A life-threatening disease is pulmonary embolism (pulmonary embolism). After all, we are talking about the formed blood clots. Among all pathologies, pulmonary embolism is distinguished by threatening statistics. Blood clots in the lungs can clog an artery at any moment. Unfortunately, quite often this leads to death. Almost a third of all sudden deaths of patients occur as a result of blockage of the pulmonary artery with a blood clot.
Disease characteristics
Tela 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 a blood stream. Often, blood clots occur in the vessels of the lower extremities. Sometimes localized in the right heart. A blood clot passes through the right atrium, ventricle, and enters the pulmonary circulation. It moves along the 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 may suddenly block the lumen of the branches of an artery. These vessels are numerous in number. However, their diameter decreases. Once in a vessel through which a blood clot cannot pass, it blocks blood circulation. That is what often leads to death.
If a patient has a blood clot in the lungs, the consequences depend on which vessel was blocked. An 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 develops hypoxia.
Severity of disease
Blood clots in the lungs occur as a result of complications of somatic diseases, after birth and surgical conditions. Mortality from this pathology is very high. She takes 3rd place among the causes of death, second only to cardiovascular ailments and oncology.
Today, pulmonary embolism develops mainly against the background of the following factors:
- severe pathology;
- complex surgical intervention;
- received injury.
The disease is characterized by a severe course, many heterogeneous symptoms, difficult diagnosis, a high risk of mortality. Statistics show, on the basis of a posthumous autopsy, that blood clots in the lungs were not diagnosed in a timely manner in almost 50-80% of the population who died due to pulmonary embolism.
This disease is very rapid. That is why it is important to quickly and correctly diagnose pathology. And also provide adequate treatment that can save a human life.
If a thrombus in the lungs was detected in a timely manner, the survival rate is significantly increased. Mortality among patients receiving the necessary treatment is about 10%. Without diagnosis and adequate therapy, it reaches 40-50%.
Causes of the disease
A blood clot in the lungs, a photo of which is located in this article, appears as a result of:
- deep vein thrombosis of the lower extremities;
- the formation of a blood clot in any area of the venous system.
Much less often, this pathology can be localized in the veins of the peritoneum or upper limbs.
Risk factors suggesting that the patient develops pulmonary embolism are 3 provoking conditions. They are called the "triad of Virchow." These are the following factors:
- Reduced rate of blood circulation in the vein system. Vascular stagnation. Slow blood flow.
- Increased tendency to thrombosis. Hypercoagulability of blood.
- 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 thrombus in the lungs is detected. The reasons may be hidden in the following circumstances.
To slow down venous blood flow can lead to:
- long trips, trips, as a result of which a person has to sit in a plane, car, train for a long time;
- hospitalization, which requires bed rest for a long period.
To hypercoagulability of blood can lead:
- smoking;
- the use of contraceptives, estrogen;
- genetic predisposition;
- oncology;
- polycythemia - a large number of red blood cells in the blood;
- surgical intervention;
- pregnancy.
To injuries of the venous walls lead to:
- deep vein thrombosis;
- domestic foot injuries;
- surgery on the lower extremities.
Risk factors
Doctors distinguish the following predisposing factors in which thrombus in the lungs is most often detected. The consequences of pathology are extremely dangerous. Therefore, it is necessary to carefully consider the health of those people who have the following factors:
- reduced physical activity;
- age over 50 years;
- oncological pathologies;
- surgical interventions;
- heart failure, heart attack;
- traumatic injuries;
- varicose veins;
- the use of hormonal contraceptives;
- birth complications;
- erythremia;
- overweight;
- genetic pathologies;
- systemic lupus erythematosus.
Sometimes, blood clots in the lungs of women after childbirth, especially severe ones, can be diagnosed. As a rule, this condition is preceded by the formation of a clot in the thigh or calf. It makes itself felt by pain, fever, redness, or even a tumor. Such a pathology should be immediately reported to the doctor, so as not to aggravate the pathological process.
Characteristic symptoms
To timely diagnose a blood clot in the lungs, the symptoms of pathology should be clearly presented. Extreme caution should be taken with the possible development of this disease. Unfortunately, the clinical picture of pulmonary embolism is quite diverse. It is determined by the severity of the pathology, the rate of development of changes in the lungs and signs of the underlying disease that triggered this complication.
If there is a blood clot in the lungs, the patient's symptoms (required) are as follows:
- Shortness of breath, suddenly arising for unknown reasons.
- There is an increase in heart rate (more than 100 beats in one minute).
- Pallor of the skin with a characteristic gray tint.
- Pain syndrome that occurs in different parts of the sternum.
- Impaired intestinal motility.
