Medical Mystery: What caused man’s shortness of breath after a day with his kids?

A man in his 30s came to the emergency department complaining of shortness of breath, especially with exertion. He was very concerned because his breathing problems had become worse over the course of a week, to the point where he could not walk up a set of stairs or a short distance without becoming extremely winded.

The man was healthy and his career as a landscaper required him to be physically active. He didn’t have any prior medical history that was alarming to his medical team.

During the exam, we noted that he had mild labored breathing even at rest. Despite good levels of oxygen and no sign of a fever, his heart rate was unusually fast. It was interesting that he was also found to have a heart murmur, something he never had before.

We asked more questions about his activity, and he told us he recently enjoyed a day off and spent a lot of time with his children. This information revealed the answer.

During that day off, the patient played video games with his children — for eight hours straight. The man said he had been seated on the floor with his legs crossed for the entire time.

We sent him to have a CAT scan of his chest and an ultrasound of his lower legs.

The scans revealed that the patient had extensive blood clots in both of his lungs, and a large clot in his left leg, explaining his sudden shortness of breath. He had developed a deep vein thrombosis (DVT), a potentially life-threatening condition in which a blood clot forms in one or more of the deep veins in the body. Those clots then moved up into his lungs, causing a pulmonary embolus. The clot in his lungs also caused a strain on the right side of his heart, which was seen on the heart ultrasound that was performed after he was admitted.

The clots developed from the patient sitting for a very long time. Sitting for prolonged periods can slow blood flow in the veins, and it may make blood more prone to clotting. This can happen on long airplane rides, binge-watching TV, or in some cases, even just sitting at a desk for a long time.

We gave the man blood-thinning medication injections, followed by blood-thinning pills to help resolve his blood clots. He went home from the hospital a few days later without complications.

It is becoming more and more recognized that prolonged sitting can predispose people to blood clots. This is why we recommend breaking up bouts of prolonged sitting by walking or moving around so muscles in the legs can help circulate the blood, preventing it from becoming stagnant.

Researchers from Australia found several cases of DVTs associated with playing video games. The typical patient in these cases binge-gamed for an average of 15 hours. Most of those affected had an average age of 25 years old and were generally healthy people. Furthermore, they lacked any traditional risk factors for blood clots. This demonstrates that you do not have to be an unhealthy person to develop a serious medical problem. Simply the act of sitting for extended periods can put anyone in significant danger.

So always remember to break up periods of sitting by getting up to walk around and stretching every now and then. It may save your life.

Philip Carhart, PA-C, is an emergency physician assistant at Jefferson Stratford Hospital. Alan Lucerna, DO, is assistant director of the emergency department at Jefferson Stratford Hospital. James Espinosa, MD, is an attending physician in the emergency department at Jefferson Stratford Hospital and associate professor at Rowan University.