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I Thought A Near-death Experience Would Be A Wake-up Call. I Was A Fool

At 4.58pm on New Year's Eve, a globule of blood lodged itself in my right lung. The heart is a pump and it behaved the way most pumps do when encountering a blockage: it strained, and strained some more, and began to break down.

At the time, though, I found this all fairly academic – lying on a gurney in the emergency room, I had the distinct sensation my heart was applying shear force to itself and I was about to die.

As it turns out, this was a pulmonary embolism, or PE. They are also known as "blood clots in the lung" but doctors love their Hellenisms and, because they have a monopoly on scalpels, society mostly humours them.

PEs are both "potentially fatal" and "frequently underdiagnosed", which seemed to me a particularly unfair combination. My PE wasn't fatal but it was mistaken for something else: a day earlier, when I'd gone to emergency for chest pains, a nurse wondered if I'd had a mild heart attack or moderately bad cocaine.

Here's the public service announcement. The main symptoms of PEs – shortness of breath, pains when breathing, a cough – aren't specific to embolisms. You don't even need to have a pre-existing condition to have one: mine was what doctors call "unprovoked" because it didn't seem to come from any obvious source such as clotting in the stomach or legs.

Even if you do have one, doctors might assume it's pneumonia, or asthma, or pericarditis. All this has led to, in the words of Steven Doherty, a "hypervigilance" around PE among the medical set, but if my conversations with friends and family in the last week are any indication I'd suggest awareness isn't quite there among lay people.

The quacks say my thrombus was a slight one, as these things go: a not-so-bad incidence of a very serious thing, like being shot with a potato cannon.

Still, the topic makes for sobering reading: a 2003 survey of US autopsy data showed death occurring one month after PE for 12% of people; one study pegs one-year mortality rates at almost one in five, though here co-occurrence with cancer muddies the water; a presentation for New South Wales emergency physicians discusses an otherwise healthy and well 28-year-old woman who, two weeks after being discharged from emergency, returned with a massive lung clot and brain haemorrhage.

"Following family discussion, patient was taken off ventilator and died in the presence of her family." Christ alive.

Like a fool, I always assumed a near-death experience would be some sort of wake-up call. The trouble is, the doctors who discharged me don't have much in the way of nostrums: I don't smoke, so I can't quit doing that; my vital signs are good, so they're not prescribing diet or exercise; older people are more likely to develop clots but they can't tell me to age backwards.

Essentially, the extent of medical advice received was to take it easy and do things in moderation. It's like having Aristotle as your doctor – they might as well have said "lead a virtuous life".

So instead I'm left with uncertainty. That heaviness in my chest could mean I've seen the last of my wife and daughter, or it could mean nothing at all. A swelling in my feet could be the harbinger of the end, or it could be "being 34". In a way it's like business as usual: if I get hit by a bus tomorrow, it won't matter that I'm now on blood thinners.

My father died last year, of brain cancer, which is if nothing else a fairly iconic thing to die from; very little explaining Hellenisms there. We loved one another very much, and while we got along well we didn't have much in common. It's a shame he died before my embolism, because we'd be able to bond over using the same brand of anticoagulant.

More importantly, though, we'd be able to chat about how life changes with a giant diagnosis radiating off you like cartoon stink lines. Boringly, I'd now suggest it doesn't, and a lot of his maxims about life still apply: get a swim in when you can, try to learn everyone's name, indulge your grandkids.

Everyone knows habituation is powerful, though most of the time people say that with a pejorative tinge – behold the indulgences of modern man; a single Dorito would kill a medieval peasant! That's all true, of course, but there's also a degree to which the human penchant for adaptability might be, well, adaptive.

Maybe there's another blood globule agitating in my vascular system; if so, there isn't much I can do about it, and I have less to gain by fretting.

Eventually, you have to imagine, Damocles forgets the sword hanging over him. But we shouldn't berate him for doing so, or consider him a fool – people forget he was king for a day.

