The heart is an important organ in the human body. The cessation of his work symbolizes death. There are a large number of diseases that adversely affect the functioning of the entire cardiovascular system. One of these is PE, a pathology clinic, the symptoms and therapy of which will be discussed below.
What is a disease
PE, or pulmonary embolism, is a common pathology that develops when the pulmonary artery or its branches are clogged with blood clots. They most often form in the veins of the lower extremities or pelvis.
In medical practice, the PE clinic is also considered when the vessels are blocked by parasitic organisms, neoplasms or foreign bodies.
Thromboembolism is the third leading cause of death, behind only ischemia and myocardial infarction.
Most often the disease is diagnosed in old age. Men are three times more likely than women to suffer from this disease. If PE therapy (ICD-10 code - I26) is started in a timely manner, then it is possible to reduce mortality by 8-10%.
Reason for developmentdiseases
In the process of development of pathology, clots form and blockage of blood vessels occurs. Among the causes of PE are the following:
- Impaired blood flow. This can be observed against the background of development: varicose veins, compression of blood vessels by tumors, phlebothrombosis with destruction of vein valves. Blood circulation is disturbed when a person is forced to remain still.
- Damage to the wall of a blood vessel, causing blood to clot.
- Prosthetic veins.
- Installation of catheters.
- Surgical intervention on the veins.
- Infectious diseases of a viral or bacterial nature that provoke damage to the endothelium.
- Violation of the natural process of fibrinolysis (clot dissolution) and hypercoagulability.
The combination of several causes increases the risk of PE, the pathology clinic implies long-term treatment.
Risk factors
The following risk factors for PE significantly increase the likelihood of developing pathological processes:
- Long travel or forced bed rest.
- Heart or respiratory failure.
- Prolonged treatment with diuretics, which leads to the loss of large amounts of water and increased blood viscosity.
- Neoplasms, such as the formation of hemablastosis.
- High levels of platelets and red blood cells in the blood, which increases the risk of blood clots.
- Long-term use of hormonalcontraceptives, hormone replacement therapy - this increases blood clotting.
- Violation of metabolic processes, which is often observed in diabetes mellitus, obesity.
- Vascular surgery.
- Past strokes and heart attacks.
- High blood pressure.
- Chemotherapy.
- Spinal cord injury.
- Period of bearing a baby.
- Smoking abuse.
- Old age.
- Varicose veins. Creates favorable conditions for stagnation of blood and the formation of blood clots.
From the listed risk factors, we can conclude that no one is immune from the development of PE. The ICD-10 code for this disease is I26. It is important to suspect a problem in time and take action.
Types of disease
The PE clinic will depend on the type of pathology, and there are several of them:
- Massive PE. As a result of its development, most of the vessels of the lungs are affected. The consequences may be shock or the development of hypotension.
- Submassive. A third of all vessels in the lungs are affected, which is manifested by right ventricular failure.
- Non-massive form. It is characterized by damage to a small number of vessels, so there may be no symptoms of PE.
- Fatal when more than 70% of vessels are affected.
Clinical course of pathology
The PE clinic can be:
- Lightning fast. Blockage of the main pulmonary artery or majorbranches. Respiratory failure develops, respiratory arrest may occur. Death is possible within minutes.
- Spicy. The development of pathology is fast. The onset is sudden, followed by rapid progression. Symptoms of cardiac and pulmonary insufficiency are observed. Within 3-5 days, a pulmonary infarction develops.
- Lingering. Thrombosis of large and medium arteries and the development of several pulmonary infarctions continue for several weeks. Pathology slowly progresses with an increase in symptoms of respiratory and heart failure.
- Chronic. Recurrent thrombosis of the branches of the pulmonary artery is constantly observed. Recurrent pulmonary infarcts or bilateral pleurisy are diagnosed. Gradually increases hypertension. This form most often develops after surgery, against the background of oncology and existing cardiovascular diseases.
Disease development
Pulmonary embolism develops gradually through the following stages:
- Airway blockage.
- Increased pressure in the pulmonary artery.
- As a result of obstruction and blockage, gas exchange is disrupted.
- The occurrence of oxygen deficiency.
- Formation of additional pathways for the transport of poorly oxygenated blood.
- Increased load on the left ventricle and the development of its ischemia.
- Decrease in cardiac index and drop in blood pressure.
- Pulmonary arterialpressure is rising.
- Deterioration of coronary circulation in the heart.
- Pulmonary edema.
Many PE patients experience pulmonary infarction.
Signs of disease
The symptoms of PE depend on many factors:
- The general condition of the patient's body.
- Number of damaged arteries.
- The size of the particles clogging the vessels.
- The rate of disease progression.
- Degrees of disorders in lung tissue.
Treatment of PE will depend on the clinical condition of the patient. The disease in some proceeds without giving any symptoms, and can lead to sudden death. The complexity of diagnosis also lies in the fact that the pathology of symptoms resembles many cardiovascular diseases, but the main difference is the suddenness of the development of pulmonary embolism.
Pathology is characterized by several syndromes:
1. From the side of the cardiovascular system:
- Development of heart failure.
- Lower blood pressure.
- Irregular heart rhythm.
- Increased heart rate.
- Development of coronary insufficiency, which is manifested by sudden intense pain behind the sternum, lasting from 3-5 minutes to several hours.
- Cor pulmonale, the syndrome is manifested by swelling of the veins in the neck, tachycardia.
- Cerebral disorders with hypoxia, cerebral hemorrhage and in severe cases with cerebral edema. The patient complains of noiseears, dizziness, vomiting, convulsions and fainting. In severe situations, the likelihood of developing a coma is high.
2. Pulmonary-pleural syndrome manifests itself:
- The appearance of shortness of breath and the development of respiratory failure. The skin becomes gray, cyanosis develops.
- Whistling wheezes appear.
- A pulmonary infarction most often develops 1-3 days after pulmonary embolism, a cough appears with sputum discharge mixed with blood, body temperature rises, when listening, moist fine bubbling rales are clearly audible.
3. Feverish syndrome with the appearance of febrile body temperature. It is associated with inflammatory processes in the lung tissue.
4. Enlargement of the liver, irritation of the peritoneum, intestinal paresis cause abdominal syndrome. The patient complains of pain in the right side, belching and vomiting.
5. The immunological syndrome is manifested by pulmonitis, pleurisy, skin rashes, the appearance of immune complexes in the blood test. This syndrome usually develops 2-3 weeks after the diagnosis of PE.
Clinical recommendations for the development of such symptoms is to start urgent therapy.
Diagnostic measures
In the diagnosis of this disease, it is important to establish the place of formation of blood clots in the pulmonary arteries, as well as to assess the degree of damage and the severity of disorders. The doctor is faced with the task of determining the source of thromboembolism in order to prevent relapse.
Given the complexity of diagnosis, patients are sent tospecial vascular departments, which are equipped with technology and have the opportunity to conduct a comprehensive study and therapy.
If PE is suspected, the patient is given the following examinations:
- History taking and assessment of all risk factors.
- General analysis of blood, urine.
- Blood gas analysis, determination of D-dimer in plasma.
- ECG in dynamics to rule out heart attack, heart failure.
- X-ray of the lungs to exclude pneumonia, pneumothorax, malignant tumors, pleurisy.
- Echocardiography is performed to detect high pressure in the pulmonary artery.
- Lung scans will show reduced or no blood flow due to PE.
- Angiopulmonography is prescribed to detect the exact location of the thrombus.
- USDG of the veins of the lower extremities.
- Contrast phlebography to detect the source of PE.
After making an accurate diagnosis and finding the cause of the disease, therapy is prescribed.
First aid for PE
If an attack of the disease develops when a person is at home or at work, then it is important to provide timely assistance to him in order to reduce the likelihood of developing irreversible changes. The algorithm is as follows:
- Put a person on a flat surface, if he fell or sits at the workplace, then do not disturb him, do not shift.
- Unbutton the top button of your shirt, remove your tie to allow freshair.
- If breathing stops, perform resuscitation: artificial respiration and, if necessary, chest compressions.
- Call an ambulance.
Proper care for PE will save a person's life.
