To make the correct diagnosis, establish the severity of the pathology and select an effective treatment tactic, a detailed classification of pulmonary embolism is used, which reflects all aspects of the manifestation of the pathology.
Depending on the location, pulmonary embolism is divided into left-sided, right-sided, bilateral.
Clogging can occur at the level of small, large, or intermediate blood vessels.
The course of pulmonary thromboembolism is chronic, acute or recurrent.
Doctors, based on the clinical picture of the development of the disease, distinguish:
- Heart attack pneumonia, representing thromboembolism of small branches of the pulmonary artery.
- An acute pulmonary heart in which the disease affects large branches of the blood vessels of the lungs.
- Recurrent pulmonary embolism.
Depending on the volume of the affected pulmonary blood vessels, the disease can take a massive or non-massive form. The specified characteristic directly affects the severity of the pathology.
Pulmonary embolism (pulmonary embolism) is a pathological acute condition in which there is a sudden blockage of the trunk or branches of the pulmonary artery with an embolus (thrombus). Localization of a blood clot can occur in the right or left ventricle, venous bed or atrium of the heart.
Often a blood clot can “come” with a blood stream and stop in the lumen of the pulmonary artery. With the development of this condition, a partial or complete violation of the blood flow to the pulmonary artery occurs, which causes pulmonary edema, followed by rupture of the pulmonary artery.
This condition leads to a quick and sudden death of a person.
Important! By the number of deaths, pulmonary thrombosis takes the second place after myocardial infarction. According to medical indicators, in 90% of deaths with a diagnosis of “pulmonary embolism”, the initial diagnosis was erroneous, and untimely assistance resulted in death.
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- Life forecast
- Pulmonary embolism: causes, symptoms, diagnosis and treatment
- Brain Disorders
- REASONS FOR THE BODY
- Classification of Pulmonary Thromboembolism
- Causes of
- REASONS FOR THE BODY
- Emergency care for pulmonary embolism
- Subtotal PE
- Pulmonary thromboembolism (embolism, pulmonary embolism): symptoms, treatment, what it is, small branches, signs, causes, classification, diagnosis
- REASONS FOR THE BODY
- The consequences of pulmonary embolism
- Diagnosis at the prehospital stage
- How to treat
- Complications and forecasts of doctors
There are many reasons and predisposing factors that can trigger thrombosis in the pulmonary artery, among which:
- Pathologies of the cardiovascular system: angina pectoris, hypertension, vascular atherosclerosis, ischemia, atrial fibrillation and others.
- Oncological diseases.
- Diseases of the blood.
Excessive physical exertion, prolonged nervous strain, the use of certain medications and other factors that negatively appear on the work of the cardiovascular system can provoke the development of a blood clot.
Blood clots in large vessels and arteries are difficult to diagnose, therefore, the mortality rate among the population with this diagnosis is quite large.
In the case when the pulmonary blood clot has come off, how many people can survive depends on the medical care provided, but basically death occurs instantly.
Clinical signs of pulmonary embolism can be suspected in advance. The following symptoms are often characteristic of this condition:
- Dry cough with sputum discharge with an admixture of blood.
- Pain behind the sternum.
- Increased weakness, drowsiness.
- Dizziness, up to loss of consciousness.
- Reduced blood pressure.
- Swelling of the veins in the neck.
- Pallor of the skin.
- Increase in body temperature to 37.5 degrees.
The above symptoms are not always present. According to statistics, only 50% of people encounter such symptoms. In other cases, symptoms of a thrombus of a pulmonary artery go unnoticed, and a person’s death can occur within a few minutes after the attack.
If pulmonary thromboembolism is suspected, every second is important.
If the patient was able to be delivered to the hospital, he is placed in the intensive care unit, where urgent measures are taken to normalize pulmonary circulation.
In order to prevent relapse of pulmonary embolism, the patient is prescribed bed rest, as well as infusion therapy, which allows to reduce blood viscosity and normalize blood pressure.
In the case when conservative therapy does not produce results, doctors urgently perform an operation – thromboembolectomy (removal of a thrombus). An alternative to such an operation may be catheter fragmentation of thromboembolism, which involves the installation of a special filter in the branch of the pulmonary artery or the inferior vena cava.
Important! The prognosis after surgery is difficult to predict, but given the complexity of the disease and the high risk of death, surgery is often the only chance to save the patient’s life.
If a blood clot in the lungs comes off, the consequences are rather deplorable, since death can occur within a few minutes.
Acute pulmonary embolism in 90% of cases ends with cardiac arrest and sudden death of the patient.
The complication rate increases if a person has a history of secondary hemodynamic disturbances or cardiovascular disease. In such cases, the chances of survival are nullified.
We previously wrote about the symptoms of a blood clot in the hand and recommended adding the article to your bookmarks.
With early diagnosis of thromboembolism, the prognosis is favorable. In cases where a person is sick with other pathologies of the heart and blood vessels, the survival rate is 30% with early diagnosis.
Important! The insidiousness of this condition lies in the possible relapse of the disease, which can occur against the background of any provoking factor.
In the chronic course of thromboembolism, the majority of patients suffer myocardial infarction throughout the year, which significantly reduces the chances of life.
With timely diagnosis of a blood clot in the lumen of the vessels, it is important to follow all the doctor’s recommendations, take the necessary medications.
Proper treatment will help reduce the risk of pulmonary embolism, even when a blood clot is present in a branch of the pulmonary artery.
The development of a blood clot in the lungs is much easier to prevent than to treat. It is possible to reduce the formation of thrombosis in 80% of cases, observing simple preventive measures:
- moderate physical activity;
- rejection of high heels;
- quitting smoking and alcohol;
- daily exercise and only a healthy lifestyle;
- proper and healthy nutrition;
- timely and proper treatment of all concomitant diseases.
