Pulmonary infarction disease. Pulmonary infarction: treatment and prevention. Methods of combating the disease

Pulmonary infarction is one of the most dangerous forms of the disease. It is characterized by the rapid death of organ cells due to a sudden stop in blood circulation. The disease begins suddenly, progresses rapidly and is fraught with serious complications.

What is it - pulmonary infarction?

Impairment of blood flow through the pulmonary artery due to its compression or blockage leads to oxygen starvation of the cells of the lung area, and subsequently their death. The lungs have one of the most developed vascular networks in the body and require a large flow of blood. Blocking the inflow in one of the vessels leads to systemic disorders of the cardiovascular system, causes an increase in pressure in the pulmonary circulation, and can be complicated by pulmonary hemorrhages and pneumonia. The lung is one of the shock organs, that is, the most susceptible to damage during shock, terminal conditions.

The lung is one of the shock organs, that is, the most susceptible to damage during shock, terminal conditions.

What happens to lung tissue when it does not receive enough oxygen and nutrients? Alveolocytes, lung cells, begin to die, and a focus of necrosis forms. The immune system reacts to it, stimulating the production of antibodies. As a result, necrosis is complicated by autoimmune inflammation, which involves a portion of the lung tissue, which is associated with complications of an already serious disease.

A heart attack can be ischemic, that is, caused by ischemia - insufficient blood supply to the tissue, and hemorrhagic, associated with hemorrhage into the lung parenchyma, as a result of compression of the lung tissue.

The following causes of pulmonary infarction are distinguished:

• heart failure– if the heart does not have time to pump the required amount of blood per unit of time, the residual volume remains in the vessels, including the pulmonary ones. The result of this is pulmonary edema, vasoconstriction, and heart attack;
• blood clots– the lumen of the vessel may be blocked by a thrombus, a dense blood clot. This often occurs due to surgery on cavitary vessels, such as the veins of the lower extremities and pelvis, because they have low blood flow rates and large volumes of blood. An acute variant of the development of the disease is TELA - pulmonary embolism;
• prolonged lying position– in this case, pulmonary edema, which leads to compression of surrounding vessels, develops due to blood stagnation. This pathology occurs in patients paralyzed after a stroke;
• embolism– caused by gas bubbles, drops of fat, and foreign bodies circulating in the blood. They enter the systemic circulation during surgical interventions, after fractures of large tubular bones, such as the femur;
• labor and postpartum period– dangerous both due to thromboembolic complications and the risk of massive hemorrhage and the development of shock conditions;
• taking combined oral contraceptives and drugs that increase blood clotting And.

Even in the absence of pain, the first signs of the disease can be observed, which will indicate the need for emergency hospitalization: acute respiratory failure develops.

Symptoms of pulmonary infarction

Clinically, pulmonary infarction can manifest itself in a wide spectrum - from intense chest pain to hidden progression. The severity of symptoms depends on the depth of the lesion, the location of the affected area, and the type of infarction.

Even in the absence of pain, you can observe the first signs of the disease, which will indicate the need for emergency hospitalization: acute respiratory failure develops. The patient suddenly feels worse, feels suffocated - he complains of a lack of air, and may ask to open the windows in the room or go outside. These measures are of little help in this case, since the pathogenesis of shortness of breath is associated with pulmonary failure due to a heart attack.

After some time, pronounced blueness of the lips, tip of the nose, and fingers appears - this is due to an increase in the amount of venous blood in the bloodstream. Another characteristic sign is a drop in blood pressure and worsening pulse wave characteristics. When checking the pulse of such a person, you should pay attention to its low amplitude and low strength.

Later symptoms include:

• painful sensations– sharp pain in the chest and/or diffuse pain in the back, in the armpit, which intensifies during inhalation or exhalation. Depending on whether the right lung or the left lung is affected, the location and intensity of the pain changes;
• wet, productive cough. Heart failure leads to stagnation of blood in the lungs, its leakage into the pulmonary vesicles (alveoli), which causes coughing. The sputum may contain streaks of scarlet blood;
• portal hypertension - increased pressure in the vena cava develops. At the same time, the liver enlarges, becomes hard and painful on palpation, and free fluid (ascites) may appear in the abdominal cavity.

Other signs are sticky cold sweat, chills, tension and congestion of the superficial veins of the neck, loss of consciousness.

If the heart does not have time to pump the required amount of blood per unit of time, the residual volume remains in the vessels, including the pulmonary ones. The result of this is pulmonary edema, vasoconstriction, and heart attack.

Diagnostics

The diagnosis is made at the clinic by a cardiologist and pulmonologist. During a general examination, they note the degree of cyanosis, shortness of breath, and the inclusion of additional muscles in the act of breathing. During auscultation, attention is paid to wheezing in the lungs, weakened vesicular breathing, changes in the heart - noises characteristic of heart failure. Based on physical examination data, a preliminary diagnosis is established.

