Embolism of the pulmonary artery refers to the disease of a small circle of circulation( like pulmonary hypertension and pulmonary heart disease).It is a pathological condition that occurs as a result of a sudden occlusion of the vessel or artery that is in the lungs. The embolus that becomes the direct cause of this blockage can consist of virtually any tissue: especially often it is a blood clot( or thrombus), or an air vial that travels with blood flow through the vessels and will continue its movement until such a case. An embolus can also be a particle of adipose tissue, bone marrow or a tumor.
In addition, the embolus can be an amniotic, or amniotic fluid. Also, pulmonary embolism can develop when a large vessel of light foreign bodies( this talc used by drug addicts when penetrating a gunshot wound) penetrates into the artery, multiplied parasites and microbes. It arises especially often in the veins of large pelvis and lower extremities.
What are the features of this phenomenon and what features does the disease have?
Pathophysiology of pulmonary embolism
The onset of the disease is characterized by processes of necrosis of tissues, which as a result of blockage were deprived of sufficient blood. However, large vessels and arteries may be able to deliver the right amount of oxygen-enriched blood to tissues if the embolus was not too large or the person did not suffer from lung disease. In this case, there is a lack of maintenance of the tissues of the lungs with blood, as a result of which their necrosis takes place.
The size of the embolus that clogs the vessel also affects the patient's further condition: if its size is small, it quickly dissolves and does not have time to cause significant harm to health;if the dimensions of the embolus were significant, the process of resorption slows down and the gradual death of the lung tissue begins. In the most difficult cases, possible death of a person.
With a successful outcome of embolism of the artery in the lung, a significant part of the patients experienced relapses of the disease, and those who did not receive the necessary treatment at the first manifestation of this pathological condition, there are great chances of a fatal outcome when the manifestation of the embolism is repeated. It is necessarily considered the use of drugs that reduce the degree of clotting and, accordingly, the risk of embolus formation. The general name for such drugs is coagulants.
A particular feature of the disease in question is a significant blurring of symptoms and a general clinical picture, which complicates the diagnosis. The high mortality rate for pulmonary embolism and the severity of its course are due to the frequent absence of the diagnosis;in many cases, the diagnosis is only conjectural.
There are several common forms of this pathological condition.
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More details about the peculiarities of such ailment as pulmonary embolism will be told to you by the following video:
Forms of
The course of the disease is characterized by the severity of the pathological process and the degree of lesion in the veins and arteries of the great circle of blood circulation. These indicators should be considered as the most revealing in determining the degree of disturbance of blood flow in the lungs.
The severity of the clinical picture and the extent of the lesion allows us to distinguish several forms of pulmonary embolism.
Lightning-fast
This form, as its name implies, develops instantly and is due to the supermassive development of pulmonary artery disease. The degree of damage is about 85-100%.
Externally, this form manifests itself in the form of the loss of consciousness, seizures, breathing stops and develops a diffuse lesion of the upper body, which is expressed in the "cast iron" color of the skin. Often the lightning-fast form of pulmonary embolism ends with a fatal outcome due to its rapid progression.
Severe
In severe form, pulmonary artery disease is around 45-60%, all clinical signs are as pronounced as possible and allow diagnosing the disease as quickly as possible. The manifestation of this form should include the following:
- pronounced dyspnea is caused by the rapid development of tachycardia, the specificity of dyspnea manifests itself in the patient's desire to maintain his horizontal position;
- cyanosis of the upper torso does not reach the pronounced cast iron shade, skin color is more ashy with a shade of gray;
- circulatory insufficiency in the right ventricle is manifested by the appearance of sinus tachycardia, the border of the heart widens to the right, the cardiac tremor increases significantly, and the epigastric region shows a pulsation;
- the first minutes after the defeat of the pulmonary artery reflexively continues arterial hypotension, but then develops a persistent collapse that results from a decrease in cardiac output.
In terms of the severity of all these manifestations, one can judge the severity of the shape of the embolism of the pulmonary artery, which allows you to make a preliminary prognosis for the patient. The more pronounced the manifestations and the longer the symptomatology, the less positive the forecast can give the doctor: a prolonged collapse, severe heart failure and the severity of breathing are frequent signs of rapid development of the disease, often the patients die within 24 hours.
Massive
For the massive form of pulmonary embolism, manifestations of an anginous type are characteristic, which are accompanied by pain in the upper third of the thorax, a cough may begin, a feeling of breast compression is expressed. The patient may be prone to dizziness and fear of death.
The presence of a pain syndrome with this form of the disease is of a complex nature: a lung infarct occurs, the size of the liver considerably swells and increases.
Submassive
The submissive form of the disease is characterized by the presence of symptoms that occur with pulmonary embolism of medium severity. There is an overload of blood vessels and arteries of the right side of the heart, possibly the appearance of severe soreness in the chest. Degree of lethality with submissive form is small and is of the order of 5-8%, however, recurrences are frequent
The mild form of
The most common mild form of the disease occurs in lesions of the chalk branches of the pulmonary artery, its manifestation is less pronounced and carries significantly less danger to the patient. Diagnosis of this form is very difficult - this is facilitated by the blurring and non-specific manifestations of embolism, and an easy form is established in 15% of cases of this disease.