People who are at risk or have a history of other pathologies of the cardiovascular system should periodically visit a cardiologist. Timely and high-quality diagnostics under the supervision of a highly qualified specialist will help in time to identify violations in the functioning of blood vessels, to conduct treatment that will not only improve the patient’s condition, but also save a life.
One of the main causes of sudden death is an acute violation of blood flow in the lungs. Pulmonary thromboembolism refers to conditions that in the vast majority of cases lead to an unexpected cessation of the body. Pulmonary thrombosis is extremely difficult to treat, so it is optimal to prevent a deadly situation.
The lungs perform an important task of saturating venous blood with oxygen: the main great vessel, which brings blood to the small branches of the arterial network of the lungs, departs from the right heart.
Thrombosis of the pulmonary artery causes the normal functioning of the pulmonary circulation to cease, the outcome of which will be the absence of oxygen-rich blood in the left cardiac chambers and the rapidly growing symptoms of acute heart failure.
See how a blood clot forms and leads to pulmonary thromboembolism
The chances of saving life are higher if the pulmonary thrombus comes off and leads to blockage of a small caliber arterial branch. Significantly worse if a blood clot in the lungs came off and provoked cardiac occlusion with sudden death syndrome. The main provoking factor is any surgical intervention, therefore, it is necessary to strictly follow the preoperative prescriptions of the doctor.
Age is of great prognostic value (in people under 40 years of age, pulmonary thromboembolism is extremely rare during surgery, but for an older person, the risk is very high – up to 75% of all cases of fatal obstruction in the pulmonary artery occur in elderly patients).
An unpleasant feature of the disease is the untimely diagnosis – with 50-70% of all cases of sudden death, the presence of pulmonary thromboembolism was detected only at a postmortem autopsy.
The appearance of blood clots or fat emboli in the lung is explained by blood flow: most often the primary focus of the formation of thrombotic masses is a pathology of the heart or venous system of the legs. The main causes of occlusive lesion of the main vessels of the pulmonary system:
- any types of surgical interventions;
- severe lung disease;
- congenital and acquired heart defects with different types of valvular defects;
- abnormalities in the structure of pulmonary vessels;
- acute and chronic ischemia of the heart;
- inflammatory pathology inside the cardiac chambers (endocarditis);
- severe forms of arrhythmia;
- complicated variants of varicose veins (vein thrombophlebitis);
- bone injuries;
- gestation and childbirth.
Of great importance for the occurrence of a dangerous situation, when a blood clot in the lungs formed and breaks off, have predisposing factors:
- genetically predetermined coagulation disorders;
- blood diseases that contribute to poor fluidity;
- metabolic syndrome with obesity and endocrine disorders;
- age over 40 years;
- malignant neoplasms;
- prolonged immobility due to trauma;
- any version of hormone therapy with constant and long-term use of drugs;
Pulmonary artery thrombosis occurs when a blood clot enters the venous system (in 90% of cases, thrombi in the lungs appear from the vasculature of the inferior Vena cava), therefore, any form of atherosclerotic disease does not affect the risk of blockage of the main trunk, leaving the right ventricle.
A venous clot can disrupt blood circulation anywhere in the pulmonary circulation. The following forms are distinguished depending on the location of the thrombus in the lungs:
- blockage of the main arterial trunk, in which sudden and imminent death occurs in most cases (60-75%);
- occlusion of large branches that provide blood flow in the pulmonary lobes (the probability of death is 6-10%);
- thromboembolism of small branches of the pulmonary artery (minimal risk of a sad outcome).
Pulmonary embolism: causes, symptoms, diagnosis and treatment
In the most common cases, the following symptoms of pulmonary embolism are observed:
- shortness of breath that begins suddenly, usually within a few seconds after a pulmonary embolism;
- sudden, severe chest pain;
- coughing up blood;
- pleuritic chest pain, which is worse when inhaling;
- wheezing and whistling in the lungs (chest);
- low blood pressure
- heart palpitations (tachycardia)
- rapid breathing (shortness of breath);
- blue or pale appearance of lips and fingers (cyanosis);
- cardiac arrhythmias (cardiac arrhythmias), such as atrial fibrillation, and related symptoms or serious consequences (e.g., confusion, loss of consciousness);
- signs or symptoms of deep vein thrombosis in one or both legs.
The severity of pulmonary embolism is usually determined by the size of the obstruction. If pulmonary embolism is extensive, the case is often described as massive PE. This can cause significant blockage of the pulmonary artery, leading to serious cardiovascular disorders, a dangerous drop in blood pressure and a serious drop in oxygen in the blood or oxygen deprivation, which affects the brain and the rest of the body.
A smaller pulmonary embolism causes less significant symptoms, but is still an urgent medical situation that can lead to death if left untreated. Smaller blood clots usually block one of the smaller branches of the pulmonary artery and can completely cover a small pulmonary vessel, which ultimately leads to pulmonary infarction, death of part of the lung tissue.
Thromboembolism of small branches of the pulmonary artery is often asymptomatic or has minor manifestations in the form of elevated body temperature, cough. The massive form of the disease is manifested by serious disorders of the respiratory system and the heart.
Options for the clinical course of pulmonary embolism:
- lightning fast – rapid development, complete obstruction of the main trunk or both branches, a fatal outcome occurs within a few minutes;
- acute – occlusion of the main and part of the lobar branches, the onset of sudden, rapid progression, the respiratory, cardiovascular systems and brain suffer, the condition lasts about 3-5 days, pulmonary infarction occurs;
- subacute – thrombosis of large and medium branches, signs of respiratory failure and cardiac activity come to the forefront, symptoms increase within a few weeks, with the occurrence of repeated emboli, the manifestations persist, often a fatal outcome;
- chronic – recurrent thrombosis of the lobar branches, it is characterized by a gradual increase in pressure in the vessels of the small circle, repeated heart attacks in the lung tissue, pneumonia and pleurisy, the appearance of signs of heart failure.
