Database of diseases - Heart and circulatory diseases

Pulmonary embolism threatens pulmonary infarction!

The blood coming back from the feet is pressed through the heart to the lungs to oxygenate. This vital to life path can be blocked by a thrombus detached from the deep veins of the leg (or pelvis). When thrombus fragments get into the lungs, they can partially or completely block the flow of blood through the lungs. We then deal with a dangerous disease called pulmonary embolism (ZTP). The typical location of the blockage is the lower lobe of the right lung. In extreme cases, a massive embolism can cause necrosis of the lung segment provided by the artery with obstructed embolism, i.e. pulmonary infarction. Massive pulmonary embolism - sometimes called pulmonary infarction, threatens sudden death!


TREATMENT OF PULMONARY LOSS

General principles of treatment of pulmonary embolism

The standard treatment for pulmonary embolism is the administration of heparin followed by oral anticoagulants. The purpose of this procedure is to restore the patency of the vessels in the lungs. In most cases, patients with massive pulmonary artery obstruction must also use thrombolytic agents that rapidly dissolve the thrombus. When pharmacological treatment is ineffective (or contraindicated), surgery is used. After pulmonary embolism, it is necessary to conduct secondary antithrombotic prophylaxis, usually with the aid of low molecular weight heparin or oral anticoagulants.


Treatment of severe pulmonary embolism

There are generally two types of proceedings:
- symptomatic treatment resulting from the need to counteract symptoms such as: rapid drop in blood pressure, arrhythmia, shortness of breath, and paralyzing pain.
- treatment with anticoagulants and thrombolytics, ie causative treatment.


Treatment of life-threatening symptoms

In the situation of severe symptoms of embolism, special attention is paid to the use of drugs that normalize blood pressure, anti-arrhythmic drugs, rational oxygen therapy, analgesics. An ambulance doctor should already use oxygen, analgesic opiates, and appropriate drugs to support blood pressure and counteract arrhythmias.


When the patient is in a state of shock and the heart activity disappears ...

An external cardiac massage should be taken immediately, according to rules for conducting the so-called resuscitation. This treatment is characterized by relatively high effectiveness in crushing a massive blockage closing the pulmonary artery. However, the patient should get to the intensive care unit as soon as possible, so that he can effectively treat the failure of his circulation and breathing.


The ill person should go to the hospital as soon as possible.

Such a patient must receive anticoagulant medication as soon as possible. Currently, it is preferable to start treatment with unfractionated heparin. Then, in the majority of patients with pulmonary embolism, low molecular weight heparin is used in the subcutaneous injection (but not in the first day). Unfractionated heparin (injected intravenously) is preferred for patients in a more severe condition, obese and with renal insufficiency and in the case of a high risk of bleeding complications - in a word, a significant percentage of patients. At the right time, you can also receive oral anticoagulants (anticoagulants), which are activated in the body with a certain delay. The discontinuation of the combined use of heparin and oral medications is determined by the results of appropriate laboratory blood tests. In addition to anticoagulants, a patient in severe condition usually requires immediate administration of fibrinolytics.


Operation of removing the blockage

In patients with contraindications for the use of fibrinolytic drugs - eg endangered by hemorrhagic complications, after recent operations, after childbirth, etc. - the embolic material is removed operationally during the so-called pulmonary embolectomy. In the case of increasing chronic pulmonary embolism, an operation called pulmonary thrombendarterectomy is also possible, during which pulmonary embolisms are removed together with the inner layer of the vessel wall. However, it should be known that the procedures described require very specialized equipment (including apparatus for extracorporeal circulation), experienced personnel and are subject to high perioperative mortality. Therefore, sometimes, despite the existence of contraindications, fibrinolytic therapy is preferred (these are the so-called relative contraindications).
In the world, attempts are also made to fragment the blockage by means of catheters inserted into the pulmonary artery.
 

AFTER THE TRANSFER OF PERSONAL ASSASSMENT


Antithrombotic prophylaxis

After hospital treatment of the acute phase of the disease, patients should continue to use chronically heparin. Usually, this is done in an outpatient manner through subcutaneous injections for 6-12 months from the onset of the disease. In addition - if your doctor does not decide otherwise - you should use oral anticoagulants. The latter, as well as heparin, can also be taken alone at home by detailed doctor's recommendations. In some people with recurrent pulmonary embolism it may be necessary to use the above-mentioned drugs for the rest of their lives. At the same time, constant supervision of the doctor along with periodic blood clotting control is necessary. In the case of recurrent attacks of pulmonary embolism due to clots formed in the veins of the legs, sometimes a special filter is inserted into the vena cava, which is designed to retain blood clots and prevent their movement through the heart to the lungs.

The recurrences of deep vein thrombosis and pulmonary embolism are particularly vulnerable to:

- patients permanently immobilized after surgery,
- pregnant women and in puerperium,
- elderly and obese people,
- people with numerous varicose veins conducive to reflux in deep veins.
- thrombosis also promotes immobilization in a position that hinders the outflow of blood from the lower limbs, eg when traveling by plane or by coach. The disease occurs above average often. professional drivers, aviators, people traveling by plane on long-haul flights.


Prophylactic anticoagulation in patients undergoing surgery and patients with deep vein thrombosis

Persons before and after major surgery are usually given prophylactically anticoagulants from the heparin group.


Physiotherapeutic methods to prevent pulmonary embolism

Principle # 1 is the prevention of "leg movement" and special exercises for flexing leg muscles, feet exercises, breathing exercises, etc. Currently, patients are being started up after surgery as soon as possible. Special devices (so-called rails), including mechanical, computer controlled ones, are helpful in this.


Rehabilitation

After the resolution of the acute symptoms of the disease, a gradual return to the previous physical activity is indicated. It is also recommended to use the rehabilitation agreed with the doctor and avoiding a sedentary lifestyle. The diet should be easy to digest, stop smoking, use oral contraceptives.

Traveling by plane threatens thrombosis
ed. Edward Ozga Michalski, MA
drug consultation med. Michał Wojtyczka

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