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Thromboembolism of the pulmonary artery: causes, symptoms, diagnosis and treatment

The mortality from cardiovascular diseases is confidently holding the first place. Such ailments are usually exposed to older people, but often pathological processes are identified at an early age.

Particular difficulty in diagnosis differs thromboembolism of the pulmonary artery in connection with the lack of specific signs.

Content

Thromboembolism of the pulmonary artery (PE), what is it?

Thromboembolism of the pulmonary artery (PE) is the obstruction of the pulmonary artery or its branches by thrombi that form (most often) in the large veins of the lower limbs.

Pulmonary embolism

Embolism refers to a disorder accompanied by circulation in the vessels of elements unusual for the normal state. A thrombus is a blood clot that occurs as a result of clotting. The process of coagulation is vital, because it damages the damaged vessels. But it is possible and pathological coagulation, due to a number of reasons.

If a flotating thrombus forms in the veins of the lower limbs or small pelvis (weakly attached to the vessel wall) - the probability of its detachment and movement to the heart and into the mainstream of the pulmonary artery is great.

At large sizes, the lump is capable of clogging large vessels, and at small sizes it reaches small capillaries, where it sticks. Thus, the essence of thromboembolism of the pulmonary artery (PE) is the clogging of pulmonary vessels with thrombi.

Causes of PE

Causes of PE

The cause of the disease is one - a blood clot interferes with normal blood flow and gas exchange in the lungs. This provokes a reflex narrowing of the vessels and, as a consequence, an increase in pressure in the pulmonary artery and an increase in the load on the right ventricle. Physicians call 3 factors that contribute to the development of this pathology:

  1. Too little blood flow in the lower extremities and pelvis.
  2. Damage to the endothelium of the vascular wall.
  3. Increased blood clotting.

Each of these factors (together or separately) provokes thromboembolism of the pulmonary artery. The causes of the decrease in the rate of blood flow are seen in primary diseases, which include varicose veins and the destruction of veins. In addition, there is a possibility of pressure on the vessels from the outside - for example, in the case of the appearance of a tumor. This neoplasm is quite capable of squeezing the vein and causing stagnation of blood.

You can not discount the sedentary lifestyle - perhaps the only factor in the history, which is a consequence of the careless attitude of man to health.

Violation of the integrity of the endothelium itself triggers coagulation. The damage can occur both in surgical intervention and in case of physical trauma. Possible variant of the action of leukocytes, which are especially activated in the inflammatory process in the body. In addition, toxins and viruses can also damage the endothelium.

Increased blood clotting usually provokes a high level of fibrinogen, a special protein responsible for the formation of thrombi.

If the blood plasma contains little water and many uniform elements, the probability of coagulation significantly increases. In turn, the number of erythrocytes, platelets and other cells increases with polycythemia, so PE can be considered a secondary disease.

Symptoms of thromboembolism of the pulmonary artery

Symptoms of thromboembolism of the pulmonary artery

Acute thromboembolism of the pulmonary artery develops when the vessels are clogged with a large thrombus, while the risk of fatal outcome is 15%. But small blood clots are not so dangerous, although you can not ignore them, of course. In general, physicians divide the pathology into 3 species that are characterized by the degree of vascular lesion and the corresponding symptoms of PE:

1. Unmassive (<30% of vessels are blocked):

  • cough;
  • slight increase in temperature;
  • pain in the sternum;
  • hemoptysis
  • infarct of the lung.

2. Submassive (30-50% of vessels are blocked):

  • increased pressure in the pulmonary artery;
  • failure of the right ventricle.

3. Massive (occluded> 50% of the pulmonary arteries, including the largest ones):

  • hypotension (pressure less than 90/50);
  • dyspnea;
  • tachycardia (heart rate more than 100 beats per minute);
  • fainting.

In the non-masculine form of thromboembolism of the pulmonary artery, symptoms are often absent, so the patient may not even know about his disease. More pronounced signs make you go to the hospital, but doctors do not immediately understand the cause of the disorder.

