Clots of Trouble: Large Lung Embolism Spurs Heart Scare

If you’ve ever wondered just how connected your heart and lungs are, Mary Holderman is Exhibit A.

She sometimes uses an inhaler when seasonal allergies begin to get the upper hand on her breathing, but what happened April 17 went way beyond spring’s usual airborne suspects. In the morning, she was helping a family member get to a medical appointment in Allentown. She needed to stop and rest after walking just a short distance.

That evening, back at home in Freeland, she was fine sitting down, but otherwise couldn’t manage 10 steps. She was going to try to drive for medical help, but barely made it to her car. She was gasping for air. “I thought I was going to pass out. I couldn’t breathe,” Holderman says.

The 68-year-old, mother of two and grandmother of one, called her daughter, who took her to Lehigh Valley Hospital (LVH)–Hazleton.

Various tests at LVH–Hazleton included an echocardiogram, which led her cardiologist, Yaqoob Mohyuddin, MD, associate chief of the cardiology division at LVH–Hazleton, to suspect blood clots. A subsequent CT scan showed significant, suffocating blood clots in both of Holderman’s lungs. Her heart’s right ventricle, which pumps blood to the lungs, was barely working.

“I didn’t know how bad I was,” she says.

With the weather grounding MedEvac, she was transferred by ambulance to LVH–Cedar Crest, where interventional cardiologist Chirdeep Patel, MD, performed an innovative catheter thrombectomy in the cardiac catheterization lab. In this procedure, which is not available at all hospitals, a catheter is inserted through the groin and up through the heart, guided by X-ray, toward the clots in the pulmonary arteries. Once in position, the catheter is used to suction out the blood clots.

“Mary was very ill when she arrived at LVH–Hazleton,” Dr. Patel says. “The clots, or embolisms, in her lungs also were causing serious cardiac problems. Her heart’s right ventricle was severely enlarged.”

Holderman remembers arriving at LVH–Cedar Crest. “They took me right into the catheterization lab. They were all waiting. The whole team was there,” she says. She was awake during the procedure, which took about two hours.

The results of the thrombectomy were immediate. Holderman was taken off supplemental oxygen after the procedure, and her heart rate returned to normal. A test the following day showed her right ventricle was back to its normal size and function.

“The right ventricle went from failure mode to functioning totally well again,” Dr. Patel says. “How long and how well we live, a lot of that depends on heart health. We were able to preserve Mary’s heart function and that’s what makes me happy.”

The heart and lungs work together, depend on each other, and are amazingly efficient. It takes about 16 seconds for blood to travel through the body, allowing about five quarts of blood to circulate each minute. 

Catheter-guided thrombectomies are a relatively recent advance, Dr. Patel says. “Medical science in this field has come a long way. Less than 10 years ago, we didn’t have some of these technologies. Patients we’re able to save today may not have survived before,” Dr. Patel says. “Lehigh Valley Heart and Vascular Institute uses these life-saving technologies and also is involved in important cardiovascular research.”

Dr. Patel says Holderman will need blood thinning medication going forward to help prevent the formation of new clots. Blood thinners don’t dissolve existing clots, he says. “That’s why it makes sense to remove the clots,” Dr. Patel says.

Dr. Patel says a drug called tissue plasminogen activator (tPA) can be used to dissolve blood clots in cases of pulmonary embolism or stroke but noted the “potent blood thinner” has a risk of causing brain bleeding. For that reason, he says, it is used for extremely critical patients who are at risk of immediate death. Holderman wasn’t in that category and was stable enough for the thrombectomy.

Holderman says Patel, despite being very busy, took time to talk to her family and fully explained the procedure. “He’s a remarkable man,” she says.

She says she’s feeling good. The successful procedure gave her a second chance. “You appreciate every day. I feel blessed. I would recommend the procedure for anybody.”