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Magazine
Clots in the lungs
DR. R. NARASIMHAN
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Breathlessness may not always be due to asthma or cardiac trouble.
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Clots in the lungs are increasingly being diagnosed as a cause for unexplained for dyspnoea. These clots form in the legs in those who travel long distances and do not move from their seats at all or those who consume excess alcohol during flights. T
his also occurs in people who are ill and immobile due to various reasons. More important is the situation of a young patient labelled an asthmatic but who is, in reality, suffering from a more serious but potentially treatable disease.
When I was a medical student 25 years ago, pulmonary embolism was never thought of in diagnosis as it sounded a death knell for the patient. Massive clots in the lungs used to take away the lives of individuals suddenly while slowly developing clots in the lungs used to be missed as we did not have facilities to diagnose this potentially fatal but eminently treatable and diagnosable disease.
Increasing awareness
There has been an increasing awareness about this illness in the past five years thanks to the facilities available now. Radiology plays a key role in the diagnosis. Chest x-rays, ECG and heart scans give a clue to diagnosis. It is the helical computerised axial tomogram (CAT scans) that has revolutionised diagnosis. Later developments like the 64-slice CT with pulmonary angiogram can confirm the diagnosis.
Any unexplained breathlessness that does not respond to medication or gradually worsens should alert the patient or physician to an alternative diagnosis. Many times patients are investigated for cardiac ailments and declared normal. There have been many instances both in India and abroad where pulmonary embolism was picked up in patients who had undergone detailed check-up for cardiac ailments. Patients are initially reluctant to undergo investigations for clots in the lungs as this is relatively new; heart attacks and hypertension are more frequently heard and treated.
Occurrences
According to a report from PGI in Chandigarh, pulmonary embolism strikes at a younger age than in western parts. Some of the studies done abroad and in India have also revealed that pulmonary embolism can occur in association with many medical illnesses where people are immobilised for a long periods like the post-operative states and prolonged medical illness like malignancies.
The message is clear. Don’t think all breathlessness is due to asthma or cardiac in nature. There can be something that more than meets the eye. A well-informed patient can guide the physician in the right direction.
The writer is a Senior Respiratory Physician based in Chennai. E-mail: drrnarasimhan@gmail.com
Helpful tips
Keep moving so that your calf muscles are active.
Drink lots of water to avoid dehydration.
Do not take excess alcohol before a flight especially if you suffer from ho have sleep apnoea.
Keep alcohol intake within acceptable limits, as it causes dehydration.
Carry a new inhaler in your hand baggage.
Patients with asthma, COPD and those on oral anticoagulants should be assessed before travel.
Patients with active infectious disease should get advice from their doctor before travel.
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