Diagnosis of pulmonary embolism

A quick examination and a conversation with the patient will not give any worthwhile information. The fact is that this pathology has no specific signs, so it is often confused with myocardial infarction, pulmonary heart, pneumothorax and other diseases. With such symptoms, physicians prescribe electrocardiography in the first place, but this method does not always give an unambiguous answer. ECG signs of PE (though indirect) are as follows:

  1. Sinus tachycardia.
  2. Overload of the right atrium and ventricle.

More informative is the X-ray study. In the picture, usually a dome of the diaphragm, elevated from that side of the lung, in which there was a blockage of blood vessels, is allocated. In addition, there is a noticeable increase in the right parts of the heart, and in the largest pulmonary arteries. If the picture shows a cone-shaped seal (Hampton's triangle), then there is every reason to suspect a lung infarction.

ECG and radiography are usually used to exclude other pathologies, but modern medicine has in its arsenal and special methods:

Определение количества d-димера (продукт распада фибрина): 1. Determination of the amount of d-dimer (fibrin degradation product):

  • if the substance concentration is less than 500 μg / l, then the disease is unlikely - PE;
  • the method does not give an exact answer.

Эхокардиография: 2. Echocardiography:

  • identify a violation of the right ventricle;
  • there is a chance of finding thrombi right in the heart;
  • The detected oval window explains the violation of hemodynamics.

Компьютерная томография: 3. Computer tomography:

  • apply contrasting;
  • create a three-dimensional image of the lungs;
  • effectively detect thrombi.

Ультрасонография: 4. Ultrasonography:

  • study the velocity of blood flow in the veins of the lower limbs;
  • consider the cross section of veins.

Сцинтиграфия: 5. Scintigraphy:

  • identify areas of the lungs in which blood does not flow;
  • It is applied at prohibition of carrying out of a computer tomography;
  • excludes PE in 90% of cases.

Ангиография сосудов легких: 6. Angiography of the vessels of the lungs:

  • the most accurate method;
  • reveals thrombi and narrowed vessels;
  • Invasion is required, therefore there are certain risks.

Symptoms of thromboembolism of the pulmonary artery do not always indicate this pathology - doctors need time to conduct a complete examination of the patient. And only after confirmation of the diagnosis proceed to treatment.

Treatment of pulmonary embolism (pulmonary thromboembolism)

Treatment of PE (pulmonary thromboembolism

If a person enters the hospital in an unconscious state, with low blood pressure, rapid pulse and severe shortness of breath, he is immediately placed in the intensive care unit.

If there is a suspicion of pulmonary embolism, emergency assistance consists in normalizing the gas exchange within the respiratory organs. This requires artificial ventilation of the lungs with oxygen, and as an additional measure intravenously injected vasopressors (for example, adrenaline), to somehow increase the pressure.

After primary care, the patient is thoroughly examined. If PE is confirmed, the treatment is as follows:

1. Lower blood coagulability:

  • nonfractional heparin (intravenously);
  • fondaparinux and low molecular weight heparin (administered subcutaneously, contraindicated in renal failure);
  • direct anticoagulants are treated for at least 5 days;
  • dosages are individual and depend on the weight of the patient;
  • An indirect anticoagulant Warfarin is used 3 months after the end of the intensive course.

2. Reperfusion therapy (removal of thrombi by a medicamentous method):

  • preparations - Streptokinase, Alteplase and others;
  • The danger is a high risk of bleeding, incl. and intracerebral.

3. Surgical intervention :

  • in the field of renal veins, special cava filters are installed to catch blood clots;
  • filters are injected into the femoral or jugular vein through the skin.

First of all, the patient is trying to help with medicines, but the medicines have a number of contraindications that must be observed without fail. There may be a situation where drugs simply do not lead to the desired result. In such cases, only surgical intervention remains.

Conclusion

Although thromboembolism of the pulmonary artery is difficult to diagnose, nevertheless there are effective methods for treating PE. But, in some cases, the patient's condition is so neglected that it can not be saved. Therefore, with pain in the chest, frequent palpitations and shortness of breath, you should immediately go to the hospital.

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