When the pulmonary artery or its branches are completely or partially blocked by an embolus, a pulmonary embolism develops. In most cases, an embolus is a blood clot or thrombus. Less commonly, it can be amniotic fluid (amniotic fluid), drops of fat, a fragment of a tumor, bone marrow, or an air bubble in the bloodstream.

If there is enough blood entering the affected part of the lungs through intact arteries, then tissue death does not occur. If a large vessel is blocked, there may not be enough blood, and then necrosis of the lung tissue or pulmonary infarction begins. According to statistics, this occurs in 10% of patients with a syndrome such as pulmonary embolism. Tissue damage may be minimal if the blood clots are small and dissolve quickly. With large clots that take a long time to dissolve, the heart attack can easily be extensive, that is, with a large affected area. In this case, there is a danger of sudden death.

Reasons

Pulmonary embolism most often develops due to the formation of blood clots in the veins of the pelvis or lower extremities. Rarely, blood clots can form in the right chambers of the heart and the veins of the arms. This type of vessel blockage is called “thromboembolism”. Clots form when blood moves slowly through the vessels. For example, when staying in one position for a long time, a blood clot forms in the vessels of the legs. When a person begins to move, a clot in the vein can break loose, enter the bloodstream, and then quickly reach the lung.

An embolus may consist of fat, droplets of which are released into the blood from the bone marrow, which can happen when a bone is broken. A clot can form during childbirth from the amniotic fluid that surrounds the fetus during pregnancy. Fat embolism of the lung, like blockage of an artery by amniotic fluid, is rare. Emboli of this type usually form in small vessels of the lungs: capillaries and arterioles. Air bubbles can enter the bloodstream, blocking the pulmonary artery and leading to an air embolism.

The reasons for the formation of a clot in a vessel vary and are not always clear. Risk factors include the following:

1. Bed rest for a long time.
2. Surgical intervention.
3. Prolonged sitting in transport: airplane, bus, car.
4. Excess weight.
5. Fractures of the tibia or femur.
6. Heart attacks and strokes.
7. Varicose veins.
8. Thrombophlebitis.
9. Oncological diseases.
10. Increased blood clotting. The main reasons are the use of oral contraceptives, cancer, as well as a hereditary deficiency of substances that slow down the blood clotting process.

Symptoms

If there is a minor pulmonary embolism, there may be no symptoms. The following manifestations are possible:

• tachycardia;
• sudden feeling of shortness of breath;
• chest pain when taking a deep breath;
• feeling of anxiety.

In the absence of pulmonary infarction, shortness of breath is the only symptom.

With a pulmonary embolism, the pumping function of the heart deteriorates, which leads to an insufficient supply of oxygen-rich blood to the brain and other organs. For this reason, the following symptoms may occur:

• dizziness;
• convulsions;
• fainting;
• heart rhythm disturbance.

A detached blood clot can lead to a pulmonary embolism.

If a large vessel or several at once is blocked, the skin may turn blue and death may occur.

If a pulmonary infarction occurs as a result of an embolism, the patient experiences:

• increase in temperature;
• swelling of the veins of the neck;
• wet rales;
• chest pain when breathing;
• cough;

With recurrent episodes of blockage of the small branches of the pulmonary artery, the following symptoms are observed:

• swelling of the legs;
• weakness;
• chronic shortness of breath.

Signs of pulmonary embolism appear suddenly. A pulmonary infarction develops within a few hours and persists for several days before it begins to subside.

Classification

Pulmonary embolism is divided into types depending on the nature of the substrates:

Pulmonary embolism is distinguished by location. It can occur in the pulmonary circulation or in the large one. In the small circle, thromboembolism is most often observed.

A drop of fat from bone fractures can enter the blood from the bone marrow and block a blood vessel

There are three pulmonary embolism syndromes according to severity: pulmonary-pleural, cardiac, cerebral.

Pulmonary-pleural

This syndrome is characteristic of minor embolism, in which vascular obstruction occurs in the peripheral branches of the pulmonary artery. Typically, patients complain of shortness of breath and cough with bloody sputum.

Cardiac

Develops with massive embolism. The most typical symptoms: tachycardia, heaviness and pain in the chest, swelling of the veins in the neck, systolic murmur, strong heartbeat. Pulmonary hypertension, increased venous pressure, and loss of consciousness may develop. Investigations may reveal right ventricular myocardial ischemia, tachycardia, right bundle branch block, and arrhythmia. If these signs are not observed, this does not mean that there is no embolism.

Cerebral

This syndrome mainly occurs in older people and is associated with a lack of oxygen to the brain. Loss of consciousness, convulsions, involuntary discharge of feces and urine, paralysis of the arms and legs on one side occurs.

Diagnostics

Diagnosis of pulmonary embolism is quite difficult. The diagnosis is made based on the patient’s complaints, taking into account existing predisposing factors. In addition, it is necessary to undergo a number of studies using equipment:

1. Chest X-ray. Shows changes in blood vessels that occur after embolism, helps detect pulmonary infarction. Does not always make it possible to make an accurate diagnosis.
2. ECG. Changes in the ECG are usually dynamic, so it is only possible to suspect an embolism. Allows you to detect changes in blood vessels.
3. Perfusion scintigraphy. A radionuclide substance is injected into a vein and travels to the lungs. This method allows you to evaluate blood supply. In places where there is no normal blood supply, the radionuclide substance does not enter, so these areas appear dark.
4. Pulmonary arteriography. It is the most reliable diagnostic method, but at the same time the most difficult. It consists of injecting a contrast agent into the artery, which then enters the pulmonary arteries. On an R-image, an embolism looks like a blockage in a vessel. Prescribed if there is doubt about the diagnosis or urgent diagnosis is required.