The clinical signs of thromboembolism are non-specific, they often accompany other diseases of the lungs and the cardiovascular system, so caution should be exercised in patients with risk factors.
Symptoms of thromboembolism are often similar to diseases of the heart and lungs. Sometimes, due to the non-specificity of manifestations, pulmonary embolism is not diagnosed on time, as a result complications develop. One of the consequences of thromboembolism is chronic pulmonary hypertension, manifested by shortness of breath during exercise, weakness, and increased fatigue. The severity of signs of pulmonary embolism depends on the massiveness of damage to the lung tissue, the type and number of affected vessels, and the presence of concomitant pathology.
Symptoms of pulmonary embolism:
- heart disorders: heart rate is more than 100 beats per minute, the patient complains of pain behind the sternum, atrial fibrillation, extrasystoles, sensation of pulsation and swelling of the veins of the neck, blood pressure is reduced;
- disorders of the respiratory system: shortness of breath, rapid breathing (more than 30 per minute), pallor of the skin due to hypoxia, cyanotic or gray shade, the appearance of wheezing, hemoptysis, cough, lung infarction may develop during the first 3 days;
- fever – an increase in body temperature due to inflammation of the lungs and their membrane;
- disorders of the gastrointestinal tract: hepatomegaly (an increase in liver size), impaired peristalsis, peritoneal irritation syndrome (acute pain in the right hypochondrium, belching, vomiting, hard stomach);
- immunological syndrome: pneumonia, pleura, rashes on the skin.
The severity of symptoms determines the severity of the condition and prognosis for the patient. All manifestations should be evaluated in aggregate; in isolation, they cannot indicate the presence of pulmonary embolism. The described symptoms are not specific for thromboembolism, therefore, to establish the correct diagnosis, the doctor collects the entire medical history of the patient, clarifies the presence of a pathology that could cause vascular thrombosis.
Despite the polymorphism of symptoms, there are 4 signs, without which it is impossible to talk about the presence of pulmonary embolism: shortness of breath, rapid breathing, tachycardia, pain.
Painful sensations can be different depending on the degree of tissue damage. With obstruction of the trunk of the pulmonary artery, the pain is acute, tearing. Such sensations arise due to compression of the nerves in the wall of the injured vessel. Chest pain may occur, extending to the arm or shoulder blade. Pulmonary infarction is accompanied by pain spread throughout the chest.
Severity of pulmonary embolism:
- the mild form manifests sluggishly, small branches are affected, the erased symptoms make the disease look like an exacerbation of bronchopulmonary pathology, chronic heart failure;
- moderate severity does not have such a lightning course as a severe form, but requires urgent medical attention; shortness of breath, tachypnea, tachycardia occurs, blood pressure decreases, chest pains appear, cyanosis of the nasolabial triangle against the background of pallor of the face;
- Severe form: severe symptoms, fulminant course, loss of consciousness, convulsions.
Pulmonary embolism does not have specific symptoms of the disease. Her clinical picture is diverse, may depend on the following factors:
- the severity of the disease;
- the rate of development of pathological processes in the lungs;
- manifestations of the pathology that provoked this complication.
When 25% of the vessels of the lungs are affected, the functions of the main organs are preserved, the clinic is not expressed. The patient has only shortness of breath.
With an increase in the volume of problematic blood vessels excluded from the general bloodstream, the following symptoms of pulmonary embolism can be observed:
- sternal sharp or constricting pain;
- shortness of breath;
- increase in heart rate;
- bloody sputum cough;
- chest rales;
- blue or pale skin;
Pulmonary embolism is often disguised as a serious illness – pneumonia, myocardial infarction, etc. Pathology may not be detected during the patient’s life.
Pulmonary embolism in most cases is characterized by the presence of syndromes associated with cerebral, respiratory, cardiac disorders.
Symptoms of pulmonary embolism in cases of cerebrovascular accident are observed in severe severe form of the disease. These include:
- noise in ears;
- impaired consciousness;
Blockage of the pulmonary vessel leads to a decrease in the pumping function of the heart. As a result, blood pressure in the system drops sharply. There may be signs of atelectasis, myocardial infarction.
To compensate for this condition, the heart rate (HR) is increased to 100 and above beats per minute. Symptoms of cardiac pulmonary embolism:
- severe tachycardia;
- constricting chest pain;
- heart murmur;
- pulsating swelling of the veins of the neck and solar plexus due to overflow with their blood;
A constant sign of pulmonary embolism is persistent dyspnea, indicating pulmonary failure. There is an increase in respiratory rate. In patients, blue skin is observed.
With the development of bronchospastic syndrome and the formation of foci of pulmonary infarction, wheezing, unproductive cough, chest pain, and body temperature increase.
A method based on x-ray visualization of the pulmonary artery by introducing a contrast medium into it.
It is carried out as an alternative method, however, it is impossible to make an accurate diagnosis on the basis of only this indicator, therefore confirmation is also necessary using computed tomography or other methods.
The method is used, as a rule, after echocardiography to formulate the diagnosis of pulmonary embolism in cases where tomography is impossible. This method is applicable as the final hardware diagnostic method only in people with a high risk of developing pathology.
For moderate to low risk, a different blood clot detection algorithm is used, which begins with a blood test for the presence of a D-dimer. If the indicator is too high, the patient is referred for examination, with which you can confirm or deny the diagnosis. In addition to these hardware methods, venous compression ultrasonography, ECG or contrast phlebography can be used to determine pulmonary embolism.
