medicine 1979:pp1129-1134.) Treatment with anticoagulants is immediately indicated. A puzzlement is why a 36 year old man had clotting in the deep leg veins?
Comments
Pulmonary symptoms may vary greatly depending on the amount of the lungs is present throughout the clot and your overall health - in particular the presence or absence of lung disease or heart disease. Symptoms may include: Fever, Painful, painful, red swollen joints, Joint pain that migrates to another, Heart palpitations, Chest pain, Shortness of breath, Rash, Fatigue, Small painless.
http://www.insideheart.com/pulmonary-embolism-symptoms-identifying-them....
Pulmonary symptoms may vary greatly depending on the amount of the lungs is present throughout the clot and your overall health - in particular the presence or absence of lung disease or heart disease. Symptoms may include: Fever, Painful, painful, red swollen joints, Joint pain that migrates to another, Heart palpitations, Chest pain, Shortness of breath, Rash, Fatigue, Small painless. http://www.insideheart.com/
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