Acute pulmonary embolism involves a sudden blockage of a lung artery, usually from a leg blood clot, leading to severe breathing ...

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Pulmonary Embolism: Symptoms, Treatment, and Expert Advice from Dr. Bagirath Raghuraman

hello everybody I am Dr bagat raguraman working as senior consultant cardiologist and program director of heart transplant at Nar Health City bangaluru acute pulm embolism and chronic pulmonary embolism acute pulmonary embolism is a condition when there is a large thrombus load or a clot load in the pulmonary circulation now this can happen due to two main reasons one there can be a buildup of clot formation in the legs or the Deep veins which then travels up along the flow of the circulation and then accumulates in the lungs the other way is an insu pulmonary embolism meaning that there is a condition where the patient generates clots due to certain hematological conditions or blood problems and generates clots which soon builds up into a massive thrombus burden and udes or blocks the pulmonary circulation the basic problem here is that there is not enough oxygenation of the blood which we require so the right ventricle is on overdrive trying to pump more and more and in the process these clots will firmly plug the distal pulmonary artery circulation now if the clot burden is massive this is where the situation becomes tricky often times you'll require a very powerful litic or thrombolytic agent which we use to dissolve the clot especially if the patient has a hemodynamic compromise sometimes we receive the patient in a collapse State wherein the complete circulation has collapsed due to a very large thrombus burden so these patients have to be taken on circulatory support in the form of a ECMO and taken up for surgery to actually open up the pulmonary arteries and remove the large amount of clot there is an exceptional situation wherein we do have patients who have massive pulmonary embolism after a road traffic accident wherein they have injury to the skin subcutanous tissues and even fracture of long bones or sometimes a head injury with a bleed in the brain now these are certain exceptional situations wherein you can't really give a drug that will dissolve the clot so in these circumstances what we use is we use a catheter to actually suck out a clot manually and large amounts of clot can be removed in this manner so that the pulmonary circulation is restored now changing gears once the acute pulmonary embolism situation has resolved the patient will beond lifelong anticoagulation however in certain patients the duration of clot for further extends without dissolving and remains in the pulmonary circulation Beyond a timeline of 3 months this is called chronic pulmonary embolism now when there is lot of clot which lasts longer than 3 months these patients develop pulmonary hypertension that is the increased pressure in the right sided circulation this is called as chronic thromboembolic pulmonary hypertension or CF the basic ways to treat CF are of course medical management wherein the patient overall level of physical activity and oxygenation is reasonable however in certain patients the oxygenation is rather poor and they're unable to do day-to-day activities so if they are unable to do their day-to-day activities and the saturation is really low then these patients are shortlisted for what we called as pulmonary thrombo otomy surgery so here the patient is taken up for an open art manually take out the chronic clot burden this is for level one and level two chronic pulmonary embolism however there are certain patients wherein there is level three and level four disease and for these patients we do a procedure called as balloon pulmonary anoplasty wherein we pass a balloon and inflate it in the distal pulmonary artery tree to break the webs and clear the clots to ensure that there is a circulation into the distal pulmonary tree lastly there is a procedure called as a hybrid procedure wherein the surgeon removes the clots from the level one and level two pulmonary arteries and we follow up as an interventionalist we tackle the clot burden in the level level three and level four pulm arteries so this forms a hybrid procedure for those patients who have level 1 to level four extensive chronic palmary [Music] embolis

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