There are a number of diseases that develop in a patient suddenly, can appear for no apparent reason. Thromboembolism of the pulmonary artery also applies to such.
Today we will talk about what is thromboembolism of the pulmonary artery, can it cause death, what are its symptoms, treatment, methods of preventing the disease.
Features of
Pulmonary embolism( PE) is called obstruction of the branches or trunk of the artery due to a thrombus that forms in the right ventricle or atrium, as well as the venous bed.
It is noteworthy that approximately 0.1% of the world's population die of this pathology each year, while 90% of PE are diagnosed posthumously. The disease is characterized by severe pain, hemoptysis and shortness of breath, however, it is difficult to diagnose due to the lack of specific signs.
More details about the features of pulmonary embolism will tell the following video:
Types
Clinical classification
The clinical classification divides PE into types such as:
- Massive. More than 50% of the vascular bed is affected. The disease manifests itself in shock, systemic hypotension may appear.
- Submassive. The vasculature is affected within 30-50% of the volume. Symptom corresponds to signs of right ventricular failure.
- Not at all. It affects less than 30% of the volume of the vascular bed, while the disease can be asymptomatic.
Classification by the course of the pathology of
There is also a classification according to the course of pathology that distinguishes such forms as:
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- The sharpest. Death occurs a few minutes after development.
- Acute thromboembolism of the pulmonary artery. It is characterized by a sudden onset, chest pain, shortness of breath and similar symptoms.
- Subacute. It is characterized by hemoptysis, signs of infarct pneumonia, respiratory and right ventricular failure.
- Recurrent. It is characterized by repeated episodes of dyspnea, fainting, and also symptomatic of pneumonia.
Forms of
Also PE can be distributed on forms depending on the reasons for primary, secondary and idiopathic. The secondary form differs from the primary form in that the patient exhibits one or more risk factors that lead to the development of pathology.
If, in the course of the examination, no causes or risk factors are found for PE, an idiopathic form is indicated. The causes of thromboembolism of the pulmonary artery will be discussed below.
Causes of
The most common cause of PE is thrombosis of the deep vein of the legs or pelvis. The risk factors for PE include states like:
- Genetic predisposition to this pathology.
- Blood clotting disorders.
- Surgical interventions, especially, open.
- Trauma of pelvic bones and femur.
- Pregnancy and postpartum period.
- Diseases of the cardiovascular system.
- Obesity.
- Smoking.
- Varicose veins.
- Oncological diseases.
- Taking contraceptives with estrogen.
Also, PE can cause myocardial infarction and stroke, even those cured.
For signs of pulmonary embolism, read on.
Symptoms of
In some cases, PE can be asymptomatic until a certain stage of development. The most characteristic symptoms for pathology are:
- Signs of cerebral circulation disorders.
- Shortness of breath with sudden development. Usually, it is quiet and manifests itself regardless of the patient's position.
- Hypotension. With lowered blood pressure, the pressure in the veins increases.
- Tachycardia. The degree of severity of this symptom depends on the percentage of artery damage.
- Weakness.
- Cough, the severity of which depends on the degree of injury. Usually, this is a cough with phlegm.
- Hemoplegia. A characteristic feature that occurs in about 30% of patients. Most often, hemoptysis is abundant, the blood has the form of veins or clots.
- Multiple organ failure, which most often occurs in elderly patients.
on the diagnosis and treatment of pulmonary embolism in the clinic read further.
Diagnosis
Diagnosis of the disease is difficult due to the lack of pronounced symptoms and imperfect diagnostic tests. Diagnosis begins with standard procedures, such as family history, family and symptoms, physical examination and auscultation, suggesting PE and identifying the causes / risk factors of the condition.
To confirm the initial diagnosis, the following are used:
- Determination of the level of D-dimers, fibrin degradation products. An increase in this level indicates recent thrombosis. Normally, the level of d-dimers is within 500 μg / l. Analyzes of urine and blood. It is necessary to clarify the general well-being of the patient and to discover possible causes of pathology.
- ECG.Despite the fact that the signs of pulmonary embolism on the ECG are often absent, the patient can find sinus tachycardia, acute pulmonary heart, blockade of the right leg of the bundles. His.
