Thrombi in the lungs. Thromboembolism of the pulmonary artery: causes, symptoms, effects, treatment

A life-threatening disease is pulmonary embolism (PE). After all, we are talking about the formed blood clots. Among all pathologies, PE is distinguished by threatening statistics. Blood clots in the lungs can clog the artery at any minute. Unfortunately, this often leads to death. Almost a third of all sudden deaths of patients occur as a result of blockage of the pulmonary artery by a blood clot.

Characteristics of the disease

PE is not an independent pathology. As the name suggests, this is the consequence of thrombosis.

A blood clot, tearing away from its place of formation, rushes through a system with blood flow. Often thrombi arise in the vessels of the lower extremities. Sometimes it is localized in the right heart. The thrombus passes through the right atrium, the ventricle and enters the small circle of the circulation. It moves along the only pair of arteries in the body with venous blood - pulmonary.

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

If a patient has a clot in the lungs, the consequences depend on which vessel was sealed. Embolus disrupts the normal blood supply of tissues and the possibility of gas exchange at the level of small branches or large arteries. The patient develops hypoxia.

Disease severity

Thrombi in the lungs arise as a result of complications of somatic diseases, after the birth and operating conditions. The mortality from this pathology is very high. It occupies the third place among the causes of death, conceding only to cardiovascular ailments and oncology.

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

• Severe pathology;
• Complicated surgical intervention;
• The resulting injury.

The disease is characterized by a severe course, a multitude of heterogeneous symptoms, a difficult diagnosis, a high risk of death. Statistics show, on the basis of postmortem autopsy, that thrombi in the lungs were not diagnosed in time in almost 50-80% of the population who died due to PE.

This disease is very rapid. That is why it is important to diagnose pathology quickly and correctly. And also to conduct adequate treatment that can save human life.

If a blood clot in the lungs was detected in a timely manner, the percentage of survival is significantly increased. Mortality among patients who received the necessary treatment is about 10%. Without diagnostics and adequate therapy, it reaches 40-50%.

Causes of the disease

A thrombus in the lungs, the photo of which is located in this article, appears as a result of:

• Deep vein thrombosis of the lower extremities;
• Formation of a blood clot in any area of the venous system.

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

Risk factors suggesting the development of a patient with PE are 3 provoking conditions. They are called the "triad of Virchow". These are the following factors:

1. Reduced blood circulation in the veins. Stagnant phenomena in the vessels. Slowed blood flow.
2. Increased tendency to thrombosis. Hypercoagulability of blood.
3. Trauma or damage to the venous wall.

Thus, there are certain situations that trigger the occurrence of the above factors, as a result of which a clot in the lungs is detected. The reasons can be hidden in the following circumstances.

To slow down the venous blood flow can lead:

• 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 a long-term bed rest.

Hypercoagulability can be caused by:

• smoking;
• Use of contraceptives, estrogen;
• Genetic predisposition;
• oncology;
• Polycythemia - a large number of erythrocytes in the blood;
• surgical intervention;
• pregnancy.

To traumas of venous walls result:

• Deep vein thrombosis;
• Household leg injuries;
• Surgical intervention on the lower limbs.

Risk factors

Physicians identify the following predisposing factors, in which the thrombus in the lungs is most often detected. The consequences of pathology are extremely dangerous. Therefore, it is necessary to carefully consider the health of those people who have the following factors:

• Decreased physical activity;
• Age over 50 years;
• Oncological pathologies;
• Surgical interventions;
• Heart failure, heart attack;
• Traumatic injuries;
• Varicosity;
• Use of hormonal contraceptives;
• Complications of childbirth;
• Erythremia;
• overweight;
• Genetic pathologies;
• Systemic lupus erythematosus.

Sometimes thrombi in the lungs can be diagnosed in women after childbirth, especially severe ones. As a rule, this state is preceded by the formation of a clot in the thigh or calf. It makes itself felt by pain, fever, redness, or even swelling. About this pathology should immediately be reported to the doctor, so as not to aggravate the pathological process.

Characteristic symptomatology

To timely diagnose a thrombus in the lungs, the symptoms of the pathology should be clearly represented. Extreme caution should be given the possible development of this disease. Unfortunately, the clinical picture of PE is quite diverse. It is determined by the severity of the pathology, the rate of development of changes in the lungs and signs of the underlying disease that provoked this complication.

If there is a thrombus in the lungs, the symptoms (mandatory) in the patient are as follows:

1. Shortness of breath, which suddenly arose for unknown reasons.
2. There is an increase in heart rate (in one minute more than 100 strokes).
3. Pale skin with a characteristic gray tinge.
4. Pain syndrome, which occurs in different parts of the sternum.
5. Disrupted intestinal peristalsis.
6. Sharp blood filling of the cervical veins and solar plexus, their swelling is observed, aortic pulsation is noticeable.
7. The peritoneum is irritated - the wall is quite tense, there is pain during the palpation of the abdomen.
8. Noises in the heart.
9. The pressure drops drastically.

In patients who have a thrombus in the lungs, the above symptoms are present. However, none of these symptoms is specific.