- A sharp blood supply to the cervical veins and solar plexus, their bulging is observed, aortic pulsation is noticeable.
- The peritoneum is irritated - the wall is quite tense, there is pain during palpation of the abdomen.
- Noises in the heart.
- The pressure is greatly reduced.
In patients who have a blood clot in the lungs, the above symptoms are necessarily present. However, none of these symptoms is specific.
In addition to the mandatory signs, the following conditions may develop:
- fever;
- hemoptysis;
- fainting;
- sternal pain;
- vomiting
- convulsive activity;
- fluid in the sternum;
- coma.
Course of the disease
Since pathology refers to very dangerous diseases that do not exclude a fatal outcome, the symptoms that arise should be considered in more detail.
Initially, the patient develops shortness of breath. Its occurrence is not preceded by any signs. The causes of anxiety symptoms are completely absent. Shortness of breath appears on exhalation. It is characterized by a quiet sound, accompanied by a rustling shade. Moreover, she is present constantly.
In addition to her, pulmonary embolism is accompanied by an increased heart rate. Listens from 100 beats and above in one minute.
The next important sign is a sharp decrease 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 pulmonary embolism.
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, with an acute, discontinuous 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 compressive. It is localized in the region of the heart. Often gives to the shoulder blade, hand.
- Pain discomfort throughout the sternum. Such a pathology can characterize a complication - pulmonary infarction. Discomfort is greatly enhanced by any movement - deep breathing, coughing, sneezing.
- Pain under the ribs on the right. Much less often, discomfort can occur in the liver area if the patient has blood clots in the lungs.
In the vessels there is insufficient blood circulation. This can provoke in a patient:
- painful hiccups;
- tension in the wall of the abdomen;
- intestinal paresis;
- bulging large veins on the neck, legs.
The surface of the skin becomes pale. Often ash or gray tide develops. Subsequently, it is possible to attach the blue lips. The last symptom indicates massive thromboembolism.
Sometimes a characteristic noise in the heart is heard in the patient, arrhythmia is detected. In the case of pulmonary infarction, hemoptysis is possible, combined with severe chest pain and a fairly high temperature. Hyperthermia can be observed for several days, and sometimes a week and a half.
In patients with a blood clot in the lung, circulatory disorders of the brain may be observed. In such patients, there are often:
- fainting
- cramps
- Dizziness
- coma;
- hiccups.
Sometimes symptoms of renal failure, in acute form, may join the described symptoms.
Complications of pulmonary embolism
A pathology in which a thrombus is localized in the lungs is extremely dangerous. The consequences for the body can be very diverse. It is the complication that arises that determines the course of the disease, the quality and life expectancy of the patient.
The main consequences of pulmonary embolism are:
- Chronically elevated pulmonary pressure.
- Lung infarction.
- Paradoxical embolism in the vessels of a large circle.
However, not everything is so sad if thrombi in the lungs are timely diagnosed. 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 a complication of pulmonary embolism:
- pleurisy;
- pulmonary infarction;
- pneumonia;
- empyema;
- lung abscess
- renal failure;
- pneumothorax.
Recurrent pulmonary embolism
This pathology is able to repeat in patients several times throughout life. In this case, we are talking about a recurring form of thromboembolism. About 10-30% of patients who once had such a disease are prone to repeated episodes of pulmonary embolism. One patient may experience a different number of seizures. On average, their number varies from 2 to 20. Many transferred episodes of pathology are a blockage of small branches. Subsequently, this pathology leads to embolization of large arteries. A massive pulmonary embolism is formed.
Reasons for the development of a relapsing form can be:
- 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 pulmonary embolism can manifest itself in the following conditions:
- persistent pneumonia that occurs for some reason;
- fainting conditions;
- pleurisy flowing for several days;
- asthma attacks;
- cardiovascular collapse;
- labored breathing;
- increased heart rate;
- fever that is not eliminated by antibacterial drugs;
- heart failure, in the absence of chronic pathology of the lungs or heart.
This disease can lead to the following complications:
- emphysema;
- pneumosclerosis - lung tissue is replaced by connective;
- heart failure;
- hypertension of the lungs.
Recurrent pulmonary embolism is dangerous in that any subsequent episode can lead to death.
Diagnosis of the disease
The symptoms described above, as already mentioned, are not specific. Therefore, based on these signs, it is impossible to make a diagnosis. However, with pulmonary embolism, 4 characteristic symptoms are necessarily present:
- dyspnea;
- tachycardia - an increase in heart contractions;
- chest pain;
- rapid breathing.
If the patient does not have these four signs, then he does not have thromboembolism.
