After Life-Saving Heart Procedure at Mount Sinai Morningside, a Call for Awareness of Blood Clots

In August 2021, 41-year-old Zarreen Perpall started feeling exhausted and easily winded. “Walking around wore me out to the point that I needed to sit down constantly and catch my breath,” she says in an interview with about her health journey. “My heart rate was racing, going to the bathroom was like running a marathon.” And that makes it hard for a camp and after-school program director to do her job, much less live her life.

Not sure how to proceed, the Brooklyn resident went to the emergency department at a local hospital for help. The Emergency Department doctors did bloodwork and a computed tomography scan, which showed blood clots in her heart and lungs. This wasn’t Zarreen’s first blood clot issue; she’d had deep vein thrombosis six months earlier and had been treated with medication. But this incident seemed far more serious.

When it became clear that Zarreen needed surgery to remove the clots—immediately—she was transferred to Mount Sinai Morningside, where she was treated by a renowned surgeon, Omar Lattouf, MD, PhD, Professor of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai.

Dr. Lattouf and his interventional radiology colleagues initially considered removing the clots from Zarreen’s heart and lung via catheters, but soon after, she went into near full cardiac arrest. Her blood pressure dropped, and her heart rate slowed. “We effectively lost her, but were able to get her back by immediately starting CPR on her for about two or three minutes,” says Dr. Lattouf. “We got her back.” The doctors knew they still had to complete the pulmonary embolectomy, to remove the clot from Zarreen’s lungs.

While Dr. Lattouf is not certain why Zarreen had so many clots at such a young age, he strongly suspects the problem may have been caused by a sizable uterine fibroid, which was discovered by the CT scan that was conducted for the clots in her heart and lungs.

The fibroid was about the size of a large softball. Dr. Lattouf speculates that this fibroid may have pushed against the large vein that carries blood to the heart (inferior vena cava) and nearby veins, causing blood flow to slow and clot. “If you think of the pelvic cavity, it’s a small area,” says Dr. Lattouf. Having a large fibroid sitting in the middle of that can really block blood flow.

If someone has a family or personal history of deep vein thrombosis, a mass in the abdomen—even a benign or noncancerous one—could increase risk of clotting. “They should be more aware, and they should be seen by surgical specialists to treat such a mass, to see a hematologist, and discuss the need for prophylactic anticoagulation,” Dr. Lattouf said.

Without question, Zarreen did the right thing when she went to the ED. “If you’re having difficulty breathing, if you become lightheaded, feel you have heart palpitations, absolutely it’s always the safest to go to the emergency department,” says Dr. Lattouf. “Don’t ignore these symptoms, and don’t try to be your own doctor.”

Susan Khalil, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science, Icahn Mount Sinai, has similar advice: “The take home point is women should come in for re-evaluation for fibroids,” Dr. Khalil says. “There are benefits to early intervention as now there are more minimally invasive ways, supported in a safe fashion.”

A few months after the procedures, Zarreen was still breathing comfortably and making great progress, Dr. Lattouf says. She plans to have the uterine fibroid removed, and will continue to see a hematologist on an ongoing basis to monitor her condition.

Zarreen was grateful to Dr. Lattouf and her medical team at Mount Sinai Morningside, and happy to share her story to help inform others.

“It’s important to share experiences,” she says. “Especially when it’s something that’s not necessarily talked about.”

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