The most informative diagnostic methods are laboratory and instrumental studies. The first group includes a general and biochemical blood test, measurement of its gas composition. Instrumental examination includes an electrocardiogram, ultrasound or rheovasography of the veins of the lower limb to find possible blood clots, radiography, computed tomography.

The main X-ray signs of the disease are expansion, deformation and increased vascularization of the lung root, an area of ​​​​increased density in the shape of a wedge, the apex of which is directed towards the root of the lung, and the base towards the periphery. There may be effusion in the pleural cavity with a long course of the disease.

The macroscopic specimen of the affected lung, that is, its appearance, is characterized by plethora, the presence of a wedge-shaped zone of necrosis, pinpoint hemorrhages closer to the surface of the lung, hemodynamic disturbances in clogged vessels - stasis, dilatation. A microslide - a sample of the lung under a microscope - has a description characteristic of a heart attack: in the center there are necrotic masses, around them there is an inflammatory leukocyte shaft, erythrocyte infiltration.

Treatment tactics

Treatment is carried out in several stages, efforts are aimed at eliminating the cause of the disease and alleviating its symptoms.

The lungs have one of the most developed vascular networks in the body and require a large flow of blood.

Fibrinolytics and vasodilators are prescribed to dissolve blood clots in blood vessels and increase the lumen of blood vessels. For this, heparin or its analogs are used.

To relieve pain, narcotic analgesics are used, since conventional painkillers are not effective enough in this case.

Massive infusion therapy is performed to maintain blood composition, normalize the internal environment, and also control pressure - for this, saline solutions and pressor drugs are used.

Sometimes there is a need for surgical treatment, which consists of removing a blood clot or other cause of pulmonary edema and installing vena cava filters in the area of ​​the renal veins.

Consequences of pulmonary infarction and prognosis

What happens to the patient after a heart attack? The disease rarely leads to death, but the timeliness of medical care provided and secondary pathologies, i.e. complications, play a big role in the prognosis.

A typical consequence of a heart attack in the presence of adequate treatment is the replacement of the necrotic area of ​​the lung with connective tissue. Because of this, the area of ​​gas perfusion decreases and the functionality of the lung decreases.

The prognosis depends on the time that elapses before the ischemia is eliminated with anticoagulants. In most cases, patients return to normal life. The development of complications worsens the prognosis.

Video

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Pulmonary infarction is a disease caused by a thromboembolic process in the vascular system of the lungs and leading in especially severe cases to the instant death of the patient. Hemorrhagic consolidation of the pulmonary parenchyma is a consequence. The main cause of the pathology is, which are formed in the vessels of the lungs or brought from peripheral veins. Inflammatory and sclerotic changes in the pulmonary artery and its branches often result in the development.

The thrombus blocks the lumen of the vessel, ischemia of the lung tissue occurs, the pressure in the affected artery reaches a maximum, which leads to hemorrhage into the lung. Infection of the affected area ends with the development of pneumonia, suppuration, and abscess formation.

the main cause of pulmonary infarction is blockage of the pulmonary artery by a thrombus

Pulmonary infarction is common in people with heart disease: congenital and acquired defects, arrhythmia, cardiomyopathy. Cardiac blood clots usually form in the right atrium, break off and travel to the pulmonary arteries. Slow blood flow or stagnation in the pulmonary vessels also leads to thrombosis. The pathology develops quickly, and the affected area falls out of the functioning pattern.

When the first signs of illness appear, the patient must be urgently taken to the hospital. After an X-ray contrast examination of the chest and electrocardiography, he will be prescribed fibrinolytic agents and drugs that improve the rheological properties of blood, which will improve the trophism of the damaged area. When the patient's condition has stabilized, they move on to antibacterial and anti-inflammatory therapy.

Causes

Various diseases can provoke the development of a pulmonary infarction:

Obstruction of the pulmonary arteries leads to pulmonary ischemia. In this case, the permeability of blood vessels is disrupted, and the ischemic area becomes overfilled with blood. Occlusion of the pulmonary vessels and reflex vasoconstriction lead to overload of the right chambers of the heart. Due to blood stagnation, it occurs. The affected area acquires a rich red color, becomes dense and rises above the healthy lung tissue. The pleural layers become dull, and hemorrhagic exudate accumulates in the pleural cavity. The risk of developing pathology increases if patients have floating blood clots. Insufficient oxygenation and trophism of the lung tissue lead to its dystrophy, and subsequently to necrosis.

Factors contributing to the development of pathology:

1. Long-term hormone therapy
2. Early postpartum period,
3. Splenectomy,
4. Taking medications that increase blood clotting
5. Chemotherapy,
6. Damage to the vascular wall during venous puncture,
7. Overweight,
8. Prolonged immobilization.

Symptoms

The symptoms of pulmonary infarction depend on the area of ​​damage to the lung tissue and the general condition of the body. If the size of the lesion is small, clinical signs may be absent, and the disease is detected only with the help of X-ray diagnostics. With an asymptomatic course, radiological changes disappear on their own after 7-10 days. A microinfarction of the lung is detected accidentally during the treatment of its infectious consequences.

