Pulmonary embolism (PE) is a life-threatening disease. After all, we are talking about the formed blood clots. Among all pathologies, PE is distinguished by threatening statistics. Blood clots in the lungs can clog an artery at any moment. Unfortunately, quite often this leads to death. Nearly a third of all sudden deaths in patients result from blockage of the pulmonary artery by a blood clot.
Characteristics of the disease
PE is not an independent pathology. As the name suggests, this is a consequence of thrombosis.
A blood clot, breaking away from its place of formation, rushes through the system with the blood flow. Often, blood clots occur in the vessels of the lower extremities. Sometimes localized in the right side of the heart. The thrombus passes through the right atrium, ventricle and enters the pulmonary circulation. He moves alongthe only paired artery in the body with venous blood - the pulmonary.
A traveling blood clot is called an embolus. He rushes to the lungs. This is an extremely dangerous process. A blood clot in the lungs can suddenly block the lumen of the branches of the artery. These vessels are numerous in number. However, their diameter is decreasing. Once in a vessel through which a blood clot cannot pass, it blocks blood circulation. This is what often leads to death.
If a blood clot breaks off in a patient's lungs, the consequences depend on which vessel is blocked. The embolus disrupts the normal blood supply to tissues and the possibility of gas exchange at the level of small branches or large arteries. The patient has hypoxia.
Severity of disease
Thrombi in the lungs occur as a result of complications of somatic diseases, after birth and operational conditions. Mortality from this pathology is very high. It ranks 3rd among the causes of death, second only to cardiovascular diseases and oncology.
Today PE develops mainly due to the following factors:
- severe pathology;
- complex surgery;
- injured.
The disease is characterized by a severe course, many heterogeneous symptoms, difficult diagnosis, and a high risk of mortality. Statistics show, based on post-mortem autopsy, that pulmonary clots were not diagnosed in a timely manner in almost 50-80% of the population who died due to PE.
This disease proceeds very rapidly. That's whyit is important to quickly and correctly diagnose the pathology. And also to carry out adequate treatment that can save a human life.
If a blood clot in the lungs was detected in a timely manner, the percentage of survival increases significantly. Mortality among patients who received the necessary treatment is about 10%. Without diagnostics and adequate therapy, it reaches 40-50%.
Causes of disease
A thrombus in the lungs, the photo of which is located in this article, appears as a result of:
- deep vein thrombosis of the lower extremities;
- formation of a blood clot in any area of the venous system.
Significantly less often, this pathology can be localized in the veins of the peritoneum or upper limbs.
The risk factors that suggest the development of PE in a patient are 3 provoking conditions. They are called "Virchow's triad". These factors are:
- Reduced rate of blood circulation in the vein system. Stagnation in the vessels. Slow blood flow.
- Increased tendency to thrombosis. Hypercoagulability.
- Injury or damage to the venous wall.
Thus, there are certain situations that provoke the occurrence of the above factors, as a result of which a blood clot is detected in the lungs. Reasons may be hidden in the following circumstances.
Can lead to a slowdown in venous blood flow:
- long trips, trips, as a result of which a person has to sit inplane, car, train;
- hospitalization requiring long-term bed rest.
Blood hypercoagulability can lead to:
- smoking;
- contraceptive use, estrogen;
- genetic predisposition;
- oncology;
- polycythemia - a large number of red blood cells;
- surgery;
- pregnancy.
Injuries to the venous walls lead to:
- deep vein thrombosis;
- domestic leg injuries;
- surgical interventions on the lower extremities.
Risk factors
Medics identify the following predisposing factors in which a blood clot in the lungs is most often detected. The consequences of pathology are extremely dangerous. Therefore, it is necessary to carefully consider the he alth of those people who have the following factors:
- reduced physical activity;
- age over 50;
- oncological pathologies;
- surgical interventions;
- heart failure, heart attack;
- traumatic injury;
- varicose veins;
- use of hormonal contraceptives;
- complications of childbirth;
- erythremia;
- overweight;
- genetic pathologies;
- systemic lupus erythematosus.
