MD V. Comagic
I apologize in advance for the length of the text. I think it's better if the text is longer and contains all the information rather than split text into several smaller posts. Any suggestions are welcome.
Pulmonary embolism is not a disease, but a complication of deep vein thrombosis. Pulmonary embolus originate from the blood clot, which is usually formed in deep veins of the lower extremities, pelvis, and cardiac atria. This is a common and potentially life-threatening condition. Most patients who die, die within the first few hours from the occurrence of this complication. Despite advances in diagnosis, difficulties in diagnosis are common and presentes a significant health problem. When we talk about sudden death, pulmonary embolism is the second leading cause after sudden cardiac death.
In patients who have survived, reappearance can be prevented by rapid diagnosis and therapy. Diagnosis is unfortunately not often mede on time because most patients there have nonspecific symptoms and signs of disease. If left untreated, about one third of patients with pulmonary embolism dies after repeated episodes of embolism.
There are four clinical syndromes: a massive pulmonary embolism, submassive pulmonary embolism, pulmonary infarction, and thromboembolic pulmonary hypertension (chronic pulmonary hypertension).
Massive pulmonary embolism means that blood flow is cutoff in one of the main branches of the pulmonary artery or there is blockage of the large number of small branches of the pulmonary artery, which make up 2/3 of the pulmonary capillary plexus. The disease usually happens rapidly, syncope, drop of tension, anginal pain (in the chest), suffocation and symptoms of acute pulmonary heart. A large number of patients (10 to 60%) died in the first hours after the beginning of embolism. The patient is pale, cyanotic (blue), tachypneic, has cold extremities, hypotension (low blood pressure); dilated veins in the neck, hepatomegaly, edema of the lower legs, ascites (free fluid in the abdomen).
Submassive pulmonary embolism is when one or more branches of the pulmonary artery are blocked with embolus. It usually manifests with sudden dyspnea (shortness of breath), and chest pain. Pulmonary arterial pressure is usually not significantly increased, and there are no signs of right heart overload. These signs can be detected but it is considered that this type of embolism is asymptomatic in a larger number of patients.
Pulmonary infarction occurs when smaller peripheral pulmonary artery get clogged and there is no collateral bronchial circulation. Typical signs and symptoms appear 3 to 7 days after occlusion of the vessel. Symptoms and signs are pleural pain, and hemoptysis (coughing up blood). Fever is typically 37.5 ° to 38 ° C, the appearance of body temperature above 39 ° C indicates pulmonary infection. The patient's tachipneic (rapid breathing) and usually has tachycardia (rapid heartbeat).
Chronic pulmonary hypertension (thromboembolic pulmonary hypertension) is the result of recurrent pulmonary embolism (manifested or asymptomatic), it occurs gradually and is getting worse with every new episode of embolism. Clinical picture is similar to the one that patients with chronic cor pulmonale have.
These symptoms may indicate that you have pulmonary embolism
In 95% of cases the cause is thrombus from the deep veins of the lower extremities (thrombophlebitis or phlebothrombosis); from the pelvic veins is much rarer, and extremely rare thrombus from the right atrium and ventricle of the heart, veins of the upper extremities, hepatic or renal vein.
Results of routine laboratory tests are of little help in the diagnosis. Accelerated erythrocyte sedimentation rate and leukocytosis most often occur only in heart attack lungs. Determining the concentration of degradation products fibrin and D-dimer can be helpful in diagnosis, but these findings are not specific enough. They can be of help in the diagnosis of pulmonary embolism but only with the results of other diagnostic tests.
Walk and move around as much as possible;
Avoid sitting for a long time;
While sitting, bend your legs as often as possible;
While traveling, drink plenty of fluids;
If you have varicose veins, wear elastic stockings,
Use therapy by direction of a physician.
I apologize in advance for the length of the text. I think it's better if the text is longer and contains all the information rather than split text into several smaller posts. Any suggestions are welcome.