In addition to the mandatory signs, the following conditions can develop:

• fever;
• Hemoptysis;
• fainting;
• Pain in the sternum;
• Vomiting;
• Convulsive activity;
• Fluid in the sternum;
• coma.

Disease flow

Since pathology refers to very dangerous diseases that do not exclude the death, it is necessary to consider the symptoms in more detail.

Initially, the patient develops shortness of breath. Its appearance is not preceded by any signs. The causes of 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 shade. In this case, it is constantly present.

In addition to it, PE is accompanied by an increased incidence of cardiac contractions. Listens from 100 beats and up in one minute.

The next important feature is a sharp drop in blood pressure. The degree of reduction of this indicator is inversely proportional to the severity of the disease. The lower the pressure, the more serious the pathological changes triggered by PE.

Painful feelings depend on the severity of the disease, the volume of damaged vessels and the level of disorders that occurred in the body:

1. Pain behind the breastbone, which has an acute, disruptive character. This discomfort characterizes the blockage of the artery trunk. Pain occurs as a result of squeezing the nerve endings of the vessel wall.
2. Stenocardial discomfort. The pain is squeezing. It is localized in the region of the heart. Often gives in the shoulder blade, hand.
3. Painful discomfort throughout the sternum. Such a pathology can characterize the complication - a lung infarction. Discomfort is greatly enhanced with any movement - deep breathing, coughing, sneezing.
4. Pain under the ribs on the right. Significantly less discomfort can occur in the liver region if the patient has thrombi in the lungs.

In the vessels there is insufficient blood circulation. This can provoke a patient:

• Agonizing hiccough;
• Tension in the wall of the abdomen;
• Paresis of the intestine;
• Bulging of large veins on the neck, legs.

The surface of the skin becomes pale. Often develops ashy or gray tide. Subsequently, it is possible to attach the blue lips. The last sign speaks of massive thromboembolism.

Sometimes the patient hears a characteristic noise in the heart, arrhythmia is detected. In the case of a lung infarction, it is possible hemoptysis, combined with a sharp pain in the chest and a fairly high temperature. Hyperthermia can be observed for several days, and sometimes even a week and a half.

Patients who have a blood clot in the lung may experience impaired blood circulation in the brain. Such patients are often present:

• Fainting;
• Convulsions;
• Dizziness;
• coma;
• Hiccups.

Sometimes signs of renal failure, in acute form, may join the described symptomatology.

Complications of PE

Extremely dangerous is a pathology in which a thrombus is localized in the lungs. The consequences for the body can be very diverse. It is the complication that arises that determines the course of the course of the disease, the quality and duration of the patient's life.

The main consequences of PE are:

1. Chronically elevated pressure in the pulmonary vessels.
2. A pulmonary infarction.
3. Paradoxical embolism in large vessels.

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 diagnosed by physicians as a result of a complication of PE:

• pleurisy;
• Lung infarction;
• pneumonia;
• Empyema;
• Abscess of the lung;
• Kidney failure;
• pneumothorax.

Recurrent PE

This pathology can be repeated in patients several times throughout life. In this case, it is a recurrent form of thromboembolism. About 10-30% of patients who have once undergone such a disease are susceptible to recurrent episodes of PE. One patient may have a different number of seizures. On average, their number varies from 2 to 20. Many of the episodes of pathology transferred are a blockage of small branches. Later, this pathology leads to embolization of large arteries. Massive PE is formed.

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

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

This form does not have clear clinical signs. It is characterized by an erased current. It is very difficult to correctly diagnose this condition. Often, non-expressed symptomatology is taken for signs of other diseases.

Recurrent PE can be manifested by the following conditions:

• Persistent pneumonia, arising for an unknown reason;
• Fainting;
• Pleurisy, which last for several days;
• Attacks of suffocation;
• Cardiovascular collapse;
• labored breathing;
• Increased heart rate;
• Elevated temperature, not eliminated by antibacterial drugs;
• Heart failure, in the absence of chronic pathology of the lungs or heart.

This disease can lead to the following complications:

• Emphysema of the lungs ;
• Pneumosclerosis - pulmonary tissue replaced by a connective;
• heart failure;
• Hypertension of the lungs.

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

Diagnosis of the disease

The above symptomatology, as already mentioned, is not specific. Therefore, on the basis of these signs, it is impossible to diagnose. However, with PE, there are necessarily 4 characteristic symptoms:

• dyspnea;
• Tachycardia - an increase in heart contractions;
• chest pain;
• Rapid breathing.

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

But not everything is so easy. Diagnosis of pathology is extremely difficult. To suspect PE, you should analyze the possibility of developing the disease. Therefore, initially the doctor draws attention to possible risk factors: the presence of a heart attack, thrombosis, surgery. This allows you to determine the cause of the disease, the area from which the thrombus got into the lung.

