[DeTomaso] DVT and Stroke, most likely scenario

[clay willmott]

For those interested this it the most likely scenario and happens quite often........


Sounds like he had a DVT (deep venous thrombosis) and probably has Factor 5 Leiden mutation or some other hypercoag state as he sounds very active and a spontaneous DVT seems less likely.  When it goes to your lung (Pulm Embolism) and it is a saddle embolus (occludes the majority of the R and L pulmonary artery) you can get syncope like he had and pass out.
He likely did have a stroke from the TPA he was likely given which is the treatment nowadays for hemodynamically unstable PE patients prior to Heparin therapy.  10  percent may bleed intracranially which it sounds like he did.  You can get a DVT to embolize to the brain BUT you have to have a patent foramen ovale (A hole in the middle wall of the heart between the atria) to be able to embolize directly to the brain.  The lungs protect against brain emboli by acting like a filter as well as oxygenation and ventilation.  If he had an Echo with a bubble saline agitation that showed this hole in the heart then he may have had a DVT piece embolize to the brain.  Either way it is a stroke or CVA, the first example would e hemorrhagic and the second an embolic stroke.  20 percent of you reading this have a hole in your heart by the way.

Without the TPA he would have likely died though so it is a good thing he got it.  Also, current literature suggests if you get TPA you are less likely to get chronic cor pulmonale (R heart failure) which is a long term complication of PE survivors like Mike describes.

It sounds like he is on his way and should do fine.  The big question is why die he get the DVT anyway and he may require life long blood thinners (Coumadin) depending on the reason for the DVT which would make racing cars a bad idea unfortunately.  Hopefully it was due to a recent surgery or some other immobilization.

Best of luck to him and his family.  I see cases like this frequently and most people do quite well if they survive the initial insult which he has.  It also sounds like his mental status is improving and thats the most important thing right now.  The IVC (inferior vena cava) filter will prevent more DVT from traversing up to the lung and most are the new Greenfield filters that can be removed down the road is needed while they hold his blood thinners due to the brain complication.

CW (Pulm and CC MD)

> From: musclebyrussell at hotmail.com
> To: detomaso at realbig.com; preproform at aol.com
> Date: Mon, 29 Dec 2008 10:36:07 -0800
> Subject: [DeTomaso] BOB BYERS IN HOSPITAL
> 
> 
>     FYI I just talked to Don, and he said while the doctors don't want to commit to anything, Bob did not have a stroke!!
> It is just the results from his fall,or passing out that the bloodclot in his lung dissipated into his brain, causing his dissassociation. But he was asking about his grandkids and the like .But Don basically has to help him do everything.
> But all things considered he is doing good as can be expected for now. I'll keep you updated it is now 10:30A.M. 12/29/08 or Monday. But one thing Don did say to me while everyone wants to say hello & pay their respects .Please cut down on the visitors.He appreciates it but at the present time all it is doing is confusing Bob. Russ B.L. Machine & Russ Fulp Racing Engines1100 E. Orangefair LaneUnit EAnaheim, CA 92801714-870-8570  
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