Walshy’s World: Heavy Hearted – The Fleischmann Situation

Our resident health and fitness expert, Cameron Walsh, takes a look at the pulmonary embolism suffered by the Avalanche’s Tomas Fleischmann.

By Cameron Walsh

Sad news, Tomas Fleischmann is out for the season with a pulmonary embolism. What the hell? How can an athlete get one and what is a pulmonary embolism? Hopefully I can help answer those questions.

Here is a definition of what a pulmonary embolism does:

“A pulmonary embolus clogs the artery that provides blood supply to part of the lung. The embolus not only prevents the exchange of oxygen and carbon dioxide, but it also decreases blood supply to the lung tissue itself, potentially causing lung tissue to die.”

“Fleisch” was pretty lucky the medical staff picked this up; it can kill you straight away without warning no matter how ‘fit’ you are. So the fact this was caught so quickly and is now being treated with blood thinners is fantastic. As much as hockey is not important right now, it looks as though Fleischmann will get back on the ice.

A pulmonary embolus may show up with the sudden onset of chest pain and shortness of breath. The pain is classically sharp and worsens when taking a deep breath, often called pleuritic pain or pleurisy. There may be a cough that produces bloody spit (fantastic hey!).

A severe pulmonary embolus can present with shock (low blood pressure) or cardiac arrest, particularly when a large clot blocks the outflow of blood from the right side of the heart to the lungs. Depending on the size of the blood clot, oxygen saturation can be variably compromised as can the blood pressure and heart rate. In a classic case, the heart rate and respiratory rate are elevated as the body tries to compensate.

Fleischmann may have had stable vital signs (blood pressure, respiratory rate, and oxygen saturation) but showed an elevated heart rate. This for someone in his physical condition is ‘common’ considering this condition is not that common in athletes, it is one of the reasons this is so hard to diagnose (sounds strange I know).

One simple way the medical staff could have diagnosed Fleischmann was to see a slight bluish tint to his skin. This shows red blood cells without oxygen, called cyanosis. He would have been feeling lightheaded and weak. I find it hard to believe he would have got to this point however, there is no way he could have been training and playing and his body function fall away that far without the team noticing.

With all of that in mind, here is a little run down of how the clot became an issue for Fleischmann:

The lungs are a pair of organs in the chest that are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and blood. The lung is composed of clusters of small air sacs (alveoli) divided by thin, elastic walls (membranes). Capillaries, the tiniest of blood vessels, run within these membranes between the alveoli and allow blood and air to come near each other.

The distance between the air in the lungs and the blood in the capillaries is very small, and allows molecules of oxygen and carbon dioxide to transfer across the membranes.

The exchange of the air between the lungs and blood are through the arterial and venous system. Arteries and veins both carry and move blood throughout the body, but the process for each is very different.

•  Arteries carry blood from the heart to the body.

•  Veins return blood from the body to the heart.

•  The heart is a two-sided pump.

•  Oxygen-carrying blood travels from the left side of the heart to all the tissues of the body. The oxygen is extracted by the tissue, and carbon dioxide (a waste product) is delivered back into the blood.

•  The blood, now deoxygenated and with higher levels of carbon dioxide, is returned via the veins to the right side of the heart.

•  The blood is then pumped out of the right side of the heart to the lungs, where the carbon dioxide is removed and oxygen is returned to the blood from the air we breathe in, which fills the lungs.

•  Now the blood, high in oxygen and low in carbon dioxide, is returned to the left side of the heart where the process starts all over again.

•  The blood travels in a circle and is therefore referred to as circulation.

If a blood clot (thrombus) forms in the one of the body’s veins (deep vein thrombosis or DVT), it has the potential to break off and enter the circulatory system and travel (or embolize) through the heart and become lodged in the one of the branches of the pulmonary artery of the lung. A clot that travels through the circulatory system to another location is known as an embolus (plural emboli).

Hopefully that cleared things up, rather than made them murkier, no matter what team a player plays for you never want to hear about a head or heart problem, well no injury at all really but these two are, well, just not fair.

Here is to a quick recovery.

Until next time guys.