The following studies are the mandatory examinations for the detection or exclusion of PE:

1. ECG. Very informative way of diagnosis. An electrocardiogram gives an idea of the degree of severity of the pathology. If you combine the information with the history of the disease, PE is diagnosed with high accuracy.
2. X-ray. This study for the diagnosis of PE is poorly informative. However, it allows one to distinguish the disease from many other pathologies with similar symptoms. For example, from croupous pneumonia, pleurisy, pneumothorax, aortic aneurysm, pericarditis.
3. Echocardiography. The study allows to identify the exact location of the thrombus, the shape, its dimensions, volume.
4. Scintigraphy of the lungs. This method provides the doctor with a "picture" of the pulmonary vessels. It clearly indicates the zones of disturbed blood circulation. But it is impossible to detect a place where thrombi is localized in the lungs. The study has a high diagnostic value only in the pathology of large vessels. It is impossible to identify problems in small branches using this method.
5. Ultrasound of the veins of the legs.

If necessary, the patient may be assigned additional methods of investigation.

Emergency help

It should be remembered, if a blood clot has come off in the lungs, the symptomatology of the patient can develop at a lightning speed. And just as quickly lead to death. Therefore, in the presence of signs of PE it is necessary to provide the patient with complete peace and immediately call a cardiac "First Aid". The patient is hospitalized in the intensive care unit.

Emergency assistance is based on the following activities:

1. Emergency catheterization of the central vein and the introduction of the drug "Reopoliglyukin" or glucose-novocaine mixture.
2. Intravenous injection of drugs: "Heparin", "Dalteparin", "Enoxaparin".
3. The pain effect is eliminated by narcotic analgesics, such as Promedol, Fentanyl, Morin, Lexir, Droperidol.
4. Oxygenotherapy.
5. The patient is given thrombolytics: Streptokinase, Urokinase.
6. In cases of arrhythmia, the following drugs are added: "Magnesium sulphate", "Digoxin", "ATP", "Ramipril", "Panangin".
7. If a patient has a shock reaction, he is administered "Prednisolone" or "Hydrocortisone", as well as antispasmodics: "No-shpu", "Eufillin", "Papaverin."

Methods for dealing with PE

Resuscitative measures can restore blood supply to the lungs, prevent the development of the patient's sepsis, and protect from the formation of pulmonary hypertension.

However, after providing first aid, the patient needs to continue treatment. The fight against pathology is aimed at preventing relapses of the disease, complete resorption of the blood clot.

To date, there are two ways to eliminate thrombi in the lungs. Methods of treatment of pathology are as follows:

• Thrombolytic therapy;
• surgical intervention.

Thrombolytic therapy

Drug treatment is based on such medications as:

• "Heparin";
• "Streptokinase";
• Fraksiparin;
• Tissue plasminogen activator;
• "Urokinase."

Such drugs allow you to dissolve thrombi and prevent the formation of new clots.

The drug "Heparin" is administered to the patient intravenously for 7-10 days. At the same time, carefully monitor blood coagulability. 3-7 days before the end of treatment, the patient is prescribed one of the following drugs in a tablet form:

• Warfarin;
• "Thrombostop";
• "Cardiomagnet";
• "Trombo ACC".

The control of blood coagulability continues. The intake of the prescribed tablets lasts (after the transferred PE) for about 1 year.

Medicines "Urokinase", "Streptokinase" are administered intravenously throughout the day. Such manipulation is repeated once a month. The tissue activator of plasminogen is also used intravenously. A single dose should be administered for several hours.

Thrombolytic therapy is not performed after surgical interventions. It is also prohibited in the case of pathologies that can be complicated by bleeding. For example, peptic ulcer. Because thrombolytic drugs can increase the risk of bleeding.

Surgery

This question is raised only when a large area is affected. In this case, it is necessary to quickly remove the localized thrombus in the lungs. Treatment is recommended as follows. A special thrombus is removed from the vessel. This operation allows to completely eliminate the obstruction in the path of blood flow.

Complex surgical intervention is performed if large branches or an artery trunk are clogged. In this case, it is necessary to restore blood flow to almost the entire area of the lung.

Prevention of pulmonary embolism

Disease of thromboembolism tends to recurrent course. Therefore, it is important not to forget about special preventive measures that can protect against the repeated development of severe and formidable pathology.

Such measures are extremely important in people with a high risk of developing this pathology. This category includes persons:

• Over 40 years of age;
• Suffered a stroke or a heart attack;
• Overweight;
• The anamnesis of which contains an episode of deep vein thrombosis or PE;
• Postoperative operations on the chest, legs, pelvic organs, abdomen.

Prevention includes extremely important activities:

1. Ultrasound of the veins of the legs.
2. Regular input under the skin preparations "Heparin", "Fraksiparin" or injection into the vein of the drug "Reopoliglyukin."
3. Applying tight bandages to your feet.
4. Pressurization of the crural veins with special cuffs.
5. Bandaging the large veins.
6. Implantation of cava filters.

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

• "Mobin-Uddina";
• "The tulip of Gunther";
• "Greenfield";
• "Hourglass".

At the same time, remember that such a mechanism is extremely difficult to establish. Incorrectly introduced cava filter not only does not become a reliable prevention, but it can lead to an increased risk of thrombosis and subsequent development of PE. Therefore, this operation should be carried out only in a well-equipped medical center, exclusively by a qualified specialist.