Pulmonary artery thromboembolism: symptoms and treatment


Thromboembolism of the pulmonary artery is a blockage of the pulmonary artery by a thrombus or other foreign body (bone marrow fragments, fat accumulations, parasites). A thrombus can form in the venous system, right or left atrium, the ventricle of the heart. If timely medical assistance is not provided, a fatal outcome occurs.

According to statistics, pulmonary embolism is a frequent cause of sudden death. Both men and women are affected. In some cases, the ailment is diagnosed even in children. In the main risk group people of the age group 50-60 years.

Etiology

The first and most common cause of thromboembolism of the pulmonary artery is the detachment of the venous embolus and the obstruction of the vessels. In addition, it is necessary to identify and such reasons for the development of the pathological process:


  • injuries;
  • heart failure;
  • the consequences of a heavy operation;
  • prolonged bed rest.

The latter is due to the fact that in this position, a person is disturbed by the natural flow of blood in the body.

In more rare cases, the cause of pulmonary embolism may be as follows:


  1. thrombophilia
  2. Deep venous thrombosis
  3. Oncological diseases
  4. autoimmune reactions of the body to platelets
  5. diseases of the cardiovascular system.

Also, thromboembolism of the pulmonary artery may result in a metabolic disorder and alcohol and drug abuse. The reasons for the development of such a dangerous ailment are many.

General Symptoms

It is rather difficult to diagnose an ailment, because in the early stages of a pulmonary artery thromboembolism may not give any symptoms at all. As a consequence, the syndrome of «sudden death» may occur. The nature of the disease can be from asymptomatic type to rapid development in a few minutes, which leads to a lethal outcome.

In some clinical cases, at the first stages of the development of the disease, you can notice such symptoms:


  • pain in the chest area
  • shortness of breath;
  • tachycardia
  • unstable body temperature;
  • cough for no apparent reason (sometimes with blood);
  • cyanosis of the limbs;
  • wet wheeze

In elderly people, symptoms may be less pronounced at the initial stage. Also for this category of people is characterized by a sudden cerebral syndrome. It manifests itself in the form of such symptoms:


  1. loss of consciousness
  2. cramps;
  3. symptoms of heart failure;
  4. dizziness.

Thromboembolism of the pulmonary artery at this age is most often fatal.

Syndromes of the disease

In addition to general symptoms, as pulmonary embolism develops, such syndromes can be observed:


  • cardiovascular;
  • pulmonary-pleural
  • feverish
  • abdominal;
  • Immunological.

Cardiovascular syndrome is characterized by acute heart failure, a drop in blood pressure, tachycardia.

With pulmonary-pleural syndrome , shortness of breath, coughing with bloody discharge is observed. Skin covers of the patient can be pale or gray.

With febrile syndrome , the inflammatory process in the lungs can begin. Body temperature is unstable. This condition of the patient can last from several hours to two days.

Abdominal syndrome is accompanied by severe pain in the right hypochondrium, sometimes vomiting. There is a swelling of the liver.

Immunological syndrome is rare, as it occurs only on the 2-3 week of the disease. The main symptom is a rash on the skin, similar to an allergic reaction.

The clinical picture for pulmonary embolism is quite ambiguous. It is impossible to make an accurate diagnosis without special studies. At the same time, it is worthwhile to understand that with such an ailment of time, such diagnostics may simply not be.

Classification

There are two types of classification — by the nature of localization and depending on the volume of the affected vessels.

By the nature of localization of pulmonary artery thromboembolism can be:


  1. massive;
  2. damage to the lobar arteries of the lobar artery
  3. small artery vascular lesion (most often bilateral)

The type of volume distinguishes such forms of the disease:


  • small (up to 25% of pulmonary vascular lesions)
  • Submassive (30 to 50%)
  • massive (more than 50%);
  • fatal (more than 75% of pulmonary vessels are affected).

Nature of development of pathology

By the nature of the development of the clinical picture, the disease can develop in this form:


  1. chronic;
  2. long or subacute;
  3. acute;
  4. fulminant (there is an instant clogging of the vessel with a thrombus or foreign body).

With the latter form of development, there is almost always a lethal outcome.

The most «favorable» is a chronic and protracted form of pulmonary embolism thromboembolism. In this case, the symptomatology develops within a few days. Therefore, it is possible to diagnose the disease in time and take the necessary measures to eliminate it. A timely diagnosed disease is already 50% of that treatment will be successful.

