Pulmonary embolism and pulmonary infarction – what is it, causes, symptoms. How is it diagnosed and treated?

Proven content

A pulmonary embolism and pulmonary infarction are the result of obstruction or branching of the pulmonary artery with “embolic material” applied through the blood, such as a fragment of a clot or a thrombus formed at the site. This ailment is a common complication of cardiovascular diseases, which are a direct threat to the patient’s life.

Pulmonary embolism – definition

A pulmonary embolism is a complication that in most cases is caused by thrombus material. It is a life-threatening condition. In 90% of cases, deep vein thrombosis is the place where the thrombus or clots reaching the pulmonary artery originate (the cause of the embolus is blockage of the lumen of the branches in the pulmonary artery). The pulmonary arteries (right and left) are branches of the pulmonary trunk that supply deoxygenated blood from the right ventricle of the heart to the lungs, where this blood is then oxygenated. More rarely, the embolic material is found in the veins of the small pelvis, the veins of the upper limbs and the liver. Much less frequently, the source of PE can be located in the cavities of the “right heart”. Occasionally, embolic material may include bone marrow, fat, tumor cells, air (air embolism), and amniotic fluid. Thus, pulmonary embolism is a consequence of deep vein thrombosis. In people with pulmonary embolism, shortness of breath as well as shallow and rapid breathing are observed. There is pain behind the breastbone, sometimes fever and cough. The symptoms therefore resemble a heart attack.

Causes of pulmonary embolism

As mentioned above, pulmonary embolism is a consequence of deep vein thrombosis (usually of the legs). An embolus occurs when the clot breaks away from the vein wall and travels with the blood to the right side of the heart and then to the pulmonary arteries. There is then a lack of blood flow through the vessel. Mortality from pulmonary embolism and pulmonary infarction is as high as 30%. People who easily develop blood clots are particularly at risk of embolism, i.e .:

1. suffering from heart failure or ailments that facilitate clotting,
2. people who are immobilized for a long time (e.g. after surgery),
3. people suffering from obesity,
4. sepsis patients,
5. the elderly, especially after the age of 70
6. cancer patients,
7. patients after surgery (in the area of ​​the lower limbs and abdominal cavity),
8. patients with thrombophilia (congenital or acquired),
9. people suffering from Crohn’s disease,
10. patients with ulcerative colitis,
11. people after severe injuries, e.g. fractures of the pelvis or other bones of the lower limbs,
12. people with paresis of the spinal cord or paralysis of the lower limbs, as a result of which they are permanently immobilized,
13. people suffering from varicose veins of the lower extremities,
14. patients with a history of thromboembolism.

The risk of pulmonary embolism and pulmonary infarction increases further if the above-mentioned factors occur in a person over 40 years of age. It is also worth mentioning pregnant women and women in the puerperium period. The increased risk also applies to women who take hormonal contraceptives (tablets, patches, rings) and also smoke cigarettes.

Until some time ago, pulmonary embolism was divided into sub-massive and non-massive. However, recently this classification has been revised: high-risk and low-risk embolism (in this case, low and intermediate risk embolism are additionally distinguished).

Symptoms of pulmonary embolism

The symptoms of the disease are mainly:

1. unexpected severe pain in the chest
2. sinica,
3. feeling anxious
4. cough (usually dry)
5. hemoptysis (manifested at the latest),
6. shortness of breath (over 80% of patients),
7. faster and shallow breathing,
8. increased heart rate (tachycardia) over one hundred beats per minute
9. cyanosis (especially on the face),
10. high temperature,
11. fainting or loss of consciousness
12. Pressure drop.

The listed symptoms are an indication for a quick call for an ambulance and urgent transport of the patient to the hospital. These changes result in passive hyperemia, and sometimes blood extravasation and exclusion of a specific part of the lung tissue from physiological activities, and sometimes even its necrosis. The size of the infarction depends on the size of the obstructed vessel lumen. The part of the lung affected by the infarction reaches its base to the smallest branching of the vessel, i.e. usually to the pleura. The part of the lung affected by the infarction loses its aeration.

The appearance of a pulmonary infarction is usually characterized by the unexpected, very sudden, severe stabbing pain in the chest of the pleural type, general anxiety, rapidly increasing dyspnoea, and usually cyanosis and subsequent hemoptysis. The severity of these symptoms depends on the extent of the infarction. In a complicated course, an exudative fluid may develop in the pleural cavity, an inflammatory process in the infarcted part of the lung, and even necrosis and abscess formation.

Diagnosis of pulmonary embolism

The diagnosis of pulmonary embolism is made only by a physician based on basic clinical data and radiological examination. It sometimes happens that the diagnosis causes a number of difficulties, because the above-mentioned symptoms may also occur in the course of other diseases, e.g. pneumonia. A pulmonary embolism is a life-threatening condition and diagnosis is essential. People who fail to die may have further episodes. Then they should be constantly monitored by a doctor.

In diagnostics, medical history and physical examination (auscultation of the patient, medical history) and other additional tests, e.g. imaging and blood tests, are used. In people with suspected pulmonary embolism, tests for the level of cardiac troponins and blood clotting tests are ordered, in which the concentration of D-dimer is measured (its level increases in the course of the embolism). A positive result of dimers is an indication for the extension of diagnostics to include imaging tests. It is useful:

1. ECG examination,
2. determination of markers of myocardial dysfunction in the blood,
3. spiral computed tomography, which enables an accurate assessment of the patency of the pulmonary trunk,
4. Chest X-ray (sometimes there is an enlarged heart and pleural fluid)
5. pulmonary perfusion scintigraphy (a test that assesses the blood supply to the lung parenchyma by intravenous administration of substances retained in the pulmonary circulation),
6. Computed tomography with the administration of a contrast agent intravenously (this examination shows the embolism through visible flow losses).