Timely diagnosis of pulmonary embolism significantly increases the chances of a successful outcome, because mortality is reduced to about 1-3%. Today, pulmonary embolism is still a problem for treatment, this is due to the possibility of almost instant death of the patient.
Anticoagulant therapy can be prescribed to the patient at the stage of diagnosing the disease until the final test results. The main goal of this method is to reduce mortality among people with a high risk of the disease, and also if there is a recurrent pulmonary embolism. Anticoagulant therapy is suitable as prevention of pulmonary embolism.
Treatment of pulmonary embolism with anticoagulants on average lasts about 3 months, although according to the doctor’s test, the duration of therapy can be increased. Thrombolytic therapy is based on the use of drugs, the exact dosage and reception of which the doctor calculates based on the weight of the patient and the current condition. Here is a list of the most popular drugs that the history of pulmonary embolism requires for use:
- Unfractionated heparin;
REASONS FOR THE BODY
Classification of Pulmonary Thromboembolism
Often, blockage of blood vessels occurs by a thrombus formed in the lower extremities as a result of thrombosis. With a blood stream, the embolus is transferred to the lung and blocks the vessels. Blood clots from the upper extremities, abdominal cavity, and heart can provoke pulmonary embolism.
The main cause of pulmonary embolism should be considered deep vein thrombosis. This disease may be associated with:
- with impaired blood flow due to human inactivity;
- with an increase in blood coagulability, which is facilitated by diseases – oncology, thrombophilia, heart failure, etc .;
- with damage to the vessel wall due to injuries during operations, inflammatory processes, etc.
Other causes of pulmonary embolism are the presence of severe pathologies such as coronary heart disease, myocardial infarction, infectious endocarditis, rheumatism, etc.
Factors contributing to the emergence of pulmonary embolism should be considered:
- old and senile age;
- pregnancy and complicated birth;
- excess weight;
- taking hormonal contraceptives;
- the presence of a relative with venous thrombosis;
- any surgical intervention.
In rare cases, during the formation of pulmonary embolism, the causes may be associated with a long stay in an immobilized position.
Today, a very high percentage of people with cardiovascular diseases die precisely due to the development of pulmonary embolism.
Quite often, pulmonary embolism causes the death of patients in the period after surgery. According to medical statistics, approximately one fifth of all people with manifestation of pulmonary thromboembolism die.
In this case, a fatal outcome in most cases occurs already in the first two hours after the development of embolism.
Experts say that it is difficult to determine the incidence of pulmonary embolism, since about half of the cases of the disease pass unnoticed. General symptoms of the disease are often similar to signs of other diseases, so the diagnosis is often erroneous.
Most often, pulmonary embolism occurs due to blood clots that originally appeared in the deep veins of the legs. Therefore, the main cause of pulmonary embolism is most often the development of deep vein thrombosis.
In more rare cases, thrombi from veins of the right heart, abdomen, pelvis, and upper limbs provoke thromboembolism. Very often, blood clots appear in those patients who, due to other ailments, constantly observe bed rest.
Most often these are people who suffer from myocardial infarction, lung diseases, as well as those who received spinal cord injuries, underwent surgery on the hip. Significantly increases the risk of thromboembolism in patients with thrombophlebitis.
However, pulmonary embolism sometimes affects people without signs of chronic illness. Usually this happens if a person is in a forced position for a long time, for example, often makes flights by plane.
In order for a blood clot to form in the human body, the following conditions are necessary: the presence of damage to the vascular wall, slowed blood flow at the site of damage, and high blood coagulation.
Damage to the walls of the vein often occurs with inflammation, during injuries, as well as with intravenous injections. In turn, the blood flow slows down due to the development of heart failure in a patient with a prolonged forced position (wearing gypsum, bed rest).
Doctors determine a number of disorders of a hereditary nature as causes of increased blood coagulation, and a similar condition can provoke the use of oral contraceptives and AIDS. A higher risk of blood clots is determined in pregnant women, in people with a second blood group, as well as in patients with obesity.
The most dangerous are blood clots, which are attached to the vessel wall at one end, while the free end of the blood clot is in the lumen of the vessel.
Sometimes just a little effort is enough (a person can cough, make a sharp movement, strain), and such a blood clot breaks off. Further, with blood flow, a blood clot appears in the pulmonary artery.
In some cases, a blood clot hits the walls of the vessel and breaks into small parts. In this case, blockage of small vessels in the lungs may occur.
Specialists determine three types of pulmonary embolism, depending on how much lung vessel damage is observed. With massive pulmonary embolism affects more than 50% of the vessels of the lungs. In this case, the symptoms of thromboembolism are expressed by shock, a sharp drop in blood pressure, loss of consciousness, there is a failure of the function of the right ventricle. The result of cerebral hypoxia in massive thromboembolism is sometimes cerebral disturbance.
Submassive thromboembolism is determined in case of damage from 30 to 50% of the vessels of the lungs. With this form of the disease, a person suffers from shortness of breath, but blood pressure remains normal. Violation of the functions of the right ventricle is less pronounced.
With non-massive thromboembolism, the function of the right ventricle is not impaired, but the patient suffers from shortness of breath.
According to the severity of the disease, thromboembolism is divided into acute, subacute and recurrent chronic. In the acute form of the disease, pulmonary embolism begins abruptly: hypotension, severe chest pain, shortness of breath are manifested.
In the case of subacute thromboembolism, there is an increase in right ventricular and respiratory failure, signs of heart attack pneumonia.
A recurring chronic form of thromboembolism is characterized by a recurrence of shortness of breath, symptoms of pneumonia.
