Travelers beware: Pulmonary embolism can quickly claim lives

When NBC News Correspondent David Bloom, an Iraqi war reporter, died suddenly in early April, it alerted many to a little-known killer. The 39-year-old co-anchor of the weekend ?Today? show was traveling with troops about 25 miles south of Baghdad when he suddenly collapsed. Bloom was airlifted to a nearby field medical unit, where he was pronounced dead from pulmonary embolism.

The American Heart Association reports that annually more than 600,000 Americans experience a blocked artery in their lungs — a condition known as pulmonary embolism. In many cases, the blockage is caused by one or more blood clots that travel to the lungs from another part of the body.

Most blood clots originate in the legs, but they also can form in the veins of arms, the right side of the heart or even at the tip of a catheter placed in a vein. Smaller clots prevent adequate blood flow to the lungs, sometimes causing damage to lung tissue. Large clots that completely block blood flow can be fatal. Each year, pulmonary embolism claims 60,000 lives in the United States.

Dr. Dave Haukeness, an internist with Kaiser Permanente at Boulder Community Hospital, divides the most common causes for pulmonary embolism into three groups. The first is from inadequate blood flow, which is a relatively common complication in hospitalized patients who are confined to bed-rest for long periods.

?The second is a hyper-coagulated state. These are people with conditions that are more prone to clot, such as women on birth control or people with cancer or rare genetic conditions,? Haukeness said.

?The third is people who have experienced trauma to their internal structures,? he continued. ?This is someone who takes a fall or is in a car accident.? With people who experience trauma, bruising can also be a factor. He recently treated a rugby player who was hit on his back leg and developed bruising and leg swelling. Without treatment, his condition could have become severe.

Another common cause of blood clots is travel resulting in prolonged inactivity.

?We see many people with leg pains or swelling mainly due to travel, from sitting on a plane or in a car,? said Dr. Mary Jo Jacobs, who works at Kaiser Permanente’s after-hours clinic in downtown Denver. ?The sitting position can cause clots because it cuts off blood flow right at the groin between the thigh and the body.?

To prevent blood clots, Jacobs recommends that travelers stand up and move around every 30 minutes when on a plane and every two hours while on car trips. When travelers cannot get up and stretch, she suggests flexing and extending the feet to stimulate blood flow through the lower body.

Because it’s impossible to screen every person who exits an airplane, said Dr. Eric Zacharias, an internist at Boulder Medical Center, travelers need to be aware of their risk level for blood clots and must take preventative measures to ensure adequate circulation.

?Many of my patients travel a lot, and I get on them about hydrating, avoiding alcohol, and getting up and walking around,? Zacharias said. ?I tell them to try to use common sense and be proactive? about their health.

The most common symptoms of pulmonary embolism that Zacharias sees are pains or aches in the calf, behind the kneecap or in the thigh. Other symptoms of blood clots may include swelling in the leg, sudden shortness of breath, lightheadedness or fainting, and chest pains. However, in some cases when pulmonary embolism occurs, there are no symptoms.

The Mayo Foundation for Medical Education and Research estimates about 10 percent of people with pulmonary embolism die within the first hour, making prompt treatment crucial. However, the foundation also reports that pulmonary embolism is seldom fatal when diagnosed and treated immediately.

The encouraging news is that a few simple steps can go a long way toward preventing pulmonary embolism. An evaluation of someone’s risk for blood clots can be done through the patient’s history, a physical exam, and diagnostic tests such as blood tests, magnetic resonance imaging (MRI), and venography (involving dye and X-rays).

?Compared with 10 years ago, several new risk factors are known,? said Dr. Hunter Smith, pulmonary critical care physician, Boulder Community Hospital. For example, medical research has identified that a predisposition to blood clots can be genetically passed on to descendants.

?If someone has a history of blood clots within their family, they should ask their doctor if they should be tested,? Smith said.

Another fairly new development with the diagnosis of pulmonary embolism is the D-dimer blood test, Jacobs added. As a tool in the diagnostic work-up of patients, a D-dimer test can help to rule out the possibility of deep vein thrombosis, which is a blood clot in the calf’s deep vein that frequently leads to pulmonary embolism if untreated.

?If the blood test is negative, you can feel certain that don’t have a clot,? Jacobs said. ?If it’s positive, it doesn’t mean that you do. We then perform an ultrasound of the extremities to see whether something is blocked. That will provide a more definitive answer.?

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