- Chest X-ray. It allows to determine concomitant diseases, to detect signs of pulmonary hypertension.
- Echocardiography. Detects abnormalities in the work of the right ventricle, pulmonary hypertension and tricuspid regurgitation. With transoesophageal echocardiography, it is often possible to find a thrombus in the heart. The study is necessary to exclude other pathologies.
- CT angiopulmonography, which detects a thrombus in the pulmonary artery.
- ultrasound of the veins of the lower extremities, which reveals in this area a thrombus. Most often, it is the cause of thromboembolism.
- Ventilation-perfusion scintigraphy. The study reveals areas of the lung that are ventilated, but the blood reaches them feebly. With a normal result, PE can be excluded with a 90% probability.
- Angiography of the lungs. The most accurate study, however, is invasive. It allows to detect the breakage of the artery branch, thrombus, narrowing of the pulmonary artery branch.
Other studies may be used depending on the indications and equipment available, such as CT and MRI.It is also recommended to visit other specialists for accuracy, in particular, the therapist.
For more details on the diagnosis and treatment of PE, specialists in the video below tell the following:
Treatment of
The basis of treatment is medication therapy, carried out in conjunction with a therapeutic technique. If the patient's condition does not improve, surgical interventions can be used. Treatment with folk remedies is strictly prohibited, as this can smooth out the symptoms by deceiving the patient and leading to death.
Let's first of all pogovriem about emergency first aid for thromboembolism of the pulmonary artery.
Emergency care
If you suspect a PE, you should urgently call an ambulance. Before the patient is hospitalized, it is necessary:
- Ensure patient peace by placing it on a flat surface and freeing from tight clothing.
- Enter 10-15k ED of heparin in a vein at a time, then drip 15 ml of eufilin 2,4%, diluted in 400 ml of rheopolyglucin, while observing a rate of 60 cap / min.
- If arterial hypotension is observed, reopolyglucin should be injected into the vein( 20-25 ml / min).
- If severe ODN events occur, respiratory failure therapy should be performed.
When a patient's heart is stopped, urgent resuscitation is urgently needed.
Therapeutic methods
When treating PE, strict strict bed rest is necessary. Loads can trigger a recurrence of thromboembolism.
- In order to maintain oxygenation, patients perform oxygen inhalation.
- To reduce the viscosity of blood and maintain blood pressure in a normal state, massive infusion therapy is performed.
Medical methods
The basis of drug treatment is thrombolytic and anticoagulant therapy. These drugs can be prescribed:
- Morphine with isotonic sodium chloride solution to eliminate severe pain syndrome.
- Non-narcotic analgesics in developing infarct pneumonia.
- Heparin, which reduces bronchospasm and areola.
- Pressor amine therapy for right ventricular failure, hypotension or shock.
- Norepinephrine, if pressor amines can not be used.
Other drugs may also be prescribed depending on the symptoms.
Operation
If the patient does not respond to drug therapy, he may be prescribed thrombectomy, that is, surgical removal of the thrombus. At an increased risk of recurrence of PE, a cava filter, which is a screen filter, can be placed on the patient.
Prevention of disease
Preventive measures should be performed in patients with risk factors. They are included in:
- ultrasound of the veins of the legs;
- need to tightly bandage your feet;
- wearing cuffs compressing the veins on the shins;
- administration of heparin subcutaneously;
- implantation of cava filters suitable for the situation of modification;
In the latter case, it is important to correctly insert the cava filter, because improper installation increases the risk of formation of a thrombus.
Complications of pulmonary embolism of the pulmonary artery
The disease even with timely diagnosis can be complicated by dangerous conditions, for example:
- lung infarction;
- pleurisy;
- pneumonia;
- abscess;
- empyema;
- pneumothorax;
- acute renal failure;
For the prognosis and consequences of pulmonary embolism, read at last.
Forecast
If the patient receives first aid and competent treatment of PE in time, then the prognosis for recovery is favorable. High lethality( up to 30%) is noted with severe cardiovascular disorders and with extensive form.
When considering PE, there is frequent recurrence. However, statistics show that half of the relapses occur in patients who did not take anticoagulants.
Even more useful information about PE includes a video with Elena Malysheva: