Pulmonary Embolism Patient Case Study
Mrs S.F, a 49-year-old scientist, had a high-powered job, which amongst other pressures, involved a lot of international travel.
For the past 2 years, she had noticed episodes of shortness of breath - often associated with flying. She initially attributed these episodes to stress - though, deep down, she didn't think this was the case. The episodes commonly came on late in the flight or shortly after arrival at her destination.
It also became noticeable that she was "jet lagged" with exhaustion, much more than before, after long-haul flights.
She paid for a 'full medical screen' but no obvious abnormalities were found. She started to make plans to change her job to one with no flying.
Her GP referred her to a chest physician who, at first could find nothing wrong. But the symptoms persisted.
Finally, a diagnosis. Lung scans tests picked up areas of "under perfusion" - in plain English, areas of poor blood supply. To cut a long story short a diagnosis of multiple pulmonary emboli (lung clots) was made, and the patient started on long- term anticoagulants.
Despite a detailed search, no evidence of a primary source of the clots (e.g., in the legs or the pelvis or the heart valves) was found.
Five years later, the patient remains well and well controlled on warfarin. Long distance travels, not a problem!
What is this patient teaching us?
Pulmonary embolism (a clot on the lung) is often very acute - dramatic and life threatening. However, as in the case of Mrs S.F., multiple small pulmonary emboli can be much more low key and less easy to diagnose.
In some cases, the condition can be extreme, leading to a condition known as pulmonary hypertension where the blood pressure in the lungs is too high causing the heart to be put under strain because it has to pump against this pressure. Fortunately this is a rare association of Hughes Syndrome.
As with any blood clotting problems, patients such as Mrs S.F. should be tested with a "clotting profile" or "clotting screen” to see if there are any underlying predisposing causes such as Hughes Syndrome/APS or genetic predispositions to clotting such as Factor V Leiden. In fact, Mrs S.F. was positive for all 3 tests for Hughes Syndrome namely Lupus Anticoagulant, anticardiolipin antibodies and beta-2-glycoprotein-1.
And interestingly, there were no other diagnostic clues in her past history or family history. But in the words of the patient: "I got my life back".