- Pulmonary embolism (pulmonary embolism): causes and risk factors
- Pulmonary embolism (pulmonary embolism): symptoms
- Pulmonary embolism: complications
- Pulmonary embolism: diagnosis
- Pulmonary embolism: treatment
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Pulmonary embolism (pulmonary embolism, pulmonary embolism) is a life-threatening condition that requires medical intervention as soon as possible. Pulmonary embolism occurs when the embolic material (most often clotted blood) obstructs the lumen of the pulmonary vessels, leading to circulatory failure. What are the causes and symptoms of a pulmonary embolism? How is the treatment going?
Pulmonary embolism(aka pulmonary embolism or pulmonary embolism) is a condition in which the pulmonary artery or any of its branches becomes partially or completely obstructed by embolic material. As a result, some parts of the lungs are dysfunctional and sometimes even necrotic.
Pulmonary embolism (pulmonary embolism): causes and risk factors
The most common embolic material that obstructs the pulmonary artery is clotted blood. It usually comes from the deep veins of the lower extremities or the smaller pelvis (less often from the veins of the upper body), from where it enters the pulmonary artery along with the blood stream. The most common cause of blood clots in the deep veins of the lower extremities is thrombosis.
In rare cases, the embolic material is fat (it can arise after fractures of long bones), air (it enters the bloodstream most often during insertion or removal of a vascular catheter from a vein), neoplastic masses, amniotic fluid (in the case of premature separation of the placenta) in a pregnant woman), a foreign body (it can be, for example, embolization material, used during endovascular procedures).
Pulmonary embolism is the third cardiac cause of death after myocardial infarction and stroke.
In turn, the risk factors are:
- previous pulmonary embolism
- cardiovascular diseases - venous thromboembolism, congestive heart failure, increased platelet count, previous stroke
- chronic advanced lung disease
- age - the risk of its occurrence increases significantly in the elderly, especially after the age of 70
- long-term immobilization
- advanced stage cancer
- fractures, especially in the long bones and pelvis
- condition after surgery
- obesity
- oral hormonal contraception
- pregnancy
- postpartum condition
Pulmonary embolism (pulmonary embolism): symptoms
In the event of an embolism in the lungs, symptoms such as:
suddenly appear- rapidly increasing shortness of breath accompanied by cyanosis
- severe, usually prickly, retrosternal chest pain
- dry cough
- hemoptysis (arrives latest)
The accompanying symptoms are increased breathing and heart rate, shallow breathing, general restlessness, and sweating. You may feel faint or faint.
Pulmonary embolism most often occurs in people with chronic, advanced diseases - usually cardiovascular and respiratory diseases.
It should be noted that the severity of symptoms depends on the degree of pulmonary vascular closure and the general condition of the patient. Closure of the pulmonary artery trunk or major branches causes violent symptoms and usually results in shock or even cardiac arrest.
In the case of occlusion of a smaller vessel, the intensity of symptoms depends on the patient's respiratory efficiency, e.g. in patients with heart failure the symptoms will be more severe than in he althy people.
Pulmonary embolism: complications
The consequence of pulmonary embolism may be chronic pulmonary embolism, pulmonary infarction, and in extreme cases, sudden cardiac arrest and death.
Pulmonary embolism: diagnosis
If a pulmonary embolism is suspected, the following is done:
- angio-CT of the pulmonary arteries (helical computed tomography), which enables an accurate assessment of the patency of the pulmonary trunk, both pulmonary arteries
Some specialists believe that perfusion lung scintigraphy (instead of pulmonary CT angiography) should be performed first
- blood tests - incl. determination of plasma d-dimers, cardiac troponins (markers of myocardial damage) and natriuretic peptides.
In the case of pulmonary embolism, the concentration of these parameters is significantly increased.
Supportive examinations are chest X-ray, echocardiographic and electrocardiological (EKG) examinations.
When diagnosing a patient, physicians should distinguish between pulmonary embolism and conditions such as heart attack, dissolving aortic aneurysm, pneumothorax, pneumonia, pericarditis, viral pleurisy, and exacerbation of COPD (chronic obstructive pulmonary disease).
Pulmonary embolism: treatment
A patient with a pulmonary embolism is rarely saved.
The patient is first administered unfractionated heparin (inhibits the blood clotting process), and then thrombolytic drugs thatthe task is to dissolve the clot remaining in the pulmonary vessels and restore blood flow. When the patient's condition stabilizes, anticoagulant treatment with vitamin K antagonists (acenocoumarol, warfarin) is administered.
If thrombolytic therapy is unsuccessful, a pulmonary embolectomy may be required, a procedure that involves surgical removal of the embolic material from the pulmonary arteries using extracorporeal circulation.
Another solution is to install an inferior vena cava filter that will block the access of embolic material to the heart and lungs.
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Pulmonary embolism is very dangerous for pregnant women and during the puerperium. Statistically, it occurs in 1/7000 deliveries. Unfortunately, the risk increases significantly even more in women who have a genetic burden of congenital thrombophilia. Changes characteristic of thrombophilia, i.e. a mutation of e.g. factor V (Leiden), the prothrombin gene, are observed in more than half of women who experienced thrombotic situations.