For a mild form, recurrences are frequent, which already have more serious forms and, in the absence of necessary treatment, can have an extremely negative prognosis. Next, we'll talk about the causes of pulmonary embolism.
Causes of
Pulmonary embolism occurs with blockage of large vessels and arteries of the lung, while the nature of the embolus, which becomes the immediate cause of the disease, can vary significantly. Consider the most common:
- The most frequent occurrence of blockage of a vessel or artery is a blood clot. The formation of a blood clot can occur due to an excessively high blood clotting rate, with its slow flow or lack of flow velocity in general. A blood clot can occur in the veins of the hands or feet that have been without movement for a long time or have not moved actively enough. This is possible when a person for a long time is without movement when traveling in an airplane or transport, and also simply when in one position.
- When an embol is formed from fat, the presence of a broken bone is mandatory, when the particles of fat from the bone marrow of the bone are isolated.
- Formation of the embolus from the amniotic fluid occurs during childbirth, but this kind is rare and occlusion occurs, as a rule, only small vessels and capillaries.
However, when a significant number of vessels are affected by this type of embolus, it can provoke the development of an acute respiratory distress syndrome. There are also a number of factors that can be considered provoking this disease, or risk factors for pulmonary embolism. Consider them as well.
More details about the causes of embolism( thromboembolism) of the pulmonary artery will be told by a well-known TV presenter in his video:
Risk factors
The cause that caused the development of pulmonary embolism may not always be clear, but the reasons that can trigger the development of the disease include:
- availabilityvarious cardiovascular diseases that can cause the embolus to develop in veins and vessels:
- prolonged immobility or lack of active activity for a long timeth time. And here it is possible to carry not only long forced preservation of one position of a body, but also specificity of work of some people are drivers truckers, people working at the computer;
- rheumatism with the presence of signs of atrial fibrillation;
- heart failure;Atrial fibrillation;
- cardiomyopathy;
- non-rheumatic myocarditis, which have a severe course;
- hypertension;
- heredity;
- excess weight and obesity;
- malignant neoplasm;
- injuries and burns;
- old age;
- first time after childbirth and pregnancy;
- thrombophlebitis;
- prolonged use of a venous catheter;
- diabetes;
- strokes;
- infarction;
- increased blood clotting - this can be facilitated by taking certain medications, for example, oral hormonal contraceptives;
- of the spinal cord.
Often the cause of this pathological condition is the change in body position after a long period of immobility, weight lifting, straining, as well as a sharp and prolonged cough.
To speed up the initiation of treatment and to simplify the diagnosis, one should know about the main manifestations of the disease.
Pulmonary embolism( diagram)
Symptoms of
Symptomatic of the disease is often not clearly expressed, but the most common first manifestation of pulmonary embolism is the occurrence of dyspnea. At the same time, the patient's breathing becomes superficial, and when trying to take a deep breath, a strong pain is felt in the chest. A person can get restless - a condition called a panic attacks by a doctor. Pain when inhaled is called pleural pain, which occurs in the chest.
The clinical picture is complemented by the following external signs of pulmonary embolism:
- marked dizziness;
- syncope;
- tenderness in the chest, especially when inhaled;
- convulsions;
- surface respiration.
Dizziness and fainting occur as a result of impaired blood supply, and there may also be a change in heart rate: their speed and rhythm. Cyanosis, in which the skin changes its color and acquires a pronounced blueness, may become a sign of an impending respiratory arrest and death.
Unlike pulmonary infarction, where symptoms similar to pulmonary embolism may occur within a few hours or even days, they then gradually decline. With embolism of the pulmonary artery, the symptoms quickly progress and in the absence of treatment the patient's death quickly comes.
It should be noted that a visit to a doctor is indicated if there is severe pain during inhalation and coughing, attacks of unreasonable fear and asymptomatic dyspnea. A call of an ambulance becomes necessary in the following cases:
- acute pain, which is localized in the chest and accompanies the inspiration;
- with an increase in body temperature and the appearance of blood in the sputum;
- sudden convulsions, fainting;
- changes the color of the skin of the upper body - the skin becomes cyanotic or ashy.
Once the diagnosis has been made, adequate treatment should immediately begin, which will stop the pathological process.
Diagnosis
A preliminary diagnosis of "pulmonary embolism" is possible by the physician when describing the patient's underlying symptoms, but a number of additional studies should be carried out to clarify the diagnosis.
- With the X-ray study, it is possible to detect visible changes in the state of the blood vessels of the lungs, which precedes the embolism. However, one X-ray will not be enough to make a diagnosis.
- The ECG( or electrocardiogram) of the vessels also allows you to observe abnormalities in their condition, but the ECG readings are not always clearly expressed and are often unstable, therefore the data of this method of investigation will only suggest the presence of pulmonary embolism.
