• Patient rushed to Max Hospital, Shalimar Bagh with feeble BP and pulse
• Investigation revealed right heart chamber dilated, pointing towards massive pulmonary embolism
• Massive kidney damage because of low BP for a long time
• Patient was immediately and rapidly thrombolysied with the thrombolytic agent
• Driving an automatic car for long hours wearing tight jeans was found to be the root cause of DVT

A 30-year-old man from Delhi, who had reached in state of shock (pulseless and no recordable BP), got a new lease of life at Max Super Speciality Hospital, Shalimar Bagh. Sourabh Sharma was brought in a critical condition to Max Shalimar Bagh’s Emergency on October 12^th by his colleagues. He was referred from another hospital as a case of cardiac arrest. With a pulse of 10-12/minute and no BP. In the emergency, the Cardiology team administered CPR for 45 minutes continuously in order to revive him.

Sourabh Sharma, a 30-year-old resident of Delhi was leading a normal life, until October 12^th, 2019 – when his life came to a screeching halt. Sourabh was on his way to work, when suddenly he suffered a blackout for 5 minutes. He was found unconscious on the office staircase by his colleagues. Sharma briefly regained consciousness after initial attempts by his colleagues but soon fell unconscious again. He  was immediately rushed to nearby hospital thereafter. 

To make matters worse, the health centre could not detect his BP and pulse and they referred him to Max Hospital, Shalimar Bagh. At Max Hospital, the team of Dr Naveen Bhamri, Dr Devendra Kumar Agarwal and ER team of Dr Datta revived Sharma post 45-minutes of CPR. An ECHO revealed that the right chambers of his heart were dilated, the artery that supplies blood to the Lungs indicated a possibility of massive pulmonary embolism (blood clot travelling from a limb to block supply to the heart or brain, usually with fatal consequences). Since Saurabh’s condition was particularly critical (with extremely feeble BP and pulse), the team instantly administered a life-saving thrombolytic agent to perform “rapid” systemic thrombolysis, as that was the only way to revive and arrest further deterioration to his failing heart without any further investigations like CT.

Explaining the case in detail, Dr. Naveen Bhamri, Director & HoD, Cardiology, Max Super Speciality Hospital, Shalimar Bagh, said, “When Sourabh was rushed into the emergency– he was at the brink of death – with no BP or pulse recordable, and limbs had turned blue. Our only priority at that hour was to ensure that we do everything in our power to revive him. After initially successfully reviving his heart, he re-gained consciousness and a stabilised BP in 24 hours. But his urine output was NIL. Due to a low BP over a long period, his kidneys were unable to function properly. He was immediately put on Continuous Renal Replacement Therapy (CRRT) – a continuous 24-hour dialysis therapy. We later found out that the reason why he suffered from a massive pulmonary embolism was because of an eight-hour long drive! He was driving the car for such a long period of time, with no breaks during the journey. His leg was stiff and did not move for that period. Not only that, he was also wearing a tight-fitted denim a day prior to the occurrence, which we believe can be a possible reason of clot in his leg.”

He added, “Pulmonary Embolism is a potentially life threatening condition and 50% of them present with cardiac arrest. So clinical diagnosis in a patient who turned with cardiac arrest is very important to differentiate the case of cardiac arrest from the other cardiac causes”.PE can happen because of immobility of lower limbs for long duration, dehydration, post-surgery (in case patient is advised bed rest for more than 24 hours), coagulation disorder, pregnancy and some genetic reasons.”

Dr. Yogesh Kumar Chhabra, Consultant, Nephrology, Max Super Speciality Hospital, Shalimar Bagh, added, “While it is widely known that BP has a direct impact on one’s heart health, eyes, breathing etc., a lot of people are still unaware of its negative implication on their kidneys. In this case, Sourabh’s kidneys were damaged due to long standing low BP and needed immediate CRRT support. The patient recovered after 5 days and is doing well now. People need to be careful while indulging in activities where there is limited movement for long duration, as it might lead to much bigger consequences.”

Mr. Sourabh Sharma said “I would like to take this moment to thank Dr. Bhamri and his team. This was an extremely difficult time for me and my family, but they made sure that we were always in good hands. The entire team responsible for my treatment – from doctors to nurses, everyone was extremely thoughtful and caring. One message that I would like to share with everyone is that living a healthy and active life is really important. This incident has taught me to be more mindful of my health – regular check-ups, avoiding alcohol and junk food, eating a healthy meal, etc – all play an important role.”

Incidence of deaths from cardiac related ailments are high in India and the annual incidence of pulmonary embolism ranges between 23 and 69 cases per 100,000 population. The rising incidences are majorly due to poor lifestyle choices, no exercise and unhealthy habits. There are many symptoms to identify the condition, but as the saying prevention is always better than cure, we must focus on exercising regularly and start adopting healthy lifestyle. Also, it is recommended to take a break after every 2 hours of any continuous immobility. Physical activity is extremely important for muscle movement and blood flow. Driving for long hours without any halt or break and wearing tight attire – both can disrupt blood flow in the body.