Pulmonary infarction is a disease caused by thromboembolic processes in the vascular system of the lungs. This is a fairly serious ailment that can lead to death in especially severe cases.
Causes of the disease
The disease can develop due to surgery, 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 hemorrhage into the lung tissue. Pathogenic bacteria enter the affected area, leading to inflammation.
Development of pulmonary infarction
Acute pulmonary hypertension with an increased load on the right heart can be due to 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 aggravated by the release of unoxidized blood through intersystem and pulmonary arteriovenous anastomoses. The development of pulmonary infarction occurs against the background of already existing stagnation in the veins. A day after the obstruction of the pulmonary vessel, a heart attack forms, its full development ends about 7 days.
Pathological anatomy
The area of the lungs affected by a heart attack has the shape of an irregular pyramid, its base directed towards the periphery. The affected area can be of various sizes. In some cases, exudative pleurisy or infarction pneumonia joins. Under the microscope, the affected lung tissue has a dark red color, it is dense to the touch and protrudes above the level of healthy tissue. The pleura becomes dull, dull, often fluid collects in the pleural cavity.
Pulmonary infarction: symptoms diseases
The manifestations and severity of the disease depend on the size, number and location of the vessels closed by blood clots, as well as on concomitant heart and lung diseases. Minor heart attack often gives almost no signs and is detected by x-ray examination. More pronounced heart attacks are manifested by pain in the chest, often occurring suddenly, shortness of breath, cough, hemoptysis. A more objective examination reveals a frequent pulse and fever. Symptoms of severe heart attacks are: bronchial breathing with wet wheezing and crepitus, dullness of percussion sound. Symptoms such as:
pale, often ashen skin tone;
blue nose, lips, fingertips;
lowering blood pressure;
the appearance of atrial fibrillation.
The defeat of large branches of the artery of the lung can provoke right ventricular failure, asphyxiation. Leukocytosis is detected in the blood, the erythrocyte sedimentation reaction (ROE) is significantly accelerated.
Diagnostics
Diagnose often hard enough. It is very important to identify diseases that could potentially complicate pulmonary infarction. For this, it is necessary to conduct a thorough examination of the patient (especially the lower limbs). With a heart attack, unlike pneumonia , pain in the side occurs earlier than 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 expansion of the root of the lung and its deformation.
ECG - to detect signs of overload of the right heart.
Echocardiography - manifestations of overload of the right ventricle are determined.
Doppler ultrasound examination of the veins of the lower extremities - the diagnosis of deep vein thrombosis.
Radioisotope lung scan - to detect areas of reduced lung perfusion.
Angiopulmonography - to detect obstruction of the branches of the artery of the lung, intra-arterial filling defects.
Pulmonary infarction: consequences
This disease, as a rule, does not pose a great threat to human life. However, after ailments such as pulmonary infarction, the consequences can be dire. Various complications are possible. For example, such as post-infarction pneumonia, suppuration and the spread of inflammation to the pleura, pulmonary edema. After a heart attack, there is a high risk of a purulent embolus (blood clot) getting into the vessel. This, in turn, causes a purulent process and contributes to an abscess at the site of a heart attack. Pulmonary edema with myocardial infarction develops, first of all, with a decrease in the contractility of the heart muscle and with simultaneous blood retention in the small circle. Since the intensity of heart contractions decreases suddenly, an acute low-release syndrome develops, which provokes severe hypoxia. At the same time, brain excitation, the release of biologically active substances contributing to the permeability of the alveolar-capillary membrane, and increased redistribution of blood into the pulmonary circulation from the large circulation are observed. The prognosis of pulmonary infarction depends on the underlying ailment, the size of the affected area and the severity of the general manifestations.
Disease treatment
If the first signs that indicate a pulmonary infarction are identified, treatment should be started immediately. The patient must be taken as soon as possible to the intensive care unit of the medical institution. Treatment begins with the introduction of the drug "Heparin", this tool does not dissolve a blood clot, however, it prevents the increase in a blood clot and can stop the thrombotic process. Medication "Heparin" is able to weaken the bronchospastic and vasoconstrictor effects of platelet histamine and serotonin, which helps to reduce spasm of pulmonary arterioles and bronchioles. Heparin therapy is carried out for 7-10 days, while activated partial thromboplastin time (APTT) is monitored. Also, low molecular weight heparin is used - dalteparin, enoxaparin, fraksiparin.
In order to ease the pain syndrome, reduce the load on the
pulmonary circulation, reduce shortness of breath, use narcotic analgesics, for example, "Morphine" (1% solution is administered intravenously). If lung infarction
provokes pain of a pleural nature, which is affected by breathing, body position, cough, it is recommended to use non-narcotic analgesics, for example, "Analgin" (intravenous administration of a 50 percent solution). When diagnosing pancreatic insufficiency or shock, vasopressors (dopamine, dobutomin) are used for treatment. If bronchospasm is observed (at normal atmospheric pressure), a 2.4% solution of aminophylline should be slowly injected 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 required (thrombectomy). On average, small heart attacks are eliminated in 8-12 days.
Disease prevention
To prevent lung infarction, First of all, it is necessary to prevent venous stagnation in the legs (vein thrombosis 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 coagulability, and limit the use of the intravenous method of administering drugs. According to indications, it is possible to prescribe drugs that reduce blood coagulability. For the prevention of concomitant infectious diseases, a course of antibiotics is prescribed. In order to prevent pulmonary hypertension, the use of "Eufillin" is recommended.