A few days ago in the ER , we came across an interesting case.
To give you a brief overview, she was a young female who had a history of multiple endocrine disorders for which she was on steroids. As a part of her endocrine disorders, she had hypoadrenalism (the body produces less adrenaline), and as a result of that, she had bradycardia (low heart rate) multiple times, making her lose consciousness. To prevent this in the future, she was put on a permanent pacemaker. Now a pacemaker is a device that is put in the chest and has electrodes connected to the interior of the heart and it makes sure that the heart is beating correctly.
She was brought to the ER , with a complaint of severe shortness of breath , that started suddenly. A quick 2D echo of her heart revealed a clot in the right ventricle that was moving with each heartbeat.
So, we suspected a pulmonary embolism to be the cause of her shortness of breath. The patient also had very low blood pressure, and was requiring multiple medications to keep her blood pressure up. The cardiologist reviewed the case and surgical removal of the clot was decided to be the best option for the patient.
The patient was shifted to the operation theatre and the operation was done to remove the clot from her heart.
Graphic content ahead !!
You can see the size of the clot that was removed from her heart.
Now, a brief explanation on what is a Pulmonary Embolism and the actual procedure done to remove the clot from the heart.
Pulmonary embolism is a serious condition in which a blood clot becomes lodged in the pulmonary artery or one of its branches, blocking blood flow to the lungs. This can cause symptoms such as chest pain, shortness of breath, and rapid heart rate. If left untreated, pulmonary embolism can be life-threatening.
The surgical embolectomy procedure is a type of surgery that is used to remove a blood clot from the pulmonary artery. This procedure is typically performed in cases where the clot is large and cannot be treated with medications alone.
During the procedure, the patient is placed under general anesthesia. The surgeon makes an incision in the chest, and then uses specialized instruments to locate and remove the blood clot. The incision is then closed with sutures or staples.
After the surgery, the patient will be monitored closely to ensure that the clot has been completely removed and that the pulmonary artery is functioning properly. The patient may need to be placed on blood thinners to prevent future clots from forming.
In some cases, the surgical embolectomy procedure may be combined with other procedures, such as a thrombectomy or a pulmonary angiogram, to provide the best possible outcome.
Surgical embolectomy procedure is a potentially life-saving treatment for pulmonary embolism. It can help to restore blood flow to the lungs and prevent complications such as heart failure or permanent damage to the pulmonary artery.
However, as with any surgery, there are risks involved. These may include reactions to the anesthesia and bleeding, or infection. It is important for patients to discuss the potential risks and benefits of the procedure with their surgeon before deciding whether to undergo the surgery.
The role of an Emergency Physician in cases like this is to initially stabilise the patient , diagnose any life threatening conditions that could be causing the particular symptoms and follow up with the respective doctors to make sure that the patient receives the best care possible. The ER physician may use multiple diagnostic techniques and equipment to arrive at a diagnosis so adequate knowledge in interpreting the findings of ECG and CT scans and 2D echo is paramount.