But not everything is so easy. Diagnosis of pathology is extremely difficult. To suspect pulmonary embolism, you should analyze the possibility of developing the disease. 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 fell into the lung.
The following studies are required tests to identify or exclude pulmonary embolism:
- ECG. Very informative diagnostic method. An electrocardiogram gives an idea of the severity of the pathology. If you combine the information received with the medical history, pulmonary embolism is diagnosed with high accuracy.
- X-ray This study to diagnose pulmonary embolism 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 location of the thrombus, 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 located in the lungs. The study has high diagnostic value only in the pathology of large vessels. It is impossible to identify problems in small branches using this method.
- Ultrasound of the veins of the legs.
If necessary, the patient may be assigned additional research methods.
Urgent help
It should be remembered if a blood clot in the lungs comes off, the patient's symptoms may develop with lightning speed. And just as quickly lead to death. Therefore, if there are signs of pulmonary embolism, the patient should be completely at 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 administration of the drug "Reopoliglyukin" or glucose-novocaine mixture.
- Intravenous administration of drugs is carried out: “Heparin”, “Dalteparin”, “Enoxaparin”.
- The pain effect is eliminated by narcotic analgesics such as Promedol, Fentanyl, Morin, Leksir, Droperidol.
- Oxygen therapy.
- Thrombolytics are administered to the patient: Streptokinase, Urokinase.
- In cases of arrhythmia, the following drugs are connected: “Magnesium sulfate”, “Digoxin”, “ATP”, “Ramipril”, “Panangin”.
- If the patient has a shock reaction, they are given Prednisone or Hydrocortisone, as well as antispasmodics: No-shpu, Eufillin, Papaverin.
Ways to combat pulmonary embolism
Resuscitation measures can restore blood circulation to the lungs, prevent the patient from developing sepsis, and also protect against the formation of pulmonary hypertension.
However, after first aid, the patient needs to continue treatment. The fight against pathology is aimed at preventing relapse of the disease, complete resorption of the blood clot.
Today, there are two ways to eliminate blood clots in the lungs. The methods of treatment of the pathology are as follows:
- thrombolytic therapy;
- surgical intervention.
Thrombolytic therapy
Medication is based on drugs such as:
- Heparin
- "Streptokinase";
- "Fraxiparin";
- tissue plasminogen activator;
- Urokinase.
Such drugs can 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 coagulation indicators are carefully monitored. 3-7 days before the end of treatment, the patient is prescribed one of the following drugs in tablet form:
- Warfarin
- "Thrombostop";
- Cardiomagnyl;
- "Thrombo ACC."
Clotting control continues. Reception of the prescribed tablets lasts (after the transferred pulmonary embolism) for about 1 year.
The drugs "Urokinase", "Streptokinase" are administered intravenously throughout the day. This manipulation is repeated 1 time per month. Tissue plasminogen activator is also used intravenously. A single dose should be administered over several hours.
Thrombolytic therapy is not performed after surgery. It is also prohibited in the case of pathologies that may be complicated by bleeding. For example, peptic ulcer. Because thrombolytic drugs can increase the risk of bleeding.
Surgery
Such a question is raised only when a large area is affected. In this case, it is necessary to quickly remove the localized blood clot in the lungs. The following treatment is recommended. A special technique removes a blood clot from a vessel. This operation allows you to completely remove the obstruction in the bloodstream.
Complex surgery is performed if large branches or artery trunk are clogged. In this case, it is necessary to restore blood flow over almost the entire area of the lung.
Prevention of pulmonary embolism
Thromboembolism has a tendency to relapse. 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 with a high risk of developing this pathology. This category includes persons:
- over 40 years old;
- having a stroke or heart attack;
- overweight;
- an anamnesis of which contains an episode of deep vein thrombosis or pulmonary embolism;
- undergoing operations on the chest, legs, pelvic organs, abdomen.
Prevention includes critical events:
- Ultrasound of the veins of the legs.
- Regular injection of “Heparin”, “Fraxiparin” preparations under the skin or injection of “Reopoliglyukin” medication into a vein.
- Applying tight bandages to the legs.
- Squeezing with special cuffs of the veins of the lower leg.
- Bandaging of large leg veins.
- Implantation of cava filters.
The latter method is an excellent prevention of thromboembolism. Today, a variety of cava filters have been developed:
- "Mobin-Uddina";
- Gunther's Tulip;
- Greenfield
- "Hourglass".
At the same time, remember that such a mechanism is extremely difficult to establish. An incorrectly introduced cava filter will not only not become a reliable prophylaxis, but also can lead to an increased risk of thrombosis with the subsequent development of pulmonary embolism. Therefore, this operation should only be performed in a well-equipped medical center, exclusively by a qualified specialist.