Widening Of The Pulmonary Artery In PH Is Common: Large-scale Study

Pulmonary arterial dilatation — the abnormal widening of the main pulmonary artery leading from the heart — was a common feature among people with pulmonary hypertension (PH) in a large-scale study.

The clinical characteristics related to a dilated pulmonary artery, such as heart function and blood flow parameters, varied widely among the types of PH, but dilation wasn't associated with an increased mortality risk, according to "Pulmonary artery dilatation in different causes of pulmonary hypertension," which was published in Pulmonary Circulation.

The hallmark feature of PH is high blood pressure in the pulmonary arteries, the blood vessels that carry blood from the heart through the lungs to be oxygenated.

PH is classified into different types based on the underlying cause and symptoms. Two types are pulmonary arterial hypertension (PAH), caused by the narrowing of the smaller arteries in the lungs, and chronic thromboembolic pulmonary hypertension (CTEPH), the result of blood clots.

A dilated pulmonary artery is a long-term consequence of chronic PH and several studies have investigated the relationship between it and different PH causes and clinical factors. However, the results have been inconsistent, mostly due to the small number of participants involved, according to researchers in China who examined PA dilatation in 1,018 PH patients, ages 13-80, 699 (68.7%) of whom were women.

"As far as we know, the present study uses the biggest sample size to clarify the association between clinical features and PA dilatation in patients with various [causes] of PH," the researchers said.

Dilatation differences among PH types

Among the PH types, 22.1% were diagnosed with CTEPH, 39.2% with PAH with an unknown cause (idiopathic PAH or IPAH), 27.6% with PAH associated with congenital heart disease, and 11.1% with PAH due to connective tissue disease. The patients had been having PH symptoms for a mean of 5.6 years.

Dilatation was measured by the PA ratio, defined as the diameter of the pulmonary trunk (PA diameter) divided by the diameter of the adjacent aorta, the large artery connected to the heart that supplies oxygenated blood to the body. Nearly all the participants (88.8%) had a PA ratio greater than 1.0, a sign of PA dilatation, and 27.2% had a PA ratio greater than 1.5.

PAH patients with congenital heart defects had the largest PA diameter and PA ratio. CTEPH patients had the second-largest diameter, but the lowest PA ratio due to an enlarged aorta. There were no differences in systolic blood pressure (during a heartbeat) or resistance to blood flow (pulmonary vascular resistance) across all the groups.

The highest PA ratios were in those with PAH caused by atrial septal defect, a congenital defect marked by a hole in the wall between the upper chambers of the heart.

Among those with CTEPH, a larger PA diameter and PA ratio strongly correlated with a longer symptom duration. In this group, a larger PA diameter was significantly related to a shorter distance walked in six minutes and a broader diameter across the right heart ventricle (lower chamber) measured after a heartbeat (right ventricular end-diastolic dimension, or RVED).

IPAH patients who had PH symptoms longer also had a significantly larger PA diameter and PA ratio. Also, a wider PA diameter correlated with a larger RVED and worse blood flow parameters, including pulmonary blood pressure, pulmonary circulation volume, and cardiac index, a measure of heart function.

"It is interesting to note that only IPAH patients showed a correlation between PA diameter or PA ratio and PA pressure when we looked at different PH groups," the researchers wrote.

A larger PA diameter only correlated with pulmonary circulation volume in PAH patients with congenital heart defects, and RVED in those with PAH related to connective tissue disease.

During a follow-up that ranged from three to 109 months (about nine years), 70 (6.9%) patients died. After adjustments for factors that may influence the results, the only significant factor independently linked to a higher mortality risk was a shorter distance walked during the six-minute walking test. PA dilatation was not related to mortality risk by any cause.

"PA dilatation is frequently observed in PH patients," and "clinical features of PA dilatation vary greatly between PH types," the researchers said.

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