Sometimes, blood clots in the lungs can be diagnosed in women after childbirth, especially heavy ones. As a rule, such a condition is preceded by the formation of a clot in the thigh or calf. He makes himself knownpain, fever, redness, or even swelling. Such a pathology should be immediately reported to the doctor so as not to aggravate the pathological process.
Characteristic symptoms
In order to timely diagnose a thrombus in the lungs, the symptoms of pathology should be clearly presented. You should be extremely careful with the possible development of this disease. Unfortunately, the clinical picture of PE is quite diverse. It is determined by the severity of the pathology, the rate of development of changes in the lungs and the signs of the underlying disease that provoked this complication.
If there is a thrombus in the lungs, the symptoms (mandatory) in the patient are as follows:
- Shortness of breath, suddenly onset for unknown reasons.
- There is an increase in heart rate (more than 100 beats in one minute).
- Paleness of the skin with a characteristic gray tint.
- Pain syndrome that occurs in different parts of the sternum.
- Impaired intestinal motility.
- Sharp blood filling of the cervical veins and solar plexus, their bulging is observed, pulsation of the aorta is noticeable.
- The peritoneum is irritated - the wall is quite tense, there is pain during the palpation of the abdomen.
- Heart Murmurs.
- Highly reduced blood pressure.
In patients who have a thrombus in the lungs, the above signs are always present. However, none of these symptoms are specific.
In addition to the mandatory features, the following may developstatus:
- fever;
- hemoptysis;
- fainting;
- chest pain;
- vomit;
- convulsive activity;
- fluid in sternum;
- coma.
The course of the disease
Since pathology is a very dangerous disease that does not exclude a fatal outcome, the resulting symptoms should be considered in more detail.
Initially, the patient develops shortness of breath. Its occurrence is not preceded by any signs. The reasons for the manifestation of anxiety symptoms are completely absent. Shortness of breath appears on exhalation. It is characterized by a quiet sound, accompanied by a rustling tone. However, she is constantly present.
Besides it, PE is accompanied by an increased heart rate. Listens to 100 beats or more in one minute.
The next important sign is a sharp drop in blood pressure. The degree of reduction of this indicator is inversely proportional to the severity of the disease. The lower the pressure drops, the more serious the pathological changes provoked by PE.
Pain sensations depend on the severity of the disease, the volume of damaged vessels and the level of disorders that have occurred in the body:
- Pain behind the sternum, which has a sharp, bursting character. This discomfort characterizes the blockage of the artery trunk. Pain occurs as a result of compression of the nerve endings of the vessel wall.
- Angina discomfort. The pain is squeezing. Localized in the region of the heart. Often gives to the shoulder blade, hand.
- Painful discomfort in the entire sternum. Such a pathology can characterize a complication - pulmonary infarction. Discomfort increases significantly with any movement - deep breathing, coughing, sneezing.
- Pain under the ribs on the right. Much less often, discomfort may occur in the liver area if the patient has blood clots in the lungs.
There is insufficient blood circulation in the vessels. This can provoke the patient:
- excruciating hiccups;
- tension in the abdominal wall;
- intestinal paresis;
- bulging large veins on the neck, legs.
The surface of the skin becomes pale. Often an ashy or gray tide develops. Subsequently, the addition of blue lips is possible. The last sign indicates massive thromboembolism.
Sometimes the patient has a characteristic murmur in the heart, an arrhythmia is detected. In the case of a pulmonary infarction, hemoptysis is possible, combined with severe chest pain and a fairly high temperature. Hyperthermia can be observed for several days, and sometimes for a week and a half.
Patients who have a blood clot in the lung may experience circulatory disorders in the brain. These patients often present:
- fainting;
- convulsions;
- dizziness;
- coma;
- hiccup.
Sometimes the described symptoms may be accompanied by signs of acute renal failure.
Complications of PE
This pathology is extremely dangerous,in which a thrombus is localized in the lungs. The consequences for the body can be very diverse. It is the resulting complication that determines the course of the disease, the quality and life expectancy of the patient.