- Using a perfusion lung scintigraphy, a small volume of a radionuclide substance is injected into the veins' blood and enters the lung. This method allows you to assess the state of pulmonary large vessels and veins and blood supply to the lung. In the absence of normal blood supply, this area of the lung in the picture has a dark color - radionuclide particles did not arrive there, but the presence of pathology can be treated as a different lung disease.
- Evaluation of pulmonary ventilation also allows evaluation of lung damage and the presence of a pathological process in them.
- The most accurate method of diagnosis today is pulmonary arteriography, but this method is extremely complex and carries a certain risk to health.
- The combination of these diagnostic methods allows you to determine whether the presence of lung embolism or a predisposition to it. So, you already know what symptoms the embolism of the pulmonary artery has symptoms, let's talk about the treatment of the disease.
Treatment of
In determining the treatment method that will be used in each case, the doctor takes into account both the severity of the disease, and the presence and manifestation of symptoms.
Therapeutic, medicamental and folk methods of pulmonary embolism treatment can be used, each of which has its own peculiarities.
Therapeutic method
- As the therapeutic method of treatment, the saturation of the body with oxygen is most often used to restore the function of respiration. For this, a catheter placed in the nose can be used, as well as an oxygen mask.
- Bed rest and absence of any load are mandatory conditions for therapeutic treatment.
- If there is an acute, massive or lightning-fast form of the disease, then the measures should be applied as quickly as possible and bring a clear relief to the patient.
Medications
The use of medication allows you to quickly restore the patient's condition and prevent a fatal outcome of the disease.
Urgent measures for acute and lightning-fast forms of pulmonary embolism include:
- bed rest;
- introduction to the vein of heparin at least 10,000 units once;
- providing oxygen with a mask or by inserting a catheter into the nose;
- applies dopamine, antibiotics and reopolyglucin.
Adoption of urgent measures is necessary to restore blood circulation in the tissues of the lungs, prevent sepsis in them and prevent the development of pulmonary hypertension. To prompt resorption of the embolus and prevent recurrence of the disease, thrombolytic therapy is used, which includes the use of the following medicines:
- urokinase;
- streptokinase;
- plasminogen activator;
- fractiparin;
- heparin.
Widely used anticoagulant drugs. If more than 1/2 part of the lung is injured, the doctor is assigned a surgical procedure.
Surgical intervention
This type of treatment becomes necessary to restore blood circulation in the lungs, and it is carried out by introducing special techniques into a vessel or an affected artery, which allows you to remove embolus and return normal blood circulation. This procedure is not easy, because it is shown in especially serious cases of defeat.
An embolus removal operation is used for large vessels and arteries of the lung.
Folk remedies
This disease is considered very serious and fast current, therefore the use of folk methods can only relieve some symptoms and alleviate the condition of the patient. Methods of traditional medicine can be recommended for restorative therapy after medical treatment.
These methods include the use of drugs that increase immunity and resistance of the body to infections, and also help prevent heart disease, often causing pulmonary embolism.
The entire treatment process should be performed in a hospital setting, home treatment of the disease is unacceptable. On what to do if it overtook the cement embolism of the pulmonary artery, read on.
Special Case
Cement embolism of the pulmonary artery is a rare type of pulmonary embolism - polymethylmethacrylate, which is used for percutaneous verteroplasty. This rare type of embolism has specific manifestations and is caused by the ingress of small particles of cement into the pulmonary arteries with blood flow.
Treatment should be prescribed depending on the symptomatology and condition of the patient, but all treatment measures are aimed at restoring normal circulation in the lungs.
Prevention of the disease
To prevent the recurrence of the disease, heparin is used, which helps prevent the formation of new emboli and the prompt resolution of already existing blood clots. Indirect anticoagulants are also widely used.
The most important preventive measures are considered in the following cases:
- in the presence of excessive body weight;
- aged more than 4 years;
- with past venous and pulmonary disease;
- with a heart attack or stroke.
For early detection of pulmonary embolism, ultrasound of the veins of the lower extremities should be performed, tight bandaging of the leg veins should be performed, as well as regular administration of heparin subcutaneously. Wearing special bangs and golfs, which help to reduce the burden on the veins of the legs and thus prevent the possibility of blood clots in them, should also be considered an effective preventive measure.
Complications of
The most dangerous complication after the initial onset of embolism is considered the possibility of its recurrence. The use of preventive measures allows to detect the disease in time and start treatment.
Often after treatment of pulmonary embolism, pulmonary hypertension develops.
Forecast
The prognosis for pulmonary embolism depends directly on the severity of its manifestations, as well as the general condition of the patient.
- When the main pulmonary artery is afflicted, death occurs 2-3 hours later.
- Mortality in the early detection of the disease is about 10%, in the absence of the same treatment immediately after the onset of the disease, survival is low enough - the mortality rate is 30%.
On the predictions for the disease of pulmonary embolism, as well as about preventive measures with her, the following video will tell: