Blood clots in the lungs. Pulmonary embolism: causes, symptoms, consequences, treatment

Life-threatening disease is pulmonary embolism (PE). We are talking about the formed blood clots. Among all the pathologies of pulmonary embolism is highlighted alarming statistics. Blood clots in the lungs are able at any moment to clog an artery. Unfortunately, quite often it leads to death. Almost a third of all sudden deaths of patients occur as a result of blockage of the pulmonary artery blood clot.

Characteristic of disease

PE is not a standalone pathology. As the name suggests, is a consequence of the thrombosis.

A blood Clot, breaking away from their place of education, sweeping over the system with blood flow. Often blood clots occur in the blood vessels of the lower extremities. Sometimes it is localized in the right chamber of the heart. The clot passes through the right atrium, ventricle and enters the pulmonary circulation. He moves only in the body of the steam artery with venous blood pulmonary.

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 the artery. These vessels are numerous. However, their diameter is reduced. Entering the vessel through which the blood clot can't pass, it blocks the blood circulation. It often leads to death.

If the patient has a clot in the lungs, the consequences depend on which vessel was occluded. Embolus disrupts the normal blood supply to the tissues and the ability of gas exchange at the level of small branches or large arteries. The patient's hypoxia occurs.

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Severity of illness

Blood Clots in the lungs occur as a result of complications of somatic diseases, after birth and the operating conditions. The mortality from this disease is very high. She ranks 3rd among causes of death, second only to cardiovascular diseases and Oncology.

Today, the PE develops mainly on the background of the following factors:

• Severe pathology;
• Complex surgical intervention;
• The injury.

The Disease is characterized by severe, many disparate symptoms, difficult diagnosis and high mortality risk. Statistics show, on the basis of the autopsy that the blood clots in the lungs had not been timely diagnosed almost 50-80% of the population died because of pulmonary embolism.

The disease takes place very rapidly. That is why it is important to quickly and correctly diagnose the pathology. And to spend adequate treatment that can save a human life.

If time was discovered a blood clot in the lungs, the survival rate increases significantly. The mortality rate among patients who had received appropriate treatment, is about 10%. Without diagnosis and proper treatment, it reaches 40-50%.

Causes

Blood Clot in the lungs, a photo of which is within this article is the result:

• Deep vein thrombosis of the lower extremities;
• Blood clot formation in any region of the venous system.

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

Risk Factors involving the development of the patient's pulmonary embolism, are the 3 triggers of the condition. They are referred to as ‘the triad of Virchow”. It is the following factors:

1. Reduced speed of the circulation of blood in the venous system. Stagnation in the vessels. The slow blood flow.
2. Increased tendency to thrombosis. Hyperventilatory blood.
3. Injury or damage to the venous wall.

Thus, there are certain situations that provoke the above-mentioned factors, which revealed a blood clot in the lungs. The reasons may be hidden in the following circumstances.

The slowing of venous blood flow can lead:

• Long trip, travel in which a person has long time to sit in the plane, car, train;
• Hospitalization, which required bed rest for a long time.

Hyperventilatory blood can result in:

• Smoking;
• The use of birth control pills, estrogen;
• Genetic predisposition;
• Cancer;
• Polycythemia - a large number of red blood cells;
• Surgical intervention;
• Pregnancy.

To the injury of the venous wall lead:

• Deep vein thrombosis;
• Domestic leg injuries;
• Surgical interventions on the lower limbs.

Risk Factors

Doctors have identified the following predisposing factors which most often reveals a clot in the lungs. The effects of pathology is extremely dangerous. It is therefore necessary to carefully consider the health of those people who have the following factors:

• Reduced physical activity;
• Over 50 years of age;
• Cancer pathology;
• Surgical intervention;
• Heart failure, infarction;
• Traumatic injuries;
• Varicose veins;
• The use of hormonal contraceptives;
• Complications of childbirth;
• Erythema;
• Excess weight
• Genetic pathology;
• Systemic lupus erythematosus.

Sometimes diagnosed blood clots in the lungs in women after childbirth, especially difficult. As a rule, this state precedes the formation ofclot in the thigh or the calf. It makes itself known by pain, increased temperature, redness or even swelling. About this pathology should be reported immediately to the doctor, so as not to exacerbate the pathological process.

Typical symptoms

In Order to diagnose a blood clot in the lungs, symptoms of the pathology it is important to understand. Extremely careful you should be with the possible development of this disease. Unfortunately, the clinical picture of pulmonary embolism is quite diverse. It is determined by the severity of disease, rate of progression changes in the lungs and signs of the underlying disease that triggered this complication.

If there is a clot in the lungs, symptoms (required) the patient has the following:

1. Shortness of breath, sudden for unknown reasons.
2. The Observed increase in heart rate (one minute more than 100 beats).
3. Pale skin with a gray tint.
4. Pain, occurring in different parts of the sternum.
5. Disturbed intestinal peristalsis.
6. Sharp hyperemia of the cervical veins and the solar plexus, there is a bulging, visible pulsation of the aorta.
7. Irritated the peritoneum wall is quite tense, there is pain during a feeling of the abdomen.
8. Heart Murmur.
9. Greatly reduced the pressure.

Patients who have detected a clot in the lungs, the above symptoms are present is necessary. However, none of these symptoms does not apply to specific.

In addition to the mandatory attributes, can develop the following States:

• Fever;
• Haemoptysis;
• Fainting;
• Pain in sternum;
• Vomiting
• Seizure activity;
• Fluid in the chest;
• Coma.

The Course of disease

Since pathology is a very dangerous disease with possible fatal outcome should be considered more emerging symptoms.

Initially the patient develops shortness of breath. Its appearance is not preceded by any signs. Causes manifestations of anxiety symptoms are completely absent. Shortness of breath occurs during expiration. It is characterized by a quiet sound, followed by rustling shade. However, she is always there.

In addition to it, the pate is accompanied by increased frequency of contractions of the heart. Bugged from 100 beats and above per minute.

The Next important symptom 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 pathological changes, triggered by pulmonary embolism.

Pain depend on the severity of the disease, the amount of damaged vessels and the level of violations that occurred in the body:

1. Pain in the chest, with sharp, explosive character. This discomfort characterizes the clogging of the arterial trunk. The pain occurs as a result of compression of the nerve endings of the vessel wall.
2. Stenokardicheskie discomfort. The pain is of a compressive nature. Localized in the heart. Often radiates to the shoulder, the arm.
3. Pain in the whole sternum discomfort. This pathology may characterize the complication is pulmonary infarction. Much discomfort increases with any movement, deep breathing, coughing, sneezing.
4. Pain under ribs on the right. Much less discomfort may occur in the region of the liver, if the patient has blood clots in his lungs.

In the vessels there is a lack of circulation. It is able to provoke the patient:

• Painful hiccups;
• Tension in the abdominal wall;
• Ileus;
• Bulging large veins on the neck, the legs.

The surface of the skin takes on a pale shade. Often develop ash or grey sheen. Subsequently the accession of blueing of the lips. The last sign speaks of a massive embolism.

Sometimes the patient hears a distinctive heart murmur, detected an arrhythmia. In the case of pulmonary infarction, possible hemoptysis, combined with sharp pain in chest and high temperature. Hyperthermia may occur for several days and sometimes a week and a half.

In patients who have a clot into the lung, there may be circulatory disorders of the brain. These patients often present:

• Fainting;
• Seizures;
• Dizziness;
• Coma;
• Hiccup.

Sometimes to the described symptoms can join signs of kidney failure, in an acute form.

Complications of pulmonary embolism

Extremely dangerous this pathology, in which is localized the clot in the lungs. The health consequences can be varied. It emerged complication determines the course of the disease, the quality and duration of life of the patient.

The Main consequences of pulmonary embolism are:

1. Chronically high blood pressure in the pulmonary vessels.
2. Pulmonary Infarction.
3. Paradoxical embolism in the vessels of the great circle.

However, not all so sad, if timely diagnosed blood clots in the lungs. The forecast, as noted above, favorable if the patient will receive appropriate treatment. In this case a high chance to minimize the risk of unpleasant consequences.

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

• Pleural effusion;
• Pulmonary infarction;
• Pneumonia;
• Empyema;
• A lung abscess;
• Renalfailure;
• Pneumothorax.

Recurrent pulmonary embolism

This pathology can be repeated in patients several times throughout life. In this case we are talking about the form of recurrent thromboembolism. About 10-30% of patients once the disease is prone to repeated episodes of pulmonary embolism. The same patient may experience different amounts of attacks. On average, the number varies from 2 to 20. Many transferred episodes of the pathology is an obstruction of the small branches. In consequence of this pathology leads to embolisation of large arteries. Formed massive pulmonary embolism.

The Reasons for the development of recurrent forms can be:

• Chronic pathology of the respiratory, cardiovascular systems;
• Cancer;
• Surgical interventions in the abdomen.

This form has no clear clinical signs. It is characterized by the erased current. To correctly diagnose this condition is very difficult. Often, mild symptoms are mistaken for signs of other diseases.

Recurrent pulmonary embolism can be manifested in the following States:

• Persistent pneumonia caused by unknown reason;
• Fainting;
• Pleurisy, occurring over several days;
• Asthma;
• Cardiovascular collapse;
• Difficulty breathing;
• Increased frequency of cardiac contractions;
• High temperature, not eliminates antibacterial medicines;
• Heart failure, in the absence of chronic disease of the lungs or heart.

The disease can lead to the following complications:

• Emphysema;
• Pulmonary fibrosis - lung tissue is replaced by connective;
• Heart failure;
• Pulmonary hypertension.

Recurrent pulmonary embolism is dangerous because any subsequent episode can lead to death.

Diagnosis of disease

The above symptoms, as mentioned, is not specific. Therefore, based on these signs to make a diagnosis impossible. However, in PE, be sure there are 4 characteristic symptoms:

• Shortness of breath;
• Tachycardia - increase of heart;
• Chest pain;
• Rapid breathing.

If the patient is missing four signs, thromboembolism had not.

But it is not so easy. Diagnosis of pathology is extremely difficult. To suspect pulmonary embolism, you should consider the possibility of developing the disease. Therefore, initially, the doctor draws attention to possible risk factors: presence of infarction, thrombosis, surgery. This allows you to identify the cause of the disease, the region from which the clot into the lung.

Mandatory surveys for the detection or exclusion of pulmonary embolism are the following studies:

1. ECG. Very informative method of diagnostics. Electrocardiogram gives an idea of the severity of the pathology. If you combine this with history of the disease, pulmonary embolism is diagnosed with high precision.
2. X-ray. This study for the diagnosis of pulmonary embolism is uninformative. However, it allows to distinguish the disease from other pathologies with similar symptoms. For example, from lobar pneumonia, pleurisy, pneumothorax, aortic aneurysm, pericarditis.
3. Echocardiography. The study allows to identify the precise localization of the thrombus, form, dimensions, volume.
4. Scintigraphy of the lungs. This method provides physician “picture” the pulmonary vessels. It clearly identified areas of impaired circulation. But to find a place where localized clots in the lungs, it is impossible. The study has a high diagnostic value only in the pathology of large vessels. To identify problems in small branches with the help of this method impossible.
5. Ultrasound of leg veins.

If necessary, the patient may be administered additional testing.

Immediate assistance

Keep in mind, if you have blood clot in lung symptoms the patient may develop with lightning speed. And just as quickly lead to death. Therefore, if there are signs of pulmonary embolism should ensure the patient at rest and immediately call cardiology «Ambulance». Hospitalitynet patient in the intensive care unit.

Urgent help is based on the following events:

1. Emergency catheterization of a Central vein and insertion of the drugs “Reopoliglyukin” or glucose-novocaine mixture.
2. Administered intravenously enter preparations: “Heparin”, “Dalteparin”, “enoxaparin”.
3. The effect of the Pain is eliminated narcotic analgesics, such as "Morphine”, “Fentanyl”, “joy”, “Leksir”, “Droperidol”.
4. Oxygen therapy.
5. The Patient is administered thrombolytics: means “Streptokinase”, “Urokinase”.
6. In cases of arrhythmia connect the following drugs: "magnesium Sulfate”, “Somebody”, “ATF”, “Ramipril”, “Panangin”.
7. If the patient has shock reactions he receives "Prednisolone" or "Hydrocortisone" as well as antispasmodics: “Nospanum”, “Aminophylline”, “Papaverine”.

Ways of dealing with pulmonary embolism

Allow Resuscitation to restore blood flow to the lungs, to prevent the development in a patient of sepsis, andto protect against the formation of pulmonary hypertension.

However, after first aid the patient requires continued treatment. The struggle with disease is aimed at preventing the recurrence of the disease, complete resorption of the clot.

Today, there are two ways to remove blood clots in the lungs. Methods of treatment of pathology of the following:

• Thrombolytic therapy;
• Surgery.

Thrombolytic therapy

Medical treatment based on such drugs, KEK:

• «Heparin»;
• «Streptokinase»;
• «fraxiparin»;
• Tissue plasminogen activator;
• “Urokinase”.

These drugs can dissolve blood clots and prevent the formation of new clots.

The Cure “Heparin” is administered to a patient intravenously for 7-10 days. At the same time carefully monitor the indicators of blood coagulation. For 3-7 days before the end of the treatment the patient is prescribed one of these drugs in tablet forme:

• «Warfarin»;
• «Trombotto»;
• «Cardiomagnyl»;
• «Thrombotic ass”.

The Monitoring of blood clotting is continuing. Appointment tablets lasts (after suffering a pulmonary embolism), about 1 year.

Medications “Urokinase”, “Streptokinase” introduce throughout the day of intravenous. Such manipulation is repeated 1 time per month. And used intravenous tissue plasminogen activator. A single dose should be administered for 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 disease. Because tromboliticaskie medications can increase the risk of bleeding.

Surgical treatment

This question raised only with the defeat of a large area. In this case you need to quickly remove localized clot in the lungs. The following treatment is recommended. Special equipment from the vessel removed the clot. Such operation allows to eliminate the impediment to blood flow.

Complex surgery is carried out if the clogged large branches or the trunk of the artery. In this case, you must restore blood flow in almost the entire area of the lung.

Prevention of pulmonary embolism

The Disease is thromboembolism has a tendency to a relapsing course. Therefore, it is important not to forget the special preventive measures that can protect against the re-development of heavy and menacing pathology.

Such measures are essential to people with high risk of developing this disease. This category includes persons

• Over 40 years;
• Stroke or heart attack;
• With overweight;
• History which contains the episode of deep venous thrombosis or pulmonary embolism;
• Underwent surgery on the chest, legs, pelvic organs, abdomen.

Prevention involves extremely important activities:

1. Ultrasound of leg veins.
2. Regular input under the skin of preparations “Heparin”, “fraxiparin” or injection into a vein medication “Reopoliglyukin”.
3. Suitable to apply tight bandages on his feet.
4. The special Compression of the veins of the lower leg cuffs.
5. Tying a foot of large veins.
6. Implantation of Vena cava filters.

The Last method is an excellent prevention of thromboembolism. Today, developed a variety of Vena cava filters:

• “Mobin-Uddin”;
• “Tulip Gunther”;
• “Grinfeld”;
• The‘Hourglass’.

Note that this mechanism is extremely difficult to install. Incorrectly cava filter not only become a reliable prevention, but also can result in increased risk of thrombosis with subsequent pulmonary embolism. Therefore, this operation should only be performed in well-equipped medical center, uniquely qualified.