Pulmonary embolism is not a disease, but a complication of deep vein thrombosis. Pulmonary embolus originate from the blood clot, which is usually formed in deep veins of the lower extremities, pelvis, and cardiac atria. This is a common and potentially life-threatening condition. Most patients who die, die within the first few hours from the occurrence of this complication. Despite advances in diagnosis, difficulties in diagnosis are common and presentes a significant health problem. When we talk about sudden death, pulmonary embolism is the second leading cause after sudden cardiac death.
Symptoms of pulmonary embolism
There are four clinical syndromes: a massive pulmonary embolism, submassive pulmonary embolism, pulmonary infarction, and thromboembolic pulmonary hypertension (chronic pulmonary hypertension).Massive pulmonary embolism means that blood flow is cutoff in one of the main branches of the pulmonary artery or there is blockage of the large number of small branches of the pulmonary artery, which make up 2/3 of the pulmonary capillary plexus. The disease usually happens rapidly, syncope, drop of tension, anginal pain (in the chest), suffocation and symptoms of acute pulmonary heart. A large number of patients (10 to 60%) died in the first hours after the beginning of embolism. The patient is pale, cyanotic (blue), tachypneic, has cold extremities, hypotension (low blood pressure); dilated veins in the neck, hepatomegaly, edema of the lower legs, ascites (free fluid in the abdomen).
Submassive pulmonary embolism is when one or more branches of the pulmonary artery are blocked with embolus. It usually manifests with sudden dyspnea (shortness of breath), and chest pain. Pulmonary arterial pressure is usually not significantly increased, and there are no signs of right heart overload. These signs can be detected but it is considered that this type of embolism is asymptomatic in a larger number of patients.
Pulmonary infarction occurs when smaller peripheral pulmonary artery get clogged and there is no collateral bronchial circulation. Typical signs and symptoms appear 3 to 7 days after occlusion of the vessel. Symptoms and signs are pleural pain, and hemoptysis (coughing up blood). Fever is typically 37.5 ° to 38 ° C, the appearance of body temperature above 39 ° C indicates pulmonary infection. The patient's tachipneic (rapid breathing) and usually has tachycardia (rapid heartbeat).
Chronic pulmonary hypertension (thromboembolic pulmonary hypertension) is the result of recurrent pulmonary embolism (manifested or asymptomatic), it occurs gradually and is getting worse with every new episode of embolism. Clinical picture is similar to the one that patients with chronic cor pulmonale have.
These symptoms may indicate that you have pulmonary embolism
- Sudden shortness of breath
- Sharp chest pain that is amplified by coughing or deep breathing
- Cough with sputum which pinkish color and foamy consistency.
What causes pulmonary embolism?
In 95% of cases the cause is thrombus from the deep veins of the lower extremities (thrombophlebitis or phlebothrombosis); from the pelvic veins is much rarer, and extremely rare thrombus from the right atrium and ventricle of the heart, veins of the upper extremities, hepatic or renal vein.
Therefore, pulmonary thromboembolism is considered a complication of deep vein thrombosis. For the formation of such thrombosis following factors are responsible, traditionally called Virchow's triad, are responsible :
Clinical conditions which are as risk factors are: prolonged bed rest or immobilization in bed, state after surgical intervention in the abdomen and pelvis, pregnancy, postpartum period (after delivery), hip fracture and bones of the lower limbs, acute myocardial infarction, congestive heart failure, obesity, older age (over 70 years), the use of estrogen preparations (contraception), malignancy (pancreas, liver, ovary, stomach, prostate), connective tissue diseases and others. The primar hypercoagulablility is a rare hereditary disorder of blood coagulation, characterized by deficiency of antithrombin III, protein C, protein S or disorders of fibrinolysis. This condition leads to frequent deep vein thrombosis and pulmonary embolism, and young adults (under 45 years)are at risk, a similar condition is often recognized with relatives. However, more commen is secendary hypercoagulability, with the above mentioned risk factors it leads to the formation of thrombus in the deep veins of the lower extremities, and consequently to a pulmonary embolism.
