Pulmonary embolism ( PE ) - Causes, Symptoms and Treatment .MF .
Pulmonary embolism (PE) - a serious disorder characterized by complete or partial closure of the pulmonary artery luminal thrombus.As a rule, it is blood clots in the veins of the lower limbs or pelvis, at least from the right heart.
thrombosis of the pulmonary artery.
Pulmonary thromboembolism is a major cause of sudden death.Unfortunately, only 30% of cases it is diagnosed in vivo.
Causes of pulmonary embolism
All risk factors for pulmonary embolism can be divided into three groups depending on the driving mechanism of formation of a blood clot.
1. Damage to the vein wall. This group includes diseases such as thrombophlebitis (inflammation of the vein wall, combined with vein thrombosis), phlebitis (the formation of the vein wall inflammation by attaching external infection, for example, intravenous injection), as well as injury, accompanied by total or partial rupturewall vein (intravenous catheter production, vascular surgery).
2. Local slowing blood flow. main importance is prolonged b
3. Increased blood clotting. This risk factor prevalent in individuals with certain inherited blood diseases, chronic inflammation, while taking birth control pills.
to blood clots forming in the lumen of the vein, the following features: one end of a blood clot is attached to the wall, the other moves freely in the lumen of the vein.In sharp movements is detached thrombus part which the bloodstream falls into the right heart and then into the pulmonary artery, causing, depending on the size of the thrombus, the complete or partial closure of its lumen.The right ventricle of the heart is not able to push blood into the pulmonary artery thrombosed, it overflows and becomes reduced.Blood from the lungs does not reach the left heart, in large vessels branching off from the heart, which causes a drop in blood pressure.In a very short period of time an empty heart ceases to contract.
Symptoms of pulmonary embolism
Lechgochnaya artery branches into increasingly narrow arteries, which is why it becomes a haven of the separated blood clot.The nature of the external manifestations of pulmonary embolism depends on the volume of pulmonary vascular lesions.
• When "off" more than 50% of the pulmonary vessels, including the main pulmonary artery, develops massive pulmonary embolism.It is characterized development of shock (drop in blood pressure, shortness of breath, loss of consciousness).This condition is usually very quickly leads to death.
• Thrombosis 30-50% of pulmonary vessels occurs submassive pulmonary embolism .At the same time against the background of varying degrees of severity of dyspnea blood pressure remains normal.The patient pale, bluish coloration possible tip of the nose, ears, lips.He was excited, restless, can not sit still.In some cases, a slight relief is achieved in a horizontal position.Perhaps the appearance of pain in the heart, palpitations.
• When struck by at least 30% of the pulmonary arteries, occurs nonmassive pulmonary embolism .In this case at first symptoms may be absent.An increase in temperature, the occurrence of cough (possibly with blood), chest pain causes, seek medical advice.When X-ray of the chest to the lungs revealed a characteristic triangular shadow - pulmonary infarction (tissue death portion of the lung due to an insufficient supply of nutrients and oxygen).
Survey for suspected pulmonary embolism
As can be seen from the description, symptoms of pulmonary embolism nonspecific.Therefore, the detection of risk factors for the disease and the occurrence of the above claims, it is first necessary to exclude pulmonary embolism as a serious life-threatening conditions.Diagnosis of pulmonary embolism is performed only in a hospital, so at the slightest suspicion require hospitalization.
the diagnosis of PE, there are certain difficulties, as the non-specific complaints, but the tests are not highly sensitive.There is a common diagnosis of the following types:
• Determination of D-dimer blood. D-dimers - degradation products of fibrin-index increased formation of blood clots in the body.The increase in the value of its favors pulmonary embolism.
• Electrocardiography. This revealed signs of right heart enlargement and improvement of pulmonary artery pressure.Electrocardiography informative with massive PE and submassive.
• Radiography chest cells allows to diagnose the increase in right heart, the expansion of the pulmonary vessels and pulmonary infarction.
• Echocardiography provides information about the degree of cardiac dysfunction, as well as to determine the amount of pressure in the pulmonary artery.
• Ultrasound examination of the lower extremities reveals clots that can cause pulmonary embolism or are potentially dangerous for the development of pulmonary embolism.
• Spiral computed tomography .Intravenously administered contrast, then, with the help of a computer tomograph, visible lung tissue for thrombosis.
• Angiography - the most accurate method for determining pulmonary embolism, but, at the same time, the most invasive.Intravenously dosed contrast agent and made a series of X-rays.According to the "breakage" of staining of a vessel conclude its closing thrombus.
Treatment of pulmonary embolism
Treatment of pulmonary embolism - a complex process whose efficiency is increased many times with timely treatment for medical help.This identified two main goals of treatment:
1. Saving Lives.
2. Warnings repeated pulmonary embolism.
necessary to save the life as much as possible to restore the patency of the vessel faster.This aim is achieved by conservative and / or surgical procedures.Intravenously administered drugs that dissolve blood clot (streptokinase, alteplase, urokinase), as well as drugs that prevent further thrombosis (enoxaparin, dalteparin, heparin).
Thrombectomy - surgical removal of the blood clot, is shown at the impossibility of drug exposure.
Prevention of pulmonary embolism
To eliminate the recurrence of pulmonary embolism is necessary to conduct a comprehensive study of the veins of the lower extremities and the pelvis to the identification of potentially hazardous sites and direct removal of thrombus, or filter production (cava filter) into the lumen of blood vessels, retaining part removed blood clots.
therapists Sirotkin EV