Symptoms of thromboembolism directly depend on how massive the process is, as well as on the condition of the patient’s blood vessels, heart and lungs. The main signs of developing pulmonary thromboembolism are severe shortness of breath and rapid breathing. The manifestation of shortness of breath is usually sharp. If the patient is in a supine position, then it becomes easier for him.
The onset of dyspnea is the first and most characteristic symptom of pulmonary embolism. Shortness of breath indicates the development of acute respiratory failure. It can be expressed in different ways: sometimes a person thinks that he does not have enough air, in other cases shortness of breath manifests itself especially pronounced.
In addition to shortness of breath and tachycardia, pain in the chest or a feeling of some discomfort is manifested. The pain can be different. So, most patients note a sharp dagger pain behind the sternum. The pain can last several minutes and several hours.
If embolism of the main trunk of the pulmonary artery develops, then the pain can be tearing in nature and felt behind the sternum. With massive thromboembolism, pain can spread beyond the sternum. Embolism of small branches of the pulmonary artery can occur without pain at all.
In some cases, blood spitting, blueing or blanching of the lips, ears of the nose may occur.
When listening, the specialist detects wheezing in the lungs, systolic murmur over the region of the heart. When conducting an echocardiogram, thrombi are found in the pulmonary arteries and the right heart, there are also signs of impaired right ventricular function. X-rays show changes in the patient’s lungs.
As a result of blockage, the pumping function of the right ventricle decreases, as a result of which insufficient blood enters the left ventricle. This is fraught with a decrease in blood in the aorta and arteries, which provokes a sharp decrease in blood pressure and a state of shock. Under such conditions, the patient develops myocardial infarction, atelectasis.
Often the patient has an increase in body temperature to subfebrile, sometimes febrile indicators. This is due to the fact that many biologically active substances are released into the blood.
Fever can last from two days to two weeks.
A few days after pulmonary thromboembolism, some people may experience chest pain, coughing, blood spitting, symptoms of pneumonia.
The main examination methods for thromboembolism should include an ECG, chest x-ray, echocardiogram, and biochemical blood tests.
It should be noted that in approximately 20% of cases, the development of thromboembolism cannot be determined using an ECG, since no changes are observed. There are a number of specific features identified during these studies.
The most informative method of research is ventilation-perfusion scanning of the lungs. An angiopulmonography study is also being conducted.
In the process of diagnosing thromboembolism, an instrumental examination is also indicated, during which the doctor determines the presence of phlebothrombosis of the lower extremities. To detect vein thrombosis, radiopaque phlebography is used. Ultrasound dopplerography of the vessels of the legs reveals violations of patency of the veins.
The treatment of thromboembolism is aimed primarily at enhancing lung perfusion. Also, the goal of therapy is to prevent manifestations of postembolic chronic pulmonary hypertension.
If there is a suspicion of the development of pulmonary embolism, then at the stage prior to hospitalization, it is important to immediately ensure that the patient adheres to the strictest bed rest. This will prevent the recurrence of thromboembolism.
Catheterization of the central vein is carried out for infusion treatment, as well as careful monitoring of central venous pressure.
To reduce severe pain and relieve a small circle of blood circulation, the patient needs to take narcotic analgesics (for this purpose, 1% morphine solution is mainly used). This drug also effectively reduces shortness of breath.
Patients who have acute failure of the right ventricle, shock, arterial hypotension, reopoliglyukin administered intravenously. However, this drug is contraindicated in cases of high central venous pressure.
In order to lower the pressure in the pulmonary circulation, intravenous administration of aminophylline is prescribed. If systolic blood pressure does not exceed 100 mm Hg. Art., then this drug is not used. If a patient is diagnosed with heart attack pneumonia, he is prescribed antibiotic therapy.
- The fastest method to solve the problem is surgical thrombectomy. The operation will help even in cases where pulmonary embolism develops rapidly, but the patient is promptly delivered to the cardiac surgery department. This method involves cutting both pulmonary arteries and removing a blood clot.
- Another way to solve the problem of repeated episodes of pulmonary embolism is through venous filters. Basically, the technique is used for contraindications to anticoagulants. The essence of the filters is that they do not allow the torn off emboli together with the bloodstream to reach the pulmonary artery. Filters can be set for several days or for a longer period. However, such treatment for pulmonary embolism is usually associated with many risks.
- It is worth noting the features of treatment in specific patients. Pulmonary embolism can occur in pregnant women, but it is difficult to determine the diagnosis. At moderate or low risk, a blood test for a D-dimer is practically useless, since during this period its indicators will in any case differ from normal ones. Conducting CT and other diagnostic procedures is associated with irradiation of the fetus, which often negatively affects its development. Treatment is carried out with anticoagulants, since most of them are absolutely safe both during pregnancy and during lactation. There is no way to use only vitamin K antagonists (warfarin). In the treatment of pulmonary embolism, the doctor pays special attention to the delivery.
- If the clot was caused not by a blood clot, but by another clot, pulmonary embolism will be treated based on the reasons for its formation. A foreign body can only be removed surgically. However, if the clot that formed after the injury consists only of fat, treatment does not require surgical intervention, since the fat will resolve on its own over time, it is only necessary to maintain the patient in good condition.
- Removal of air bubbles from the bloodstream is carried out by introducing a catheter. The infectious embolus is removed by intensive treatment of the disease that caused it. Unfortunately, the most common cause of infectious embolism is intravenous drug administration with an infected catheter. Complications of pulmonary embolism in this case are manifested not only in the form of a clogging clot, but also in sepsis.
REASONS FOR THE BODY
- obstruction of the trunk of the pulmonary artery – the most severe form, mortality in 60-75% of cases;
- obstruction of large branches leads to blockage of blood flow in the lobes of the lung, mortality with this form of the disease reaches 6-10%;
- embolism of small branches of the pulmonary artery – the minimum risk of death.