To summarize, risk factors are:
- Hypercoagulability
- Hemodynamic changes (stasis, turbulence) and
- Damaged endothelium of the blood vessel (inner layer of blood vessels).
Clinical conditions which are as risk factors are: prolonged bed rest or immobilization in bed, state after surgical intervention in the abdomen and pelvis, pregnancy, postpartum period (after delivery), hip fracture and bones of the lower limbs, acute myocardial infarction, congestive heart failure, obesity, older age (over 70 years), the use of estrogen preparations (contraception), malignancy (pancreas, liver, ovary, stomach, prostate), connective tissue diseases and others. The primar hypercoagulablility is a rare hereditary disorder of blood coagulation, characterized by deficiency of antithrombin III, protein C, protein S or disorders of fibrinolysis. This condition leads to frequent deep vein thrombosis and pulmonary embolism, and young adults (under 45 years)are at risk, a similar condition is often recognized with relatives. However, more commen is secendary hypercoagulability, with the above mentioned risk factors it leads to the formation of thrombus in the deep veins of the lower extremities, and consequently to a pulmonary embolism.
To summarize, risk factors are:
- inactivity, which may be due to long lying after some surgeries;
- long sitting, inactivity in general;
- surgery of the hip, leg or abdomen;
- certain diseases such as cancer, heart failure, severe infections;
- pregnancy (birth, especially caesarean section)
- use of hormone therapy (contraception);
- smoking,
- age of 70 years old and more.
Pulmonary embolism diagnosis
For diagnosis of this condition the most important is that the doctor has in mind this possibility. Mistakes are very common, whether the diagnosis is not set when is necessery or it is set incorrectly, ie. when there is no pulmonary embolism.Results of routine laboratory tests are of little help in the diagnosis. Accelerated erythrocyte sedimentation rate and leukocytosis most often occur only in heart attack lungs. Determining the concentration of degradation products fibrin and D-dimer can be helpful in diagnosis, but these findings are not specific enough. They can be of help in the diagnosis of pulmonary embolism but only with the results of other diagnostic tests.
Lung scintigraphy (perfusion and ventilation) is most commonly used method in the diagnosis of this disease. Perfusion scintigraphy is performed by intravenous injection of macroaggregates particles of albumin labeled with radioactive isotope of technetium.
Pulmonary angiography is the most reliable method for the diagnosis of pulmonary embolism. With this method seriousness of pulmonary embolism, thrombus localization and size of clogged arteries is evaluated. It is considered to be the "gold standard" for the diagnosis. It is indicated in all patients in whom a finding of scintigraphy is moderate or indeterminate degree of probability, for those who have low probability it is indicated only when there is a high clinical suspicion of this disease.
Pulmonary embolism treatment
The therapy involves treating embolism itself as well as prevention and treatment of deep vein thrombosis.
Therapy can be anticoagulant and thrombolytic, rarely surgical.
Anticoagulation therapy is the treatment of choice for both conditions
When clinical suspicion of pulmonary embolism is proven, initial dose of heparini s applied (bolus of heparin intravenously at a dose of 5 000 to 10 000 I.U.), if there are no contraindications (fresh bleeding and coagulation disorder).
Heparin prevents the growth and propagation of the clot. There are various schemes for the following application of heparin: continuous intravenous, discontinuous intravenous and subcutaneous.
Recurrences are common, which means that if you had it once it is a likely that it will happen again.
Prevention of pulmonary embolism
If you have high risk for the formation of acute lung diseases, prevention is of crucial importance:Walk and move around as much as possible;
Avoid sitting for a long time;
While sitting, bend your legs as often as possible;
While traveling, drink plenty of fluids;
If you have varicose veins, wear elastic stockings,
Use therapy by direction of a physician.
References:
- http://masmedika.com/interna-medicina/plucna-embolija/
- http://www.planetazdravlja.com/plucna-embolija/
- http://www.simptomi.rs/index.php/bolesti/9-pulmologija-bolesti-pluca/1409-tromboembolija-pluca
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