The main consequences of PE are:
- Chronic increased pressure in the pulmonary vessels.
- Lung infarction.
- Paradoxical embolism in the vessels of the great circle.
However, not everything is so sad if blood clots in the lungs are diagnosed in a timely manner. The prognosis, as noted above, is favorable if the patient receives adequate treatment. In this case, there is a high chance to minimize the risk of unpleasant consequences.
The following are the main pathologies that doctors diagnose as a result of PE complications:
- pleurisy;
- lung infarction;
- pneumonia;
- empyema;
- lung abscess;
- kidney failure;
- pneumothorax.
Recurrent PE
This pathology can recur in patients several times throughout life. In this case, we are talking about a recurrent form of thromboembolism. About 10-30% of patients who once had such a disease are subject to repeated episodes of PE. One patient may experience a different number of seizures. On average, their number varies from 2 to 20. A lot of past episodes of pathology is a blockage of small branches. Subsequently, this pathology leads to embolization of large arteries. A massive PE is forming.
The causes of the development of a recurrent form maybecome:
- chronic pathologies of the respiratory, cardiovascular systems;
- oncological diseases;
- surgical interventions in the abdomen.
This form does not have clear clinical signs. It is characterized by an erased current. Correctly diagnosing this condition is very difficult. Often, unexpressed symptoms are mistaken for signs of other diseases.
Recurrent PE may present with the following conditions:
- Permanent pneumonia of no apparent reason;
- fainting;
- pleurisy occurring for several days;
- suffocation;
- cardiovascular collapse;
- shortness of breath;
- increased heart rate;
- fever not treated with antibiotics;
- heart failure, in the absence of chronic lung or heart disease.
This disease can lead to the following complications:
- emphysema;
- pneumosclerosis - lung tissue is replaced by connective tissue;
- heart failure;
- pulmonary hypertension.
Recurrent PE is dangerous because any subsequent episode can be fatal.
Disease diagnosis
The symptoms described above, as already mentioned, are not specific. Therefore, based on these signs, it is impossible to make a diagnosis. Howeverwith PE, 4 characteristic symptoms are necessarily present:
- shortness of breath;
- tachycardia - increased heart rate;
- chest pain;
- rapid breathing.
If the patient does not have these four signs, then he does not have a thromboembolism.
But not everything is so easy. Diagnosis of pathology is extremely difficult. To suspect PE, the possibility of developing the disease should be analyzed. Therefore, initially the doctor draws attention to possible risk factors: the presence of a heart attack, thrombosis, surgery. This allows you to determine the cause of the disease, the area from which the blood clot entered the lung.
Mandatory examinations to detect or rule out PE are the following studies:
- EKG. Very informative diagnostic tool. An electrocardiogram gives an idea of the severity of the pathology. If the information obtained is combined with the medical history, PE is diagnosed with high accuracy.
- X-ray. This study for the diagnosis of PE is uninformative. However, it is it that makes it possible to distinguish the disease from many other pathologies that have similar symptoms. For example, from croupous pneumonia, pleurisy, pneumothorax, aortic aneurysm, pericarditis.
- Echocardiography. The study allows you to identify the exact localization of a blood clot, its shape, size, volume.
- Lung scintigraphy. This method provides the doctor with a "picture" of the pulmonary vessels. It clearly marked areas of impaired circulation. But it is impossible to find a place where blood clots are localized in the lungs. The study has a high diagnostic value only in the pathology of large vessels. It is impossible to identify problems in small branches using this method.
- Ultrasound of leg veins.
If necessary, additional research methods may be prescribed to the patient.
Urgent help
It should be remembered that if a blood clot breaks off in the lungs, the patient's symptoms can develop at lightning speed. And just as quickly lead to death. Therefore, if there are signs of pulmonary embolism, the patient should be given complete rest and immediately call a cardiological ambulance. The patient is hospitalized in the intensive care unit.