Emergency care for pulmonary embolism
First aid for thromboembolism – creating complete rest for the patient. It is necessary to monitor the patient until the arrival of the ambulance team. Lay the victim on a hard surface, release the neck if clothing compresses it, and allow air to enter the room.
Emergency care for pulmonary embolism is based on intensive resuscitation measures: mechanical ventilation is performed, oxygenation is performed. At the prehospital stage, the administration of Heparin with Reopoliglukin is indicated intravenously, then a catheter is inserted into one of the central veins through which Eufillin, No-shpa and Altifillin are introduced.
To stop the pain, Fentanyl, Droperidol or another approved drug is used. Severe pain is an indication for the use of Morphine (in the absence of seizures). After stabilization of the patient’s condition, they are delivered to the cardiac surgery department.
In the case of subtotal pulmonary embolism, the rate of development of symptoms is much lower, but this does not reduce the risk to life. Here, the branch of the lobar pulmonary artery is obstructed, and therefore initially the volume of the lesion is much smaller. The patient does not lose consciousness abruptly, and arrhythmia does not develop suddenly. However, due to the development of reflex reactions of arteriolospasm and the appearance of shock symptoms, the patient’s condition deteriorates sharply, severe shortness of breath develops, and the severity of acute heart and respiratory failure increases.
In the absence of treatment for pulmonary embolism and the impossibility of thrombolysis, the probability of death is about 95-100%. Relatives of the patient should understand that such a patient requires emergency thrombolytic therapy, and therefore it is impossible to hesitate in going to the ambulance. For comparison, with thromboembolism of the branches of the pulmonary artery, where the vessels of small caliber are obstructed, the patient can survive without medical assistance.
It is to survive, because we are not talking about a quick recovery, but about survival with current disorders in the work of the cardiovascular and respiratory systems. The severity of his condition will gradually increase with the worsening of shortness of breath, hemoptysis and the development of heart attack pneumonia. If these symptoms appear, you must immediately contact the emergency room of the hospital or emergency medical care.
Pulmonary thromboembolism (embolism, pulmonary embolism): symptoms, treatment, what it is, small branches, signs, causes, classification, diagnosis
The main directions of therapy for patients with pulmonary embolism:
- life support;
- elimination of pathological reflex reactions;
- elimination of occlusion;
- stopping collapse;
- pressure reduction in a small circle;
- oxygen therapy.
A complex of medications is used to treat pulmonary embolism. Among them are anticoagulants (Heparin, Warfarin) and thrombolytics (Urokinase, Streptokinase).
Venous thromboembolism in most cases (with the exception of absolute contraindications) requires the use of anticoagulants (Heparin, Warfarin), which affect blood coagulation factors and prevent excessive thrombosis. Heparin has a quick effect, so its use is indicated in the early stages of pulmonary embolism.
Thrombolytics are drugs whose action eliminates a blood clot. Drugs of choice: Alteplase, Streptokinase, Urokinase. These are powerful agents, therefore, before use, the indications and possible risks should be assessed: the use of such drugs can lead to the development of bleeding, including intracerebral hemorrhages.
Surgical treatment of pulmonary embolism is performed for patients with contraindications for thrombolysis. This is a complex manipulation, which can lead to serious consequences, including death, so the doctor, deciding on the intervention, evaluates the indications and contraindications.
Indications for surgical treatment of pulmonary embolism:
- massive thromboembolism;
- lack of effectiveness of conservative therapy;
- pulmonary embolism or large branches;
- severe hypotension.
With pulmonary embolism, 2 types of operations are performed:
- embolectomy – removal of thrombotic masses, is used in acute PE;
- endarterectomy – removal of the inner vessel wall in chronic pulmonary embolism.
Installing a cava filter avoids thromboembolism in patients at high risk of relapse. The device is a special mesh, which is placed in the lumen of the inferior vena cava. Thrombotic masses cannot pass through it and reach the pulmonary artery. This is an endovascular operation, the doctor performs a puncture and introduces a special catheter into the jugular, subclavian or large saphenous vein, through which the device is delivered to the installation site.
Regardless of the qualifications of medical personnel with massive pulmonary thromboembolism, the clinic, diagnosis and treatment can fit in the first 30 minutes, especially in the case of rapid development of arrhythmia and clinical death. Then the patient quickly dies, although the diagnosis itself is not in doubt. Often, pulmonary embolism is detected at the stage of the SMP, and the main diagnostic symptoms are:
- complaints of sharply arisen severe pressing and stitching “dagger” pains in the chest, after which the patient screams and sometimes falls unconscious;
- sharply appeared shortness of breath, severe feeling of lack of air and squeezing in the chest;
- palpitations with the development of pain in the heart, irregular heartbeat;
- the sudden appearance of a dry cough at first against a background of full health, and then with bloody sputum;
- sharply developed cyanosis (bluish-cyanotic color) of the lips, gray (earthy) complexion, swelling of the veins of the neck;
- decrease in blood pressure with a massive or sharp increase in blood pressure with submassive and recurrent pulmonary embolism, fainting, or loss of consciousness.
The main goal of diagnosis for such symptoms is to exclude myocardial infarction. If the ECG does not have signs of transmural infarction, then with a high degree of probability the current state should be interpreted as pulmonary embolism and provide appropriate emergency care. With pulmonary embolism, an ECG may indicate: inversion of the T wave and the appearance of the Q wave in lead III, the appearance of the S wave in lead I.
One of the diagnostic criteria is the expansion of the P wave and the increase in its voltage in the initial segment. Also, changes on the ECG are “volatile”, that is, they can change over a short period of time, which indirectly confirms pulmonary embolism and reduces the number of convincing criteria in favor of myocardial infarction.
