A team led by Dr Sameer Garde; Pulmonologist successfully treated a 60-year-old man from Mumbai with chronic thromboembolic pulmonary hypertension (CTEPH). The patient developed respiratory failure and was put on blood thinners, oxygen therapy, and Bilevel positive airway pressure (BiPAP) to help him breathe freely.
Patient B Venkat (name changed) a bank clerk by profession; couldn’t do his daily activities with ease owing to progressive symptoms of breathlessness, chest discomfort and increasing swelling on the legs. When his difficulties kept worsening despite a couple of meetings with his family physician; the GP recommended him to take specialist opinion instantly. The family Dr suspected that Mr B Venkat was developing COPD. However, before he could meet the pulmonologist next day, on outpatient basis; he had to be rushed to Global Hospitals, Parel, Mumbai in nearly unconscious state wherein he was managed promptly with medication, mechanical ventilation and hemodynamic support
Dr Samir Garde, Director of Dept of Pulmonology and Lung Transplant, Global Hospitals, Parel, said “The patient presented in an emergency with Type II respiratory failure (dangerously raised levels of Carbon dioxide in arterial blood with severely low oxygen levels) CT scan guided pulmonary angiography was done which confirmed presence of COPD like changes (Chronic obstructive pulmonary disease) and also chronic thromboembolic Pulmonary Hypertension) (CTEPH). This can happen in majorly sedentary people where minor clots in his leg veins (that are formed due to reduced viscosity of the blood, also called DVT) can launch perpetually in the circulation of lungs. This all happened in early 2019 in this particular patient.
CTEPH is seen in 1 in 10,000 individuals. It can lead to Pulmonary hypertension (raised blood pressure of the lungs) which can send right side of the heart into failure (cor pulmonale).
Deep vein thrombosis (DVT) is an occurrence in people who follow a sedentary lifestyle, smoke or do substance abuse. The clots coming from DVT which lodge in the lung’s circulation led to this life-threatening condition. Clinical suspicion is of utmost importance to diagnose and treat this condition in time so that timely treatment can save the life of the patient.
He was managed with blood thinners, oxygen therapy, and (NIV: Non-invasive ventilator) a type of ventilator that uses positive pressure to help the patient breathe. He was discharged in 8-10 days’ time and has been on regular treatment and follow up with Inhalation therapy, blood thinners and medicines for pulmonary hypertension.
It has been almost 4 years and he is enjoying a decent quality of life by even visiting his native place 3 times a year except one more hospitalisation early this year. He was also advised regular breathing and lung exercises (physiotherapy) and nutritional guidance was given (Pulmonary rehabilitation)
Dr Garde added, “Amid the pandemic, the patient was administered flu and pneumonia vaccines to prevent these infections as well as Covid-19. But, in 2023, the patient again came in an emergency and was put on the ventilator again due to respiratory failure. It seems apart from climate change he also was exposed to some fumes (religious rituals) at his native. Similar line of treatment was instituted this time again and he responded well and was discharged again in 8 days’ time. He is also on overnight oxygen therapy at home along with NIV.
The patient is doing well now, and can bathe and walk at home without any support. Not treating him at the right time could have led to severe type II respiratory failure and even death. At Least 45 minutes of exercises for 5 days is a must to avoid conditions like CTEPH for sedentary people. Also doing a pulmonary function test and 6-minute walk test annually, can pick up abnormalities of the lungs earlier.
“I had never heard about CTEPH before. But I was fortunate enough to get timely intervention at Global Hospitals. I thank Dr Garde and his team for saving my life. I am happy that I am able to do my daily activities with ease. I urge others like me to seek treatment at the earliest to improve the quality of life,” concluded patient B Venkat.
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