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 pulmonary embolism, a pathology clinic, the symptoms and therapy of which will be discussed later.
What is a disease?
Pulmonary embolism, or pulmonary embolism, is a common pathology that develops when clogged pulmonary artery or its branches with blood clots. They most often form in the veins of the lower extremities or pelvis.
In medical practice, the pulmonary embolism clinic is also considered when the vessels are blocked by parasitic organisms, neoplasms, or foreign bodies.
Thromboembolism is the third leading cause of death, giving way only to 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 ailment. If therapy of pulmonary embolism (ICD-10 code - I26) is started in a timely manner, then it is possible to reduce mortality by 8-10%.
Causes of the disease
In the process of development of pathology, the formation of clots and blockage of blood vessels occurs. Among the causes of pulmonary embolism are the following:
- Impaired blood flow. This can be observed against the background of development: varicose veins, squeezing of blood vessels by tumors, phlebothrombosis with destruction of vein valves. Blood circulation is disturbed by forced human immobility.
- Damage to the wall of the blood vessel, as a result of which the coagulation process starts.
- Prosthetics of the veins.
- Installation of catheters.
- Surgical intervention in the veins.
- Infectious diseases of a viral or bacterial nature that provoke endothelial damage.
- Violation of the natural process of fibrinolysis (dissolution of blood clots) and hypercoagulation.
A combination of several reasons increases the risk of developing pulmonary embolism, a pathology clinic implies a long treatment.
Risk factors
The following risk factors for pulmonary embolism significantly increase the likelihood of the formation of pathological processes:
- Long journey or forced bed rest.
- Heart or respiratory failure.
- Long-term treatment with diuretics, which leads to the loss of a large amount of water and an increase in blood viscosity.
- Neoplasms, for example, the formation of hemablastoses.
- An increased blood platelet and red blood cell count, which increases the risk of blood clots.
- Long-term use of hormonal contraceptives, hormone replacement therapy - this increases blood coagulation.
- 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 injuries.
- The period of bearing a baby.
- Smoking abuse.
- Elderly age.
- Phlebeurysm. It creates favorable conditions for stagnation of blood and the formation of blood clots.
From these risk factors, we can conclude that no one is safe from the development of pulmonary embolism. 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 clinic of pulmonary embolism will depend on the type of pathology, and they are distinguished by several:
- Massive pulmonary embolism. 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 the defeat of a small number of vessels, so the symptoms of pulmonary embolism may be absent.
- Fatal when more than 70% of the vessels are affected.
The clinical course of pathology
TELA Clinic may be:
- Lightning fast. Blockage of the main pulmonary artery or major branches. Respiratory failure develops, respiratory arrest may occur. Fatal outcome is possible within a few minutes.
- Sharp. The development of pathology is fast. The onset is sudden, followed by rapid progression. Symptoms of heart and pulmonary failure are observed . Within 3-5 days, pulmonary infarction develops .
- Protracted. Thrombosis of large and medium arteries and the development of several pulmonary infarction continues 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. Diagnosed with recurring heart attacks or bilateral pleurisy. Hypertension is gradually increasing. This form most often develops after surgery, on the background of oncology and existing cardiovascular diseases.
Disease development
Pulmonary thromboembolism develops gradually, passing through the following stages:
- Airway obstruction.
- Increased pressure in the pulmonary artery.
- As a result of obstruction and blockage, gas exchange is disturbed.
- The occurrence of oxygen deficiency.
- The formation of additional pathways for the transport of blood, poorly saturated with oxygen.
- Increased load on the left ventricle and the development of its ischemia.
- Decrease in heart index and drop in blood pressure.
- Pulmonary arterial pressure rises.
- Worsening of coronary circulation in the heart.
- Pulmonary edema.
Many patients after pulmonary embolism suffer a pulmonary infarction.
Signs of the disease
Symptoms of pulmonary embolism depend on many factors:
- The general condition of the patient’s body.
- The amount of damaged arteries.
- Particle size clogging vessels.
- The rate of disease progression.
- The degree of disturbance in the lung tissue.
Treatment of pulmonary embolism will depend on the clinical condition of the patient. Some people have a disease without symptoms, but can lead to sudden death. The complexity of the diagnosis also lies in the fact that the pathology of symptoms resembles many cardiovascular ailments, but the main difference is the sudden development of pulmonary embolism.
For pathology, several syndromes are characteristic:
1. From the cardiovascular system:
- The development of heart failure.
- Lowering blood pressure.
- Heart rhythm disturbance.
- Increased heart rate.
- The development of coronary insufficiency, which is manifested by sudden intense pain behind the sternum, lasting from 3-5 minutes to several hours.
- Pulmonary heart, the syndrome is manifested by swelling of veins in the neck, tachycardia.
- Cerebral disorders with hypoxia, cerebral hemorrhage and in severe cases with cerebral edema. The patient complains of tinnitus, dizziness, vomiting, cramps and fainting. In severe situations, the likelihood of developing 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.
- Wheezing wheezing appears.
- Pulmonary infarction most often develops within 1-3 days after pulmonary embolism, cough with sputum discharge with an admixture of blood, body temperature rises, when listening, moist, small 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. An increase in the liver, irritation of the peritoneum, paresis of the intestine 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, and the appearance of immune complexes in the blood test. This syndrome usually develops within 2-3 weeks after the diagnosis of pulmonary embolism.