In people with suspected embolism, it is also performed Ultrasound of the veins of the lower extremities. In its course, it is possible to visualize clots, which almost in 100% indicate the presence of embolism in the lungs.

Diagnostics was created to make it easier for doctors scale Wellsathanks to which it is possible to assess the likelihood of a pulmonary embolism. Appropriate number of points are awarded for the presence of each of the following conditions:

1. malignant tumor – 1 point
2. krwioplucie — 1 point
3. past embolism or deep vein inflammation – 1,5 points
4. symptoms of deep vein inflammation – 3 points
5. long-term immobilization, recent surgery – 1,5 points
6. increased heart rate – 1,5 points
7. other diagnosis less likely than pulmonary embolism – 3 points.

ANALYSIS OF THE RESULTS

1. 0-1 points – negligible clinical risk of pulmonary embolism
2. 2-6 points – medium risk of pulmonary embolism
3. 7 points or more – high risk of pulmonary embolism.

Pulmonary embolism and myocardial infarction should be differentiated from the following symptoms:

1. intercostal neuralgia,
2. lung diseases (pneumothorax, pulmonary exacerbation, pneumonia, acute respiratory failure),
3. cardiovascular diseases (cardiac tamponade, heart failure, heart attack).

Treatment of pulmonary embolism

In people with pulmonary embolism, a preparation that inhibits the process of blood clotting is first administered, i.e. unfractionated heparin. Then it implements thrombolytic preparations, which are designed to dissolve clots remaining in the vessels of the lungs and restore normal blood flow. If it does not work – it is necessary Pulmonary embolectomythat is, surgical removal of the embolic material from the pulmonary artery. Extracorporeal circulation is required to perform an embolectomy. After stabilizing the patient’s condition, it turns on anticoagulant therapy (warfarin, acenocoumarol). Another method of treatment is insertion into the inferior vena cava a special filterwhich will block the access of embolic material to the heart and lungs. The filter is installed in patients diagnosed with deep vein thrombosis of the lower extremities, in whom thrombolytic treatment is not possible because of contraindications, or thrombolytic and anticoagulant therapy (in the form of chronic acenocoumarol use) does not bring the expected benefits and pulmonary embolism recurs. In addition to drugs that dissolve the clot, the patient is administered strong painkillers.

Complications of pulmonary embolism

Blockage of the branch of the pulmonary artery by the embolic material leads to lung infarction. This type of complication occurs in a small number of people with pulmonary embolism. The infarction occurs as a result of the closure of smaller vessels in the pulmonary circulation (diameter less than 3 mm) and the occurrence of additional risk factors, e.g. insufficient oxygen supply to a specific area. Pulmonary infarction is rare because the lungs are vascularized by two systems (pulmonary circulation and bronchial artery branches). When one of the oxygen supply systems fails, there are others in the back-up that partially compensate for the reduced oxygen supply. Lung infarction usually affects the elderly, who also suffer from left ventricular heart failure, cancer, pneumonia or lung collapse due to pneumothorax.

Important! The symptoms of a lung attack can be similar to a heart attack. Therefore, they should not be ignored.

Treatment of a pulmonary infarction primarily includes the management of pulmonary embolism. Oxygen must be given to the patient.

Other possible causes of a lung infarction: inflammatory vascular disease, sickle cell anemia, vascular infection, tumor cell embolism.

How can I reduce the risk of recurrence of pulmonary embolism?

People who have had an episode of pulmonary embolism should bear in mind a few guidelines that will reduce the risk of a relapse.

1. Take oral anticoagulant medications for the amount of time recommended by your doctor. While taking this type of preparation, you should avoid consuming broccoli, spinach and cabbage (they reduce the effect of the drug).

2. Check treatment results periodically. Also keep your blood under control by using the Blood Clotting Monitor – QLabs® Q1 PL INR Measuring Device.

3. Try to avoid sitting with your legs down. Move your legs frequently as you travel.

4. Do not engage in vigorous physical exertion as it promotes clot detachment and increases the risk of pulmonary embolism. In addition, patients should not lift heavy objects and get out of bed too quickly.

4. Take care of a proper diet to avoid constipation and thus effort during defecation. It is recommended to eat products containing a large amount of fiber, e.g. fruit, vegetables, brown bread.

How to avoid a pulmonary embolism when traveling by plane?

1. Hydrate your body before the trip and drink plenty of fluids during the trip.

2. When traveling, wear looser clothing that will not put pressure on your waist or legs.

3. When traveling, try to move your legs frequently or take short walks to reduce the risk of venous congestion.

4. During the journey, you can wear elastic stockings or take a prophylactic dose of heparin.

Home remedies for the prevention of pulmonary embolism

Most patients with pulmonary embolism have deep vein thrombosis of the lower limbs, so prevention is mainly based on reducing venous congestion in the lower limbs. So, to prevent the disease:

1. wear special elastic stockings,
2. remember about gymnastics adapted to your health condition,
3. bandage the legs with an elastic bandage (the greatest pressure should be around the foot and decrease towards the hip),
4. while resting, place your legs at the height of your body, e.g. on a pillow; this is to facilitate the outflow of venous blood,
5. try to avoid standing for long periods or sitting still with your legs down.