What to do if you suspect a pulmonary embolism

If your breathing becomes shallow, chest pain and a feeling of fear appear, you need to go to the hospital.

Do not forget that blockage of the pulmonary artery is a dangerous condition. According to statistics, embolism is one of the most common causes of sudden death. You should immediately call an ambulance if you have the following signs:

• severe dizziness, fainting, convulsions;
• chest pain, fever, cough with blood in the sputum;
• loss of consciousness, general bluish skin.

Prevention

A healthy lifestyle is the best protection against all diseases. This is primarily about proper nutrition and maintaining weight within normal limits.

To prevent embolism, it is important to avoid injuries and promptly treat infectious diseases.

Those who have suffered a pulmonary embolism are at high risk of developing it again. However, relapses can be life-threatening. To prevent them, especially people prone to the formation of blood clots, should avoid prolonged stay in one position, for example, in a sitting position. It is necessary to warm up periodically. To improve blood circulation in the legs, it is recommended to wear compression tights or stockings, which also prevent blood clots.

You should drink more water, especially when traveling, and, if possible, eliminate coffee and alcohol from your diet.

According to statistics, pulmonary artery thrombosis is detected in 1–2 people per 1000 population annually. And in most cases, the diagnosis is posthumous, because with the rapid development of the problem, the patient has little chance of surviving until a diagnosis is made, and thrombosis of small arteries is very difficult to diagnose, since its symptoms are similar to many other serious diseases, including myocardial infarction, heart failure, pneumonia, etc.

When they talk about pulmonary artery thrombosis, they mean thromboembolism - blockage of a vessel by a blood clot that forms on the wall of the heart or other vessel, and then breaks off and reaches the lung through the bloodstream. But in order to block the pulmonary artery, which can reach 2.5 cm in diameter, the clot must be large. If the blood clot is smaller, then it can get stuck in one of the small branches of the pulmonary artery.

Blood clots that are attached to the vessel wall only in the area of ​​their base, the so-called floating ones, come off. There may be no symptoms if a small vessel is clogged, but a large clot can impair blood circulation through a segment or even an entire lobe of the lung and cause the development of oxygen starvation. In response to this, a reverse reaction develops - the lumens of blood vessels narrow in the pulmonary circulation, and the pressure in the pulmonary arteries increases. The result is an increased load on the right heart ventricle.

Typically, pulmonary embolism (PA) is classified as follows:

• non-massive - blockage occurs at the level of segmental arteries, there are no or minimal manifestations, no more than a third of the vascular bed of the lungs is affected;
• submassive - in this case, the size of the lesion reaches half of the pulmonary vascular bed, blockage occurs at the level of many segmental or many lobar arteries, which is accompanied by failure of the right cardiac ventricle;
• massive - the vascular bed is affected by more than half, the main pulmonary arteries or pulmonary trunk are affected, to which the body’s compensatory reactions respond with shock or a systemic decrease in pressure by more than 20%.

TPA is not an independent disease. This is a complication of conditions due to which deep thrombosis occurs in the venous system, the right chambers of the heart, or causing thrombosis directly in the pulmonary artery system.

Reasons

The common cause of all types of TPA is the formation of a blood clot (thrombus) in any vessel, which subsequently breaks off and clogs the pulmonary artery, blocking the blood flow. Many diseases can lead to this, the most common of which are the following:

• thrombosis in the superior vena cava system;
• deep vein thrombosis in the legs (95% of cases);
• thrombi in the right atrium and right ventricle.

In addition to the listed reasons, there are also specific medical indicators (for example, deficiency of antithrombin, protein C, dysplasminogenemia and others), most often congenital, and secondary risk factors that depend on the patient’s lifestyle:

• smoking;
• fractures;
• stroke;
• chronic venous insufficiency;
• thrombophlebitis;
• old age;
• pregnancy;
• increased blood viscosity;
• heart failure;
• obesity;
• previous operations;
• traveling long distances;
• use of oral contraceptives;
• catheter in the central vein.

Signs and symptoms

Pulmonary thrombosis has many variants of its course, ways in which it manifests itself, and degrees of severity of symptoms. The clinical picture is non-specific and is characterized by a variety of signs, ranging from an asymptomatic course with multi-vessel lesions and ending with clearly defined hemodynamic disturbances, the development of acute right ventricular failure with massive TPA.

Manifestations of TPA can be varied, but there are general symptoms that are necessarily present for any severity of the problem and location of the thrombus:

• shortness of breath that appears suddenly and for an unknown reason, present when inhaling, sounding quiet and rustling;
• heart murmur;
• rapid shallow breathing (tachypnea);
• a significant decrease in blood pressure, which is lower the more severe the problem;
• pale grayish skin;
• tachycardia from 100 beats per minute;
• pain on palpation of the abdomen;
• chest pain.

Although none of the listed symptoms can be called specific, they are all detected with existing TPA. The following may also be present as optional (associated) symptoms:

• fainting;
• hemoptysis;
• vomit;
• feverish condition;
• accumulation of fluid in the chest cavity.

As mentioned above, the listed symptoms are characteristic of many serious diseases - pulmonary tumor, pneumonia, heart failure, pleurisy, panic attacks - therefore, in order to establish a diagnosis, in addition to a thorough history, instrumental studies are necessary, among which the most accessible are:

• radiography;
• electrocardiography;
• Doppler ultrasound of leg veins;
• echocardiography.

But the most accurate methods for determining the presence of this problem are:

• catheterization of the right heart with direct measurement of pressure in the cavities of the heart and pulmonary artery;
• spiral computed tomography with contrast;
• ventilation-perfusion lung scintigraphy.

Treatment

When TPA develops, treatment occurs in a hospital, intensive care unit, or intensive care unit. A person’s heart may stop and there may be severe oxygen deprivation. Then cardiopulmonary resuscitation, oxygen therapy using a mask and a nasal catheter are used. Artificial ventilation is rarely used. If there is a strong drop in blood pressure, adrenaline, dopamine, dobutamine, and saline solution are used intravenously. All resuscitation measures are aimed at preventing the development of blood poisoning, restoring blood circulation in the lungs, and preventing the development of chronic pulmonary hypertension.

After emergency and urgent care is provided, basic treatment begins, aimed at reducing relapses and the risk of death. The thrombus should be resolved, for which drugs are administered intravenously or subcutaneously that dissolve blood clots and prevent the formation of new ones: heparin, sodium dalteparin, fondaparinux. The thrombus is removed using reperfusion therapy, for which alteplase, urokinase, and streptokinase are used.

If more than 50% of the lungs are affected, surgery is performed - thrombectomy. It is performed in case of damage to the trunk or large branches of the pulmonary arteries. The clot is removed through a miniature incision that provides access to the inflamed artery. As a result, the obstacle in the path of blood flow is removed, and the blood supply to the lungs is restored. Surgeons intervene in treatment only when conservative methods fail.

After all, we are talking about blood clots formed. Among all pathologies, PE stands out with alarming 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 patient deaths occur as a result of blockage of a pulmonary artery by a blood clot.

Characteristics of the disease

PE 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 the bloodstream. Often blood clots occur in the vessels of the lower extremities. Sometimes localized in the right side of the heart. The thrombus 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 one.

A traveling thrombus is called an embolus. It rushes towards the lungs. This is an extremely dangerous process. A blood clot in the lungs can suddenly block the lumen of the branches of the artery. These vessels are numerous in number. However, their diameter decreases. Once in a vessel through which the blood clot cannot pass, it blocks blood circulation. This is what often leads to death.

If the patient is in the lungs, the consequences depend on which vessel is 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 experiences hypoxia.

Severity of the disease

Blood clots in the lungs occur as a result of complications of somatic diseases, after birth and surgical conditions. The mortality rate from this pathology is very high. It ranks third among the causes of death, second only to cardiovascular diseases and oncology.

Today, pulmonary embolism develops mainly against the background of the following factors:

• severe pathology;
• complex surgical intervention;
• injury received.

The disease is characterized by a severe course, many heterogeneous symptoms, difficult diagnosis, and a high risk of mortality. Statistics show, based on post-mortem 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 progresses very rapidly. That is why it is important to quickly and correctly diagnose the pathology. And also provide adequate treatment that can save a human life.

If a blood clot in the lungs is detected in a timely manner, the survival rate increases significantly. The mortality rate among patients who receive 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, the photo of which is located in this article, appears as a result of:

• lower extremities;
• formation of a blood clot in any area of ​​the venous system.

Much less frequently, this pathology can be localized in the veins of the peritoneum or upper extremities.

Risk factors presuming the development of pulmonary embolism in a patient are 3 precipitating conditions. They are called Virchow's triad. These are the following factors:

1. Reduced blood circulation rate in the venous system. Congestion in blood vessels. Slow blood flow.
2. Increased susceptibility to thrombosis. Hypercoagulability of blood.
3. 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 blood clot is detected in the lungs. The reasons may be hidden in the following circumstances.

The following can lead to a slowdown in venous blood flow:

• long trips, travel, as a result of which a person has to sit for a long time in an airplane, car, train;
• hospitalization, which requires bed rest for a long period.

Hypercoagulability can be caused by:

• smoking;
• use of contraceptives, estrogen;
• genetic predisposition;
• oncology;
• polycythemia - a large number of red blood cells in the blood;
• surgical intervention;
• pregnancy.

Injuries to the venous walls result from:

• deep vein thrombosis;
• household leg injuries;
• surgical interventions on the lower extremities.

Risk factors

Doctors identify the following predisposing factors in which a blood clot is most often detected in the lungs. The consequences of the pathology are extremely dangerous. Therefore, it is necessary to pay close attention to the health of those people who have the following factors:

• decreased physical activity;
• age over 50 years;
• oncological pathologies;
• surgical interventions;
• heart failure, heart attack;
• traumatic injuries;
• varicose veins;
• use of hormonal contraceptives;
• complications of childbirth;
• erythremia;
• overweight;
• genetic pathologies;
• systemic lupus erythematosus.

Sometimes blood clots in the lungs can be diagnosed in women after childbirth, especially severe ones. 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 swelling. Such a pathology should be reported to the doctor immediately so as not to aggravate the pathological process.

Characteristic symptoms

In order to promptly diagnose a blood clot in the lungs, the symptoms of the pathology should be clearly understood. You should be extremely careful with the possible development of this disease. Unfortunately, the clinical picture of pulmonary embolism is quite varied. It is determined by the severity of the pathology, the rate of development of changes in the lungs and the signs of the underlying disease that provoked this complication.

If a blood clot is present in the lungs, the patient's symptoms (mandatory) are as follows:

1. Shortness of breath that suddenly appeared for unknown reasons.
2. There is an increase in heart rate (more than 100 beats in one minute).
3. Pale skin with a characteristic gray tint.
4. Pain syndrome that occurs in different parts of the sternum.
5. Impaired intestinal motility.
6. Sharp blood filling of the neck veins and their bulging is observed, pulsation of the aorta is noticeable.
7. The peritoneum is irritated - the wall is quite tense, pain occurs when palpating the abdomen.
8. Heart murmurs.
9. Blood pressure drops significantly.

In patients who have a blood clot in the lungs, the above symptoms are necessarily present. However, none of these symptoms are specific.

In addition to the mandatory symptoms, the following conditions may develop:

• fever;
• hemoptysis;
• fainting;
• chest pain;
• vomit;
• seizure activity;
• fluid in the sternum;
• coma.

Course of the disease

Since pathology is a very dangerous disease that does not exclude death, 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 reasons for the manifestation of anxiety symptoms are completely absent. Shortness of breath appears on exhalation. It is characterized by a quiet sound accompanied by a rustling hue. At the same time, she is constantly present.

In addition, PE is accompanied by an increased heart rate. Can be heard from 100 beats or more 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 caused 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:

1. Pain behind the sternum, which has an acute, bursting character. This discomfort characterizes blockage of the artery trunk. Pain occurs as a result of compression of the nerve endings of the vessel wall.
2. Angina discomfort. The pain is of a compressive nature. Localized in the heart area. It often radiates to the shoulder blade or arm.
3. Painful discomfort throughout the sternum. This pathology can characterize a complication - pulmonary infarction. Discomfort increases significantly with any movement - deep breathing, coughing, sneezing.
4. Pain under the ribs on the right. Much less often, discomfort may occur in the liver area if the patient has blood clots in the lungs.

There is insufficient blood circulation in the vessels. This can cause the patient to:

• painful hiccups;
• tension in the abdominal wall;
• intestinal paresis;
• bulging of large veins in the neck and legs.

The surface of the skin becomes pale. An ashy or gray tint often develops. Subsequently, blue lips may develop. The last sign indicates massive thromboembolism.

Sometimes the patient hears a characteristic heart murmur and an arrhythmia is detected. In the event of a pulmonary infarction, hemoptysis is possible, combined with severe chest pain and a fairly high temperature. Hyperthermia can last for several days, and sometimes for a week and a half.

Patients who have a blood clot in the lung may experience cerebral circulatory problems. Such patients often have:

• fainting;
• convulsions;
• dizziness;
• coma;
• hiccups

Sometimes the described symptoms may be accompanied by signs of acute renal failure.

Complications of pulmonary embolism

A pathology in which a blood clot 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:

1. Chronically increased pressure in the pulmonary vessels.
2. Pulmonary infarction.
3. Paradoxical embolism in the vessels of the systemic circle.

However, not everything is so sad if blood clots in the lungs are diagnosed in a timely manner. The prognosis, as noted above, is favorable if the patient receives adequate treatment. In this case, there is a high chance of minimizing the risk of unpleasant consequences.

Below are the main pathologies that doctors diagnose as a result of complications of pulmonary embolism:

• pleurisy;
• pulmonary infarction;
• pneumonia;
• empyema;
• lung abscess;
• renal failure;
• pneumothorax.

Recurrent pulmonary embolism

This pathology can recur in patients several times throughout life. In this case, we are talking about a recurrent form of thromboembolism. About 10-30% of patients who have had this disease once are susceptible to repeated episodes of pulmonary embolism. One patient may experience a different number of attacks. On average, their number varies from 2 to 20. Many past episodes of pathology represent blockage of small branches. Subsequently, this pathology leads to embolization of large arteries. A massive pulmonary embolism is formed.

The reasons for the development of a recurrent form can be:

• chronic pathologies of the respiratory and cardiovascular systems;
• oncological diseases;
• surgical interventions in the abdominal area.

This form does not have clear clinical signs. It is characterized by an erased flow. Correctly diagnosing this condition is very difficult. Often, unexpressed symptoms are mistaken for signs of other diseases.

Recurrent pulmonary embolism may be manifested by the following conditions:

• persistent pneumonia that has arisen for an unknown reason;
• fainting conditions;
• pleurisy that lasts for several days;
• attacks of suffocation;
• cardiovascular collapse;
• difficulty breathing;
• increased heart rate;
• elevated temperature that cannot be eliminated with antibacterial medications;
• 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 tissue;
• heart failure;
• pulmonary hypertension.

Recurrent pulmonary embolism is dangerous because any subsequent episode can be fatal.

Diagnosis of the disease

The symptoms described above, as already mentioned, are not specific. Therefore, it is impossible to make a diagnosis based on these signs. However, with PE there are 4 characteristic symptoms:

• dyspnea;
• tachycardia - increased heart contractions;
• chest pain;
• rapid breathing.

If a patient does not have these four signs, then he does not have thromboembolism.

But not everything is so easy. Diagnosis of the pathology is extremely difficult. To suspect pulmonary embolism, the possibility of developing the disease should be analyzed. Therefore, initially the doctor pays 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 entered the lung.

Mandatory examinations to identify or exclude PE are the following studies:

1. ECG. A very informative diagnostic method. An electrocardiogram gives an idea of ​​the severity of the pathology. If you combine the information obtained with your medical history, PE is diagnosed with high accuracy.
2. X-ray. This study is not very informative for making a diagnosis of pulmonary embolism. However, it is precisely this that allows one to distinguish the disease from many other pathologies that have similar symptoms. For example, from pleurisy, pneumothorax, aortic aneurysm, pericarditis.
3. Echocardiography. The study allows us to identify the exact location of the blood clot, its shape, size, and volume.
4. This method provides the doctor with a “picture” of the pulmonary vessels. It clearly shows areas of impaired blood circulation. But it is impossible to detect the place where blood clots are located in the lungs. The study has a high diagnostic value only for pathology of large vessels. It is impossible to identify problems in small branches using this method.
5. Ultrasound of leg veins.

If necessary, the patient may be prescribed additional research methods.

Urgent help

It should be remembered that if a blood clot breaks loose in the lungs, the patient’s symptoms can develop at lightning speed. And just as quickly lead to death. Therefore, if there are signs of pulmonary embolism, the patient should be given complete rest and a cardiac ambulance should be immediately called. The patient is hospitalized in the intensive care unit.

Emergency care is based on the following measures:

1. Emergency and administration of the drug "Reopoliglyukin" or a glucose-novocaine mixture.
2. Intravenous administration of drugs is carried out: Heparin, Dalteparin, Enoxaparin.
3. The pain effect is eliminated by narcotic analgesics, such as Promedol, Fentanyl, Morin, Lexir, Droperidol.
4. Oxygen therapy.
5. The patient is administered thrombolytics: Streptokinase and Urokinase.
6. In cases of arrhythmia, the following drugs are used: Magnesium Sulfate, Digoxin, ATP, Ramipril, Panangin.
7. If the patient has a shock reaction, he is administered Prednisolone or Hydrocortisone, as well as antispasmodics: No-shpu, Eufillin, Papaverine.

Ways to combat pulmonary embolism

Resuscitation measures can help prevent the patient from developing sepsis, as well as protect against the formation of pulmonary hypertension.

However, after first aid is provided, the patient needs continued treatment. The fight against pathology is aimed at preventing relapses of the disease and completely resolving the blood clot.

Today, there are two ways to eliminate blood clots in the lungs. Treatment methods for pathology are as follows:

• thrombolytic therapy;
• surgical intervention.

Thrombolytic therapy

Drug treatment is based on drugs such as:

• "Heparin";
• "Streptokinase";
• "Fraxiparin";
• tissue plasminogen activator;
• "Urokinase."

Such drugs help 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 clotting 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".

Monitoring of blood clotting continues. Taking the prescribed pills lasts (after suffering from pulmonary embolism) for about 1 year.

Medicines “Urokinase” and “Streptokinase” are administered intravenously throughout the day. This manipulation is repeated once a month. Tissue plasminogen activator is also used intravenously. A single dose should be administered over several hours.

Thrombolytic therapy is not given 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.

Surgical treatment

This question arises only when a large area is affected. In this case, it is necessary to promptly remove the localized blood clot in the lungs. The following treatment is recommended. A special technique is used to remove the blood clot from the vessel. This operation allows you to completely remove the obstacle to blood flow.

Complex surgical intervention is carried out if large branches or the trunk of the artery are blocked. In this case, it is necessary to restore blood flow over almost the entire area of ​​the lung.

Prevention of pulmonary embolism

The disease thromboembolism has a tendency to recur. Therefore, it is important not to forget about special preventive measures that can protect against the re-development of severe and dangerous pathology.

It is extremely important to carry out such measures in people at high risk of developing this pathology. This category includes persons:

• over 40 years old;
• have had a stroke or heart attack;
• overweight;
• whose medical history contains an episode of deep vein thrombosis or pulmonary embolism;
• who have undergone surgery on the chest, legs, pelvic organs, and abdomen.

Prevention includes extremely important measures:

1. Ultrasound of leg veins.
2. Regular injection of Heparin, Fraxiparin under the skin or injection of Reopoliglucin into a vein.
3. Applying tight bandages to the legs.
4. Compression of the leg veins with special cuffs.
5. Ligation of large leg veins.
6. Implantation of vena cava filters.

The latter method is an excellent prevention of the development of thromboembolism. Today, a variety of vena cava filters have been developed:

• "Mobin-Uddin";
• "Gunther's tulip";
• "Greenfield"
• "Hourglass".

However, remember that such a mechanism is extremely difficult to install. An incorrectly inserted vena cava filter will not only not provide reliable prevention, but can also lead to an increased risk of thrombosis with subsequent development of pulmonary embolism. Therefore, this operation should be performed only in a well-equipped medical center, exclusively by a qualified specialist.

Thromboembolism of the pulmonary artery of small branches is a partial narrowing or complete closure of the lumen of one or more non-main vessels. Through these vessels, blood enters the pulmonary alveoli to be enriched with oxygen. Impairment of blood flow in the small branches of the pulmonary artery is not as fatal as massive thromboembolism of the main trunk or branches. The often recurrent process worsens health, leads to frequently recurring lung pathologies and increases the risk of massive thromboembolism.

Classmates

How often does the disease occur and how dangerous is it?

In the structure of pulmonary embolism, small-vascular localization of the thrombus accounts for 30%. According to the most reliable statistics collected in the USA, this disease is diagnosed in 2 people per 10,000 population (0.017%).
If thromboembolism of large branches of arteries leads to death in 20% of cases, then with damage to small vessels there is no such risk. This is explained by the fact that there are no significant changes in the functioning of the cardiovascular system: blood pressure and the load on the heart remain normal for a long time. Therefore, this type of thromboembolism is classified as a “non-massive” type of disease.

Patients should be aware that localization of a thrombus in small branches often precedes massive thromboembolism, in which the risk of life increases significantly.

Even if thromboembolism of larger vessels does not develop, the presence of a section of the lung to which the blood supply is difficult or stopped, over time leads to the manifestation of pathologies such as:

• pulmonary infarction;
• infarction pneumonia;
• the occurrence of right ventricular failure.

Rarely, with recurrent thromboembolism of small branches of the pulmonary arteries, chronic pulmonary heart syndrome develops with a poor prognosis.

Risk factors

Purchased

Thromboembolism refers to vascular diseases. Its occurrence is directly related to:

• Atherosclerotic process;
• elevated sugar and/or cholesterol levels;
• unhealthy lifestyle.

At risk are:

• Elderly people;
• patients with venous insufficiency;
• people with high blood viscosity;
• smokers;
• those who abuse food with animal fats throughout their life;
• obese people;
• have undergone surgery;
• long-term immobilized;
• after a stroke;
• people with heart failure.

Hereditary

As a congenital predisposition, thrombosis is rare. Today, genes are known that are responsible for the intensity of the blood clotting process. Defects in these genes cause hypercoagulability and, as a result, increased thrombus formation.

Risk groups due to hereditary factors include:

• People whose parents or grandparents had cardiovascular diseases;
• had thrombosis before the age of 40 years;
• suffering from frequent relapses of thrombosis.

How does pulmonary embolism of small branches manifest itself?

The narrowing of the lumen of small arterial vessels often does not manifest itself. In one European study conducted on a large group of patients with thrombosis of the legs, a lack of blood supply to the lung areas to one degree or another was diagnosed in half. Meanwhile, no obvious clinical manifestations of thromboembolism were observed in the study group. This is due to the possibility of compensating for the lack of blood flow from the bronchial arteries.

In cases where there is not enough compensatory blood flow or if the pulmonary artery has undergone total thrombosis, the disease manifests itself with the following symptoms:

• Pain in the lower part, on the sides of the chest;
• unmotivated shortness of breath accompanied by tachycardia;
• sudden feeling of pressure in the chest;
• difficulty breathing;
• lack of air;
• cough;
• recurrent pneumonia;
• rapidly transient pleurisy;
• fainting.

Thromboembolism of the pulmonary artery of small branches, as a rule, is the first signal foreshadowing the development of massive thromboembolism with severe symptoms and high mortality in the future.

What examinations are performed for diagnosis?

In the presence of clinical signs of pulmonary embolism of small branches, the diagnosis is often not obvious. Symptoms resemble heart failure, myocardial infarction. Primary diagnostic methods include:

• radiography;

As a rule, these two studies are enough to highly likely suggest the localization of the problem area in the lungs.
To clarify, the following studies are carried out:

• EchoECG;
• scintigraphy;
• blood test;
• Doppler ultrasound of leg vessels.

Every patient with symptoms of thromboembolism of small branches of the pulmonary artery should be examined to exclude the possibility of massive thromboembolism.

How to treat

1. Infusion therapy

It is carried out with solutions based on dextran to give the blood less viscous properties. This improves the passage of blood through the narrowed sector, reduces pressure and helps reduce the load on the heart.

2. Anticoagulation

First-line drugs are direct-acting anticoagulants (heparins). Appointed for a period of up to a week.

3. Thrombolytics

Depending on the severity of the case, age and general health, thrombolytic therapy (streptokinase, urokinase) may be prescribed for a period of up to 3 days. However, if the patient’s condition is relatively stable and there are no serious hemodynamic disturbances, thrombolytic agents are not used.

How to prevent the development of pulmonary embolism

The following general advice can be given as preventive measures:

• Loss of body weight;
• reducing the amount of animal fats and increasing the amount of vegetables in the diet;
• drinking more water.

If relapse is likely, periodic courses of heparins and anticoagulants are prescribed.

With frequent relapses of thromboembolism, it may be recommended to place a special filter in the inferior vena cava. However, it should be borne in mind that the filter itself increases the risks:

• Thrombosis at the site of the filter (in 10% of patients);
• recurrence of thrombosis (in 20%);
• development of postthrombotic syndrome (40%).

Even with anticoagulation therapy, 20% of patients with a filter installed experience a narrowing of the lumen of the vena cava within 5 years.

The video discusses the stages of development of pulmonary embolism and ways of treating it.

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Pulmonary embolism (PE)

Such a beautiful name - Tela - does not belong to a girl at all, but to one of the most terrible and severe complications, the full name of which is acute pulmonary embolism. We all know that blood clots are dangerous clots in blood vessels: as a result of thrombosis, myocardial infarctions occur (death, or necrosis of a section of the heart muscle), and strokes – necrosis of part of the brain, which occurred as a result of acute oxygen starvation when the lumen of a vessel is blocked.

But it turns out there is another way - TELA. In the world, this is the third type of serious disorders in the cardiovascular system, after heart attack and stroke. Thus, in the USA alone, despite its highly developed medicine, more than 300 thousand people have to be hospitalized with this pathology every year - more than the number who met on the Kulikovo Field. With pulmonary embolism the mortality rate is also very high.

Thus, every sixth patient dies, or 50 thousand annually, in the USA alone. Naturally, generalizing global data, we can assume that the true incidence is several times higher. What kind of condition is this, how does it develop, what symptoms does it manifest, and how is it treated?

TELA - what is it?

Pulmonary embolism (PE) is an acute disease of the large vessels of the lungs, which bring venous blood into them for oxygenation. The meaning of the pathology is that a blood clot that appears in the human venous system enters the right half of the heart, and then through the right ventricle enters the pulmonary artery.

Before reaching the heart, the clot only entered larger and larger veins, and it was “easy to float.” And after the obstacle passes the right ventricle, then, on the contrary, the smallest capillaries are needed for oxygen enrichment, so the pulmonary artery begins to branch again into vessels of ever smaller caliber.

As a result, the pulmonary artery plays the role of a filter, which ultimately retains this blood clot. Naturally, it gets stuck in the vessel, which does not allow it to pass further. As a result, a symptom complex called pulmonary embolism develops in all underlying parts of this blocked vessel.

Causes of pulmonary embolism

As we have already said, everything that “can fly” to the right heart concerns the veins and the venous part of the systemic circulation. Therefore, the causes of pulmonary embolism, which most often lead to clinically significant manifestations, are the following:

1. Thrombosis of deep-lying veins on the thigh and in higher sections, that is, large veins of the legs and pelvis;
2. Thrombosis of deep veins located on the lower leg (with complicated thrombophlebitis varicose veins)

The degrees of risk are not comparable: 50% of all high thromboses are complicated by pulmonary embolism, and with thrombosis of the veins of the legs, only 1-5% of all cases lead to pulmonary embolism. If you combine the indicators, it turns out that in 70% of patients with pulmonary embolism, the source of blood clots is the venous vessels of the legs.

However, there is a whole list of diseases that lead to a sharp increase in the chances of pulmonary embolism. These include:

• various tumors and malignant neoplasms;
• severe cardiac pathology: congestive failure, heart attack, stroke;
• sepsis (purulent emboli in the veins);
• erythremia (Vaquez disease) - with it the blood thickens very much;
• nephrotic syndrome;
• systemic lupus erythematosus;

In addition, older age, oral estrogens in women, and prolonged immobility (for example, while in intensive care) increase the risk.

It is possible to list the variants of pulmonary embolism in which there is no separation and blockage by a thrombus. These options include air embolism. An air bubble can enter the pulmonary artery even with intensive rinsing of the sinuses. Also, during childbirth, amniotic fluid can enter the pulmonary veins through the uteroplacental sinuses, and this complication has a very high mortality rate.

There are variants of fatty, traumatic and septic embolism, consisting of bacteria and purulent tissue.

It is important to say right away that mortality from pulmonary embolism has stopped increasing. If the patient is not treated and this vascular catastrophe overtakes him, then the mortality rate is always 30%. And if treatment is started correctly, timely and competently, then it will decrease threefold and will be 10%. This is, of course, a good, but clearly insufficient indicator.

The cause of death is very severe pulmonary hypertension and acute failure of the right ventricle: it cannot pump blood into the lungs, therefore, roughly speaking, death occurs from suffocation, in which you can breathe and the airways are open, but blood does not flow into the lungs.

According to pathological studies, PE does not mean that one blood clot has blocked any area: often the blood clots are multiple, and blockage occurs repeatedly. Almost 2/3 of cases lead to bilateral pulmonary artery damage (that is, both lungs are affected).

• If we take into account the angle of origin and the caliber of the branches of the pulmonary trunk, then the right lung still has a high chance of being affected, and in it the lower lobes are affected more often than the upper ones.

The main damaging mechanism for pulmonary embolism is a lack of oxygen, the discharge of blood from one vessel to another, bypassing the blocked area, and various consequences of these conditions.

Thus, when a large branch is blocked, the pressure in the main trunk of the pulmonary artery increases sharply. To “pump” the blood, the right ventricle does not have enough strength, and the phenomenon of “acute cor pulmonale” or acute right ventricular failure develops.

Patients who had lung problems before PE are somewhat more “lucky”. They have right ventricular hypertrophy and its force and contractility reserves may be greater.

Symptoms of pulmonary embolism, clinical signs

Signs of pulmonary embolism are determined by the complex interaction of many components:

• degree of obstruction (blockage) of the pulmonary artery;
• resulting cardiac output of the right ventricle;
• its initial hypertrophy;
• the presence of concomitant pulmonary pathology.

