Pulmonary infarction is a disease caused by thromboembolic processes in the vascular system of the lungs. This is a fairly serious illness that can lead to death in especially severe cases.
Causes of disease
The disease can develop due to surgical intervention, disruption of the normal functioning of the heart, bone fracture, malignant tumors, in the postpartum period, after prolonged bed rest. The resulting thrombus closes the lumen of the vessel, resulting in increased pressure in the pulmonary artery system and a hemorrhage occurs in the lung tissue. Pathogenic bacteria penetrate the affected area, which leads to inflammation.
Development of lung infarction
Acute pulmonary hypertension with an increased load on the right side of the heart can be caused by obstruction of the lumen of the vessel, vasoconstriction associated with the release of biologically active substances: histamine, serotonin, thromboxane, as well as reflex spasm of the pulmonary artery. In this case, oxygen diffusion fails and arterial hypoxemia occurs, which is exacerbated by the release of underoxidized blood through the intersystem and pulmonary arteriovenousanastomoses. The development of pulmonary infarction occurs against the background of already existing stagnation in the veins. A day after the obstruction of the lung vessel, the formation of a heart attack occurs, its full development ends approximately on the 7th day.
Pathological Anatomy
The area of the lungs affected by a heart attack has the shape of an irregular pyramid, its base is directed to the periphery. The affected area can be of various sizes. In some cases, exudative pleurisy or infarct pneumonia joins. Under the microscope, affected lung tissue is dark red, firm to the touch, and protrudes above he althy tissue. The pleura becomes dull, dull, often fluid collects in the pleural cavity.
Infarction of the lung: symptoms of the disease
The manifestations and severity of the disease depend on the size, number and location of vessels closed by blood clots, as well as on concomitant diseases of the heart and lungs. A minor infarction often gives almost no signs and is detected by X-ray examination. More pronounced heart attacks are manifested by chest pain, often occurring suddenly, shortness of breath, cough, hemoptysis. A more objective examination reveals a rapid pulse and fever. Symptoms of pronounced heart attacks are: bronchial breathing with moist rales and crepitus, dullness of percussion sound. There are also signs such as:
- pale, often ashy skin tone;
- blue nose, lips, fingertips;
- lower blood pressure;
- appearance of atrial fibrillation.
The defeat of large branches of the artery of the lung can provoke right ventricular failure, suffocation. Leukocytosis is detected in the blood, the erythrocyte sedimentation reaction (ERS) is significantly accelerated.
Diagnosis
It is often difficult to establish a diagnosis. It is very important to identify diseases that can potentially complicate a pulmonary infarction. To do this, it is necessary to conduct a thorough examination of the patient (especially the lower limbs). In a heart attack, unlike pneumonia, pain in the side occurs before fever and chills, sputum with blood also appears after severe pain in the side. The following methods are used to diagnose the disease:
- X-ray examination - to detect the expansion of the root of the lung and its deformation.
- ECG - to detect signs of overload of the right heart.
- Echocardiography - manifestations of right ventricular overload are determined.
- Doppler ultrasound examination of the veins of the lower extremities - diagnosis of deep vein thrombosis.
- Radioisotope lung scan - to detect areas of reduced lung perfusion.
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Angiopulmonography - to detect obstruction of lung artery branches, intra-arterial filling defects.
pulmonary edema after a heart attack
Lung infarction:consequences
This disease, as a rule, does not pose a great threat to human life. However, after such an ailment as a lung infarction, the consequences can be severe. A variety of complications may develop. For example, such as post-infarction pneumonia, suppuration and spread of inflammation to the pleura, pulmonary edema. After a heart attack, there is a high risk of a purulent embolus (blood clot) entering the vessel. This, in turn, causes a purulent process and promotes an abscess at the site of the infarction. Pulmonary edema in myocardial infarction develops, first of all, with a decrease in the contractility of the heart muscle and with simultaneous retention of blood in the small circle. As the intensity of heart contractions decreases suddenly, an acute low output syndrome develops, which provokes severe hypoxia. At the same time, there is excitation of the brain, the release of biologically active substances that contribute to the permeability of the alveolar-capillary membrane, and an increased redistribution of blood into the pulmonary circulation from the large. The prognosis of a pulmonary infarction depends on the underlying ailment, the size of the affected area and the severity of the general manifestations.
Treatment of disease
When the first signs indicating a pulmonary infarction are detected, treatment should be started immediately. The patient needs to be taken to the intensive care unit of a medical institution as soon as possible. Treatment begins with the introduction of the drug "Heparin", this agent does not dissolve the thrombus, but it preventsan increase in thrombus and can stop the thrombotic process. The drug "Heparin" is able to weaken the bronchospastic and vasoconstrictive effect of platelet histamine and serotonin, which helps to reduce spasm of the pulmonary arterioles and bronchioles. Heparin therapy is carried out for 7-10 days, while monitoring activated partial thromboplastin time (APTT). Low molecular weight heparin is also used - d alteparin, enoxaparin, fraxiparin.
In order to relieve pain, reduce the load on the pulmonary circulation, reduce shortness of breath, narcotic analgesics are used, for example, Morphine (a 1% solution is injected intravenously). If a pulmonary infarction provokes pleural pain, which is affected by breathing, body position, cough, then it is recommended to use non-narcotic analgesics, such as Analgin (intravenous administration of a 50% solution). When diagnosing pancreatic insufficiency or shock, vasopressors (dopamine, dobutamine) are used for treatment. If bronchospasm is observed (at normal atmospheric pressure), it is necessary to slowly inject a 2.4% solution of aminophylline intravenously. If a heart attack develops-pneumonia of the lung, antibiotics are required for treatment. Calm hypotension and hypokinesis of the right ventricle suggest the use of thrombolytic agents ("Alteplaz", "Streptokinase"). In some cases, surgery may be requiredintervention (thrombectomy). On average, small heart attacks are eliminated in 8-12 days.
Disease prevention
To prevent pulmonary infarction, it is necessary first of all to prevent venous congestion in the legs (thrombosis of the veins of the lower extremities). To do this, it is recommended to massage the limbs, for patients who have undergone surgery, myocardial infarction, apply an elastic bandage on the lower leg. It is also recommended to exclude the use of drugs that increase blood clotting, and limit the use of intravenous drug administration. According to the indications, it is possible to prescribe drugs that reduce blood clotting. To prevent concomitant infectious diseases, a course of antibiotics is prescribed. In order to prevent pulmonary hypertension, the use of Eufillin is recommended.