Treatment of disease
Therapy for PE is expected only in the hospital. The patient is hospitalized and prescribed full bed rest until the threat of vascular blockage has passed. Treatment of PE can be divided into several stages:
- Urgent resuscitation to eliminate the risk of sudden death.
- Restore the lumen of the blood vessel as far as possible.
Long-term therapy for PE involves the following activities:
- Removal of a blood clot from the vessels of the lungs.
- Carrying out activities to prevent thrombosis.
- Increase in the diameter of the pulmonary artery.
- Expansion of tiny capillaries.
- Carrying out preventive measures to prevent the development of diseases of the circulatory and respiratory system.
Treatment of pathology involves the use of drugs. Doctors prescribe to their patients:
1. Preparations from the group of fibrinolytics or thrombolytics. They are injected directly into the pulmonary artery through a catheter. These drugs dissolve blood clots, within a few hours after the administration of the drug, the person's condition improves, and after a few days there is no trace of blood clots.
2. At the next stage, the patient is recommended to take "Heparin". Firsttime, the drug is administered at a minimum dosage, and after 12 hours it is increased several times. The drug is an anticoagulant and, together with Warfarin or Phenilin, prevents the formation of blood clots in the pathological area of the lung tissue.
3. If there is no severe PE, then clinical recommendations imply the use of Warfarin for at least 3 months. The drug is prescribed in a small maintenance dosage, and then, based on the results of examinations, it can be adjusted.
All patients undergo therapy aimed at restoring not only the pulmonary arteries, but the entire body. She means:
- Cardiac treatment with Panangin, Obzidan.
- Taking antispasmodics: Papaverine, No-shpa.
- Medication to correct metabolic processes: preparations containing vitamin B.
- Anti-shock therapy with Hydrocortisone.
- Anti-inflammatory treatment with antibiotics.
- Taking antiallergic drugs: Suprastin, Zodak.
When prescribing drugs, the doctor should take into account that, for example, "Warfarin" penetrates the placenta, therefore, during pregnancy, it is prohibited to take it, and "Andipal" has many contraindications, it should be prescribed with caution to patients at risk.
Most of the drugs are injected into the body by drip infusion into a vein, intramuscular injections are painful and provoke the formation of large bruises.
Operationalinterference
Surgical treatment of pathology is rarely carried out, since such an intervention has a high percentage of patient mortality. If surgery cannot be avoided, intravascular embolectomy is used. The bottom line is that with the help of a catheter with a nozzle, a blood clot is removed through the chambers of the heart.
The method is considered risky and is used only when absolutely necessary.
In case of PE, it is also recommended to install filters, for example, "Greenfield's umbrella". It is inserted into the vena cava, and there its hooks open for fixation to the walls of the vessel. The resulting mesh freely passes blood, but the clots are retained and removed.
Treatment of PE grades 1 and 2 has a favorable prognosis. The number of deaths is minimal, the likelihood of recovery is high.
Complications of PE
Among the main and most dangerous complications of the disease are:
- Sudden death due to cardiac arrest.
- Progression of secondary hemodynamic disorders.
- Repeated pulmonary infarction.
- Development of chronic cor pulmonale.
Disease prevention
In the presence of serious cardiovascular pathologies or a history of surgical interventions, it is important to engage in the prevention of pulmonary embolism. Recommendations are as follows:
- Do not over-exercise.
- Spend a lot of time walking.
- Follow the daily routine.
- Ensuregood sleep.
- Eradicate bad habits.
- Revise the diet and remove harmful foods from it.
- Regularly visit a therapist for a preventive examination and a phlebologist.
These simple preventive measures will help avoid serious complications of the disease.
But in order to prevent pulmonary embolism, it is important to know what conditions and diseases can predispose to the development of venous thrombosis. Pay special attention to your he alth:
- People diagnosed with heart failure.
- Lying patients.
- Patients on long-term diuretic therapy.
- Using hormonal drugs.
- Diabetics.
- Stroke survivors.
Patients at risk should receive periodic heparin therapy.
PE is a serious pathology, and at the first symptoms it is important to provide a person with timely assistance and send him to the hospital or call an ambulance. This is the only way to prevent the development of serious consequences and save a person's life.