What are the main symptoms that indicate the development of pulmonary embolism? Symptoms of pulmonary embolism can be noticeable. So, the following manifestations are considered the earliest:

• shortness of breath and chest pain;
• cough and hemoptysis;
• feeling of panic;
• tachypnea (increased breathing rate over 20 per minute);
• the appearance of wheezing in the lungs;
• when listening with a phonendoscope, an accent of 2 tones appears above the pulmonary artery (the right ventricle makes every effort to “break through the blockage”);
• high temperature occurs: fever over 37.5%.

Of course, there are other signs, but they are all grouped into several main syndromes:

• Pulmonary infarction(completely similar to myocardial infarction, only occurs in the lung): shortness of breath, pain, hemoptysis.
• Acute cor pulmonale: cyanosis, fainting, and a sharp drop in pressure in the left ventricle appear.
• Chronic pulmonary hypertension. Occurs if a blood clot “leaks a little” through the blood, but stays there for a long time. As a result, the neck veins swell, venous congestion occurs throughout the large circle, and the liver enlarges.

Diagnosis of pulmonary embolism - techniques

Despite the extremely characteristic clinical picture of pulmonary embolism, instrumental diagnostics are necessary. After all, all of the listed symptoms are nonspecific, that is, they can be determined by different diseases. In addition, routine blood and urine tests, including biochemical tests, are usually normal even in severe lesions.

Therefore, diagnostic measures are necessary: ​​pneumonia, heart attack, bronchial asthma, lung cancer, severe asthma, sepsis, rib fractures and many other diseases may resemble pulmonary embolism.

The following methods are used to diagnose PE:

• Determination of the gas composition of arterial blood: the partial pressure of oxygen is less than 90 mm. Hg st;
• Electrocardiography. An ECG rather helps to exclude a heart attack, since ECG signs of PE are nonspecific: deviation of the electrical axis of the heart to the right and right bundle branch block often develop. If we take into account that rhythm disturbances can develop against the background of severe pulmonary embolism of large branches, then the ECG can record both atrial and ventricular extrasystole, as well as atrial fibrillation and flutter;
• X-ray of the lungs and chest. This must be done to rule out cancer and pneumonia, tuberculosis and emphysema. If there are no signs of these diseases, but congestion of the roots and central structures of the lungs, atelectasis, a sudden “break” along the vessel, infiltrative artifacts or the appearance of pleural effusion is visible, then this may indirectly indicate “in favor of pulmonary embolism”.

However, the “gold standard” for emergency diagnosis of pulmonary embolism is considered to be CT – angiography of the pulmonary vessels, or angiopulmonography.

To do this, it is enough to insert a catheter into a peripheral vein (as with a regular blood draw) and inject contrast. Then a CT scan of the lungs is performed, and in the case of a positive diagnosis, a “sudden” break in the branch (there was a contour and disappeared) of the pulmonary artery will immediately be visible, and you can even see the contours of a blood clot that has blocked the lumen of the vessel.

As you can see, almost all methods, except angiopulmography, exclude other diagnoses, but do not confirm them, that is, they are used in differential diagnosis. And only a CT scan can make a diagnosis. Therefore, you need to know that you need to take patients taken by ambulance only to places where there is an emergency computed x-ray tomograph that operates around the clock. How are these patients helped?

PE - emergency care and treatment

Treatment of pulmonary embolism begins at the prehospital stage, that is, by an ambulance doctor. Alas, do-it-yourself first aid is ineffective. The first thing that comes to mind is that giving aspirin to “dissolve” a blood clot can do a bad job, since doctors will do the same thing, but by other means. Alas, the only thing that relatives and friends can do is to put the patient to bed, ventilate the room, and call an ambulance.

Emergency care for pulmonary embolism will consist of the following measures:

• Intravenous injection of heparin (this is performed by an emergency physician);
• Upon admission to the hospital, against the background of an urgent and regular determination of PTT (partial thromboplastin time), treatment with indirect anticoagulants - warfarin, under the control of INR;
• Currently, in those centers that have the opportunity, thrombolytic therapy is used: alteplase, urokinase, streptokinase. By “opportunity” we mean a whole range of modern requirements and a high level of the center, which has permission to provide this most high-tech and modern type of assistance. This therapy is aimed at quickly dissolving the blood clot with special enzymes;
• Surgical methods for removing a blood clot. These are high-risk methods, and surgical intervention is used in conditions of hypoxia and reduced tissue perfusion only if attempts to “dissolve” it are ineffective;
• Continuing treatment, after eliminating the obstruction to blood flow in the lungs, a special cava filter is usually placed in the inferior vena cava (the word “cava” means a literal translation from the Latin word “hollow”), which is designed to catch repeated blood clots.

Treatment prognosis and prevention of thromboembolism

There are a number of conditions in which the risk of pulmonary embolism increases significantly. Therefore, when performing them, it is necessary to promptly carry out primary prevention through the administration of heparin and warfarin. Thus, high-risk operations include:

• Various operations on the legs, including orthopedic (for example, endoprosthetics, or replacement with an artificial joint);
• Surgeries for hip fractures (here crushed lumps of adipose tissue enter the lumen of the vein - fat embolism). By the way, it will not be possible to dissolve a fat embolus. Need to operate;
• Gynecological operations for the removal of cancerous tumors.

In order to avoid symptoms of pulmonary embolism and the need for emergency care, you need to think about such a serious complication in advance. Thus, the usual wearing of compression hosiery can relieve this formidable complication of varicose veins and thrombophlebitis in cases where, for example, the administration of anticoagulants is contraindicated.