Diagnostics

At the heart of the diagnosis for suspected thromboembolism of the pulmonary artery, is an instrumental study. As a rule, laboratory tests are not required at first.





The standard diagnostic program includes the following:


  • X-ray examination
  • CT of the chest;
  • perfusion scintigraphy
  • angiography
  • Angiographic severity index test.

As for the ECG study, it is not very effective for suspected thromboembolism of the small branches of the pulmonary artery. The development of the pathological process electrocardiogram shows only in 10-15% of all cases.

An X-ray examination may show an approximate clinical picture. If there is a suspicion of a lung infarction, then computed tomography (CT) is mandatory. In the same way, one can establish a possible cause for the development of the disease.

The most accurate data (90%) gives a method of perfusion scintigraphy. Negative data from such a study make it possible to exclude almost completely the thromboembolism of small branches of the pulmonary artery. But for an accurate diagnosis, the results of this analysis should be compared with radiographic images and other, already conducted, analyzes.

Detecting the site of obstruction and the degree of development of the disease makes possible the method of angiography. In the framework of such a study, a special drug is injected intravenously, which makes it possible to clearly see the state of all the vessels in the picture. It should be noted that it is the method of angiography that is the only available method of investigation for seriously ill patients. To date, this method of instrumental research provides the most accurate and complete picture of the development of the pathological process.

As for laboratory tests, they can be prescribed by a doctor only on an individual basis, if the clinical picture of the development of the ailment in the patient requires and allows his condition.

Diagnosis of pulmonary embolism is a very complex process that requires constant, close attention of the doctor. The patient’s condition can worsen at any time during the diagnostic procedures. In this case, the studies immediately stop and the necessary therapeutic measures are carried out.

Emergency resuscitation

The aggravation of ailment can develop at any time and not the fact that a person at this time will be in a medical institution.

If medical care is not immediately available, immediate measures should be taken:


  1. The person should be put on a level surface, not moved and not shifted, if he just fell down, stiffened in the workplace and so on
  2. ensure free air access — unbutton the outer clothing, collar of the shirt and the like
  3. If breathing has stopped — resuscitation in case of cardiac arrest

Immediately immediately call an emergency ambulance, calling the symptoms and the patient’s condition.

Correct and timely emergency care for pulmonary embolism thromboembolism provides an opportunity to save a person’s life and gives time for necessary therapeutic measures.

Treatment

If a person has a suspicion or has already diagnosed pulmonary embolism, urgent hospitalization is needed. Hospitalization of the patient implies a strict bed rest until the risk of blood clots is completely eliminated.

Treatment of thromboembolism of the pulmonary artery can be conditionally divided into the following stages:


  • urgent medical measures to save the life of the patient
  • restore the vessel to the maximum possible normal state.

Surgical intervention is very rare, as the parameters of the operation have a rather high mortality rate — from 40 to 80%.

If there are no contraindications, then the method of intravascular embollectomy is applied. The method is safe and very rarely leads to death. Using a catheter with a special attachment in the form of a sucker, the thrombus is removed through the vessels and heart chambers.

As for drug therapy, the doctor can prescribe fibrinolytics. As a result of the action of such a drug, a significant improvement in the patient’s condition may occur after 3-4 hours.

In addition, the doctor can prescribe the reception of such drugs:


  1. anticoagulants of direct and indirect action
  2. heparin
  3. antispasmodics

If the patient has severe pain syndrome, then an anesthetic is prescribed.

In the event that timely medical assistance is not provided, the consequences can be extremely negative — from a lung infarction to a fatal outcome. But if you seek medical help in a timely manner, undergo a full course of treatment, then such negative consequences can be avoided.

Prevention

Prevention of thromboembolism is rational for everyone who has suffered severe illness or surgery. People who belong to this category must in practice apply such rules:


  • moderate exercise;
  • If possible, walk as much as possible
  • strict observance of the daily routine — a healthy healthy sleep, moderate physical activity
  • proper nutrition;
  • exclusion of nicotine and other narcotic drugs
  • Regular examination with a therapist, phlebologist and pulmonologist.

In some cases, the doctor may prescribe medication intravenously, which excludes the risk of blood clots in the blood vessels. Following such preventive measures, it is possible to avoid life-threatening consequences and the disease itself. For any symptoms, prompt medical attention should be called immediately. Remember that with thromboembolism the count can go for a minute.