With recurrent pulmonary embolism, the symptoms, treatment and diagnosis are somewhat different, which is associated with a much smaller lesion volume. For example, if with a massive pulmonary embolism, the size of the thrombus is about 8-10 mm in width and from 5-6 to 20 cm in length, then with a relapsing lung, many small clots 1-3 mm in size fall into the lung.
Treatment includes oxygen therapy with 100% oxygen, preferably mechanical ventilation, narcotic analgesia (morphine or fentanyl, neuroleptanalgesia is allowed), anticoagulant therapy with unfractionated heparin 5000-10000 IU, thrombolysis with Streptokinase 250 000ED with preliminary administration of Prednisolone 90 mg.
In addition to this treatment for pulmonary embolism, infusion therapy and compensation for existing disorders are required: defibrillation with appropriate arrhythmias and cardiotonic drugs for hypotension. The indicated treatment is highly effective, but it will not help to completely dissolve the thrombus – hospitalization in the intensive care unit is required.
It is important to understand that the cost of error at the prehospital stage may not be crucial in terms of prognosis for the patient. For example, in the case of changes on the ECG that are characteristic of a heart attack on the background of developing pulmonary embolism, narcotic analgesia and anticoagulant therapy with similar drugs are also indicated. Only the appointment of nitrates can cause harm, which will accelerate the drop in blood pressure.
Patients and SMP staff also need to remember that with myocardial infarction with low blood pressure (less than 10050 mmHg) or suspected pulmonary embolism, nitrates should not be taken. Thus, the provision of care to a patient with pulmonary embolism is almost the same as for myocardial infarction with left ventricular failure amid hypotension. This means that the SMP employee has additional time for diagnosis against the background of the started effective treatment of pulmonary embolism.
Diagnosis and treatment of pulmonary embolism at the hospital stage is more effective than prehospital. This is partly a purely statistical conclusion, because due to massive thromboembolism, they often do not even end up in hospital because of the high prehospital mortality. And in the case of submassive pulmonary embolism, heart attack pneumonia and recurrent thromboembolism of the pulmonary artery disease “gives time” for high-quality diagnosis and treatment. Identified symptoms are similar to those that occurred during the diagnosis at the prehospital stage.
The exclusion of a heart attack by ECG and the appearance of signs of overload of the right heart immediately directs the doctor towards pulmonary embolism. To confirm the diagnosis, x-rays, emergency laboratory tests are performed: a quantitative analysis for D-dimers, troponin T, KFK-MB, myoglobin. With pulmonary embolism, D-dimers significantly increase with a normal troponin index (a marker of myocardial infarction).
The gold standard for diagnosing pulmonary embolism is the rarely available method of angiopulmonography or perfusion scanning. He is able to reliably confirm or refute the diagnosis of thromboembolism, however, such a study is not possible in most hospitals, or because of the severity of the condition, the patient dies before it.
REASONS FOR THE BODY
The consequences of pulmonary embolism
With the timely provision of a sufficient amount of medical care to patients with mild pulmonary thromboembolism, the prognosis is favorable. In the case of pronounced changes in the organs of the cardiovascular and respiratory systems, mortality exceeds 30%. With massive thromboembolism, the most unfavorable prognosis, mortality can reach 100%.
TELA is a dangerous condition that takes third place in the list of main causes of death.
The main factors that determine the prognosis for pulmonary embolism:
- timeliness of treatment;
- the presence of concomitant cardiovascular diseases;
- the presence of risk factors.
The main danger of pulmonary embolism is a fatal outcome that occurs with a severe course of the disease. However, even if there is a mild or moderate severity of the disease, immediate treatment is required.
In the absence of timely assistance, complications may develop:
- pulmonary infarction;
- pleurisy and pneumonia;
- acute renal insufficiency;
- embolism of blood vessels of the pulmonary circulation;
- chronic pulmonary hypertension.
Diagnosis at the prehospital stage
Hospital treatment of pulmonary embolism requires careful monitoring of the patient’s condition in the intensive care unit. After confirming the diagnosis, it is necessary to start thrombolytic therapy with tissue plasminogen proactivators – “Tenecteplase” or “Alteplase”. These are new thrombolytic drugs, the main advantage of which is the absence of thrombus fragmentation. They lyse it, as it were, in layers, in contrast to Streptokinase.
Thrombolytic therapy (TLT) is designed to dissolve a blood clot, if possible. However, if it is impossible to perform TLT, surgical thromboextraction can be performed – the most difficult operation for the patient in conditions of autonomous blood circulation, which should be resorted to only in cases where without intervention the patient will certainly die.
It is important to note that in this situation there simply cannot be any concept of “supportive strengthening treatment” that is so popular among the CIS population. It is important here not to interfere with the staff and comply with medical recommendations. Pulmonary thromboembolism is a disease that, until recently, in the case of a submassive or massive embolism, has always been lethal and incurable.
All measures during treatment are now aimed at effective thrombolysis and intensive care: adequate oxygen therapy, cardiotonic support, infusion therapy, and parenteral nutrition. By the way, pulmonary embolism is a disease where each appointment is literally “written in blood” due to the earlier total mortality.
Prevention of pulmonary embolism is the prevention of deep vein thrombosis; the need for it depends on the risks of the patient, including:
- type and duration of surgery;
- concomitant diseases, including cancer and hypercoagulable disorders;
- the presence of a central venous catheter;
- DVT or pulmonary embolism in the anamnesis.
Patients bedridden and patients subject to surgical, especially orthopedic, operations have an advantage, and most of these patients can be identified before a blood clot forms. Preventive recommendations include the administration of low-dose unfractionated heparin, low molecular weight heparins, warfarin, fondaparinux, oral anticoagulants (rivaroxaban, apixaban, dabigatran), the use of compression devices or elastic compression stockings.
The choice of drug or device depends on various factors, including the patient population, perceived risk, contraindications (such as risk of bleeding), relative costs, and ease of use.
Healthy people who just want to warn themselves against this disease need to undergo a constant diagnosis (1 time every 6 months), exercise, keep weight under control and be sure not to smoke.
Prevention of thromboembolism is indicated for people at high risk of developing pulmonary embolism:
- age: venous thromboembolism often develops in patients older than 50 years;
- history of heart attack or stroke;
- history of surgical interventions;
- deep vein thrombosis of the legs or pulmonary embolism.
Venous thromboembolism affects patients at risk and has a relapsing course. To prevent the development of the disease, special attention should be paid to prevention, which reduces the risk of re-development of the pathology.
Prevention of Pulmonary Thromboembolism:
- periodic ultrasound of the vessels of the lower extremities;
- wearing compression hosiery;
- hardware pneumatic massage;
- administration of heparin preparations subcutaneously;
- according to indications, ligation of large vessels of the lower extremities;
- the use of cava filters.
- important in the prevention of thrombosis and thromboembolism is the correction of lifestyle:
- elimination of risk factors that provoke thrombosis: normalization of nutrition, weight loss, moderate physical activity, maintaining a mobile lifestyle, eliminating alcohol and quitting smoking;
- treatment of chronic diseases.
Pulmonary thromboembolism is a serious condition requiring emergency medical care. Without adequate timely therapy, pulmonary embolism can be fatal. At the slightest suspicion of developing thromboembolism, you should consult a doctor, and in case of a serious condition, call an ambulance. Patients with a history of risk factors or episodes of pulmonary embolism should be especially wary.
To reduce the risk of pulmonary embolism in people prone to thrombosis, will help:
- balanced diet;
- the use of compression underwear;
- the use of anticoagulants;
- getting rid of bad habits – smoking, alcohol abuse;
- leading an active lifestyle;
- weight loss.
The condition of patients suffering from severe chronic pathologies (heart failure, diabetes mellitus, varicose veins, etc.) who are in bed for a long time after surgery should be strictly monitored by specialists.
How to treat
Treatment of pulmonary embolism can be:
- minimally invasive;
- emergency removal of the patient from a condition that threatens his life;
- elimination of blood clots in the arteries;
- removal of the symptoms of the disease;
- restoration of lung and heart functionality.
The tactics and type of treatment is selected by the doctor, taking into account the severity of the disease, concomitant diseases, individual characteristics of the patient.
Drug treatment of pulmonary embolism is performed with the help of anticoagulants – medications that actively influence blood coagulation factors. These drugs dissolve existing blood clots, reduce the risk of their formation.
Common anticoagulants are drugs – Warfarin and Heparin. The latter is administered to the patient subcutaneously or intravenously. Warfarin is administered orally. But their prolonged use can cause serious consequences – bleeding, cerebral hemorrhage, nausea, vomiting, etc. When taking these drugs, blood coagulation should be controlled using a coagulogram.
Today, you can treat pulmonary embolism with safer, more effective drugs. These include – Apixaban, Dabigatran, Rivaroxaban.
In severe forms of pulmonary embolism, conservative treatment becomes ineffective. To save the patient’s life requires the use of radical measures. Indications for surgical intervention for pulmonary embolism should be considered:
- massive form of the disease;
- treatment failure;
- impaired general circulation;
- relapse, etc.
Pulmonary embolism is eliminated using the following types of surgical procedures:
- embolectomy, in which a thrombus is removed;
- thrombendarterectomy, when the inner wall of the blood vessel is removed along with the plaque.
Complex operations that occur with the opening of the patient’s chest and the transition to temporary artificial blood supply to the body.
These interventions are time-consuming, require the participation of high-class specialists – thoracic surgeons and cardiac surgeons.
Today, gentle surgeries are often used to eliminate a blood clot:
- catheter embolectomy;
- catheter thrombolysis with the help of medications – streptokinase, alteplase, urokinase.
Manipulations are carried out using a special catheter through small punctures of the skin. The catheter is led through the main veins to the site of the thrombus, where it is removed under constant computer monitoring.
The kava filter is a special mesh trap designed for detached blood clots. The device is installed in the inferior vena cava and serves as a preventive measure to protect against emboli of the pulmonary artery and heart.
When installing a cava filter, minimally invasive methods of treatment in the form of endovascular intervention are used. A specialist through a small puncture on the skin using a catheter through the veins delivers a mesh to the desired location, where it straightens and fixes it. The catheter is brought out. The main veins when installing the trap are considered large subcutaneous, jugular or subclavian veins.
Manipulations are carried out under slight anesthesia and last no more than an hour. After this, the patient is prescribed for 2 days bed rest.
Complications and forecasts of doctors
The likelihood of death from pulmonary embolism is very low, but massive pulmonary embolism can cause sudden death. Most deaths occur before the disease is diagnosed, usually within a few hours after embolism. Important factors in determining life prognosis include:
- size of occlusion;
- clogged pulmonary arteries;
- the number of blocked pulmonary arteries;
- the effect of the condition on the ability of the heart to pump blood;
- general state of human health.
Anyone who has a serious heart or lung problem is at increased risk of death from a pulmonary embolism. A person with normal lung and heart function usually survives if occlusion does not block half or more of the pulmonary arteries.
Pulmonary embolism has an unfavorable prognosis of the course, which depends on the timeliness of detection, proper treatment, the presence of other serious pathologies. With unfavorable development of pulmonary embolism, mortality is more than 60%. Patients die due to complications from the respiratory and cardiovascular systems.
Common complications of this disease should be considered:
- pulmonary infarction;
- lung abscess;
- cardiac arrest, etc.