Emergency care is based on the following activities:
- Emergency catheterization of the central vein and the introduction of the drug "Reopoliglyukin" or glucose-novocaine mixture.
- Intravenous administration of drugs is carried out: Heparin, D alteparin, Enoxaparin.
- The pain effect is eliminated by narcotic analgesics, such as Promedol, Fentanyl, Maureen, Lexir, Droperidol.
- Oxygen therapy.
- The patient is given thrombolytics: Streptokinase, Urokinase.
- In cases of arrhythmia, the following drugs are connected: Magnesium Sulfate, Digoxin, ATP, Ramipril, Panangin.
- If a patient has a shock reaction, he is given Prednisolone or Hydrocortisone, as well as antispasmodics: No-shpu, Eufillin, Papaverine.
Ways to deal with PE
Resuscitation measures allowrestore blood supply to the lungs, prevent the development of sepsis in the patient, and also protect against the formation of pulmonary hypertension.
However, after first aid, the patient needs continued treatment. The fight against pathology is aimed at preventing relapses of the disease, complete resorption of the blood clot.
Today, there are two ways to eliminate blood clots in the lungs. Pathology treatment methods are as follows:
- thrombolytic therapy;
- surgery.
Thrombolytic therapy
Drug treatment based on drugs such as:
- Heparin;
- "Streptokinase";
- "Fraxiparine";
- tissue plasminogen activator;
- Urokinase.
Such drugs allow you to dissolve blood clots and prevent the formation of new clots.
The medicine "Heparin" is administered to the patient intravenously for 7-10 days. At the same time, blood clotting parameters are carefully monitored. 3-7 days before the end of treatment, the patient is prescribed one of the following drugs in tablet form:
- Warfarin;
- "Trombostop";
- "Cardiomagnyl";
- "Trombo ACC".
Blood clotting control continues. Taking the prescribed pills lasts (after PE) for about 1 year.
Drugs "Urokinase", "Streptokinase" are administered intravenously throughout the day. This manipulation is repeated once a month. Tissue plasminogen activator is also used intravenously. A single dose should be administered onfor several hours.
Thrombolytic therapy is not given after surgery. It is also prohibited in case of pathologies that may be complicated by bleeding. For example, peptic ulcer. Because thrombolytic drugs can increase the risk of bleeding.
Surgical treatment
This question only comes up when a large area is affected. In this case, it is necessary to promptly remove a localized thrombus in the lungs. The following treatment is recommended. A blood clot is removed from the vessel with a special technique. Such an operation allows you to completely eliminate the obstruction to the blood flow.
Complex surgery is performed if large branches or the trunk of an artery are clogged. In this case, it is necessary to restore blood flow to almost the entire area of the lung.
Prevention of PE
The thromboembolism disease tends to recur. Therefore, it is important not to forget about special preventive measures that can protect against the re-development of severe and formidable pathology.
Such measures are extremely important for people who have a high risk of developing this pathology. This category includes persons:
- over 40;
- after a stroke or heart attack;
- overweight;
- whose history contains an episode of deep vein thrombosis or pulmonary embolism;
- who underwent surgery on the chest, legs, pelvic organs, abdomen.
Preventionincludes extremely important activities:
- Ultrasound of leg veins.
- Regular injection of Heparin, Fraxiparin under the skin or injection of Reopoliglyukin into a vein.
- Putting tight bandages on the legs.
- Squeezing the veins of the lower leg with special cuffs.
- Ligation of large leg veins.
- Implantation of cava filters.
The last method is an excellent prevention of the development of thromboembolism. Today, a variety of kava filters have been developed:
- "Mobin-Uddina";
- "Guenther's tulip";
- Greenfield;
- Hourglass.
Be aware that such a mechanism is extremely difficult to install. An incorrectly inserted cava filter will not only not be a reliable prophylaxis, but can also lead to an increase in the risk of thrombosis with the subsequent development of PE. Therefore, this operation should only be performed in a well-equipped medical center, exclusively by a qualified specialist.