Clinical recommendations for the development of such symptoms are to start emergency 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 violations. The doctor is faced with the task of determining the source of the development of thromboembolism in order to prevent relapse.
Given the complexity of the diagnosis, patients are sent to special vascular departments, which are equipped with technology and have the ability to conduct a comprehensive study and therapy.
If you suspect a pulmonary embolism, the patient is given the following examinations:
- History taking and assessment of all risk factors.
- General analysis of blood, urine.
- Blood test for gas composition, determination of D-dimer in plasma.
- ECG in dynamics to rule out a heart attack, heart failure.
- X-ray of the lungs to exclude pneumonia, pneumothorax, malignant tumors, pleurisy.
- To detect high pressure in the pulmonary artery, echocardiography is performed.
- Scintography of the lungs will show a decrease or absence of blood flow due to the development of pulmonary embolism.
- To detect the exact location of the thrombus, angiopulmonography is prescribed.
- USDG of the veins of the lower extremities.
- Contrast phlebography to detect the source of pulmonary embolism.
After making an accurate diagnosis and detecting the cause of the disease, therapy is prescribed.
First aid for pulmonary embolism
If an attack of the disease develops when a person is at home or at work, it is important to provide timely assistance to him to reduce the likelihood of irreversible changes. The algorithm is as follows:
- Put the person on a flat surface, if he fell or sits in the workplace, then do not brake him, do not shift.
- To unfasten the top button of a shirt, to remove a tie to provide an influx of fresh air.
- When breathing stops, perform resuscitation: artificial respiration and, if necessary, indirect heart massage.
- Call an ambulance.
Proper care for pulmonary embolism will save a person's life.
Disease treatment
Therapy of pulmonary embolism is supposed only in a hospital. The patient is hospitalized and prescribed full bed rest until the threat of clogging of the vessels passes. Treatment of pulmonary embolism can be divided into several stages:
- Urgent resuscitation to eliminate the risk of sudden death.
- Restore the lumen of the blood vessel as much as possible.
Long-term therapy of pulmonary embolism involves the following activities:
- Removal of a blood clot from the vessels of the lungs.
- Carrying out measures to prevent thrombosis.
- An increase in the diameter of the pulmonary artery.
- Expansion of the smallest 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 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". At first, the drug is administered in 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 course of pulmonary embolism, then clinical recommendations imply the use of Warfarin for at least 3 months. The drug is prescribed in a small maintenance dosage, and then according to the results of examinations it can be adjusted.
All patients undergo therapy aimed at restoring not only the pulmonary arteries, but also the entire body. It implies:
- Cardiac treatment with Panangina, Obzidana.
- Reception of antispasmodics: "Papaverine", "No-shpa".
- Taking medications to correct metabolic processes: preparations containing vitamin B.
- Anti-shock therapy "Hydrocortisone".
- Anti-inflammatory treatment with antibacterial drugs.
- Reception of antiallergic drugs: Suprastin, Zodak.
When prescribing drugs, the doctor must take into account that, for example, Warfarin crosses the placenta, therefore it is forbidden to take it during pregnancy, and Andipal has many contraindications, it should be used with caution in patients at risk.
Most of the drugs are injected into the body by drip into a vein, intramuscular injections are painful and provoke the formation of large hematomas.
Surgical intervention
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 using a catheter with a nozzle, a blood clot is removed through the chambers of the heart.
The method is considered risky, and it is resorted to in case of emergency.
When using pulmonary embolism, it is also recommended to install filters, for example, a Greenfield umbrella. It is inserted into the vena cava, and there its hooks open to fix it to the walls of the vessel. The resulting mesh freely passes blood, but the clots are delayed and removed.
Treatment of pulmonary embolism 1 and 2 degrees has a favorable prognosis. The number of deaths is minimal, the probability of recovery is high.
Complications of pulmonary embolism
Among the main and most dangerous complications of the disease are:
- Sudden death due to cardiac arrest.
- Progression of secondary hemodynamic disturbances.
- Repeated heart attack of the lung.
- The development of chronic pulmonary heart.
Disease prevention
In the presence of serious cardiovascular pathologies or surgical interventions in the anamnesis, it is important to prevent pulmonary embolism. The recommendations are as follows:
- Avoid excessive physical exertion.
- Spend a lot of time hiking.
- Observe the daily routine.
- Provide a full sleep.
- Eradicate bad habits.
- Review the diet and remove harmful products from it.
- Regularly visit the therapist for a routine examination and a phlebologist.
These simple preventative measures will help to avoid serious complications of the disease.
But to prevent pulmonary embolism, it is important to know which conditions and diseases can predispose to the development of venous thrombosis. Particular attention should be paid to your health:
- People diagnosed with heart failure.
- Lying patients.
- Patients undergoing long-term courses of diuretic therapy.
- Taking hormonal drugs.
- Suffering from diabetes.
- Stroke survivors.
Patients at risk should periodically undergo heparin therapy.
The pulmonary embolism is a serious pathology, and at the first symptoms it is important to provide timely assistance to a person and send him to the hospital or call an ambulance team. This is the only way to prevent the development of serious consequences and save a person’s life.