• Signs of acute pulmonary vascular obstruction are the main symptoms of the pathology. The disease is characterized by a sudden onset with the appearance of acute chest pain and inspiratory shortness of breath against a background of general well-being. Pain syndrome is a clinical manifestation of ischemia.
• The cough in patients is dry at first, then becomes wet, bloody, foamy sputum of a dark brown color is released. Sputum with bloody streaks is a characteristic sign of the hemorrhagic form of the disease. The reason for its appearance is the rupture of a vessel clogged with thrombotic masses and saturation of the lung tissue with blood.
• Dyspnea accompanied by a vascular reaction: pale skin, sticky and cold sweat.
• Myocardial ischemia often accompanies pulmonary infarction. This is due to impaired coronary blood flow. Among other symptoms of the pathology are: frequent shallow breathing, thready pulse, chills, fever, pale or gray skin, acrocyanosis.

Patients develop hypotension, cerebral disorders, hepatomegaly, abdominal syndrome, asthma attacks, atrial fibrillation, panic attacks, leukocytosis in the blood, and an increase in ESR. The doctor, examining patients, discovers characteristic percussion, percussion and auscultation signs.

Complications

Pulmonary infarction is a serious disease that leads to dangerous consequences and threatens the patient’s life.

Complications:

Diagnostics

Before starting treatment for a pulmonary infarction, a specialist must identify the disease that became its direct cause. Diagnosis of pulmonary infarction consists of conducting a thorough examination of the patient, instrumental and laboratory examination.

The radiograph shows a thin wedge-shaped shadow in the middle field, usually on the right. The ischemic area has the shape of a pyramid, the base of which faces the periphery, and the apex faces the root of the lung. The characteristic triangular opacification is located in the middle and basal segments of the lung. Additional diagnostic methods are ECG, CT, MRI.

pulmonary infarction on a diagnostic image

Treatment

Pulmonary infarction is an emergency condition that requires emergency medical care in the intensive care unit of a hospital.

Treatment of pulmonary infarction is complex and long-term. The patient is prescribed several groups of drugs that dissolve blood clots and eliminate the symptoms of the pathology.

Specific treatment of pulmonary infarction continues for 8-10 days. Longer treatment with drugs from these groups can lead to the development of osteoporosis and.

Prevention

To prevent the development of pulmonary infarction, it is necessary to eliminate diseases and factors that contribute to obstruction of the pulmonary vessels. The main goal of preventive measures is to combat in order to prevent. To eliminate thrombophlebitis, it is necessary to use anticoagulants, especially in patients with myocardial infarction or heart defects.

For people at risk, foot massage will have a good therapeutic and preventive effect. Experts recommend:

1. Wear or elastic bandage, especially for patients who have had leg surgery,
2. Do not take medications that cause hypercoagulability,
3. Prevent acute infectious diseases,
4. Take Eufillin to prevent pulmonary hypertension,
5. Activate bedridden patients as early as possible.
6. For preventive purposes, surgeons tie the veins of the legs.

Pulmonary infarction is not a fatal pathology. With timely treatment, the prognosis of the disease is favorable. It can be eliminated if the main etiological factor is determined at the right time. With timely consultation with a doctor and properly selected treatment, blood clots resolve, blood flow and trophism of the ischemic area are restored, and recovery occurs.

Video: the main cause of pulmonary infarctions is pulmonary embolism, program “Live Healthy!”

Pulmonary infarction is a disease that occurs as a result of the appearance of a blood clot in the pulmonary artery system; it can be carried from an area related to the peripheral veins.

The development of the disease is facilitated by various types of operations, the period after childbirth, problems with the functioning of the heart, fractures of tubular bones, oncology, and prolonged lack of physical activity.

The main reason for the development of a disease such as pulmonary infarction is that a blood clot occurs in the body’s vascular system. In this case, the manifestation of the disease occurs exactly at the moment when, due to a blood clot, there is a blockage of the vessels that fed certain lung tissues.

In addition, a heart attack can also occur as a result of external intervention, for example, surgery performed in the area of ​​the veins of the extremities. Initially, after intervention by the surgeon, pulmonary ischemia may develop, which, if untimely and poor-quality treatment, can lead to infarction pneumonia.

It is noted that pulmonary infarction also has the following common causes of development:

• genetic predisposition;
• the presence of chronic infectious diseases in the body;
• slow blood circulation;
• presence of injuries in the area of ​​the vein walls;
• disturbances in the content of individual elements in the blood;
• long-term use of medications aimed at increasing blood clotting;
• problems with excess weight;
• problems with the functioning of the cardiac system;
• neoplasms that cause compression of blood vessels and disruption of blood flow;
• presence of rheumatism;
• lack of physical activity;
• taking various types of hormonal and contraceptive medications.

• anemia;
• vasculitis;
• nephrotic syndrome.

The manifestation of a disease such as pulmonary infarction directly depends on the location of the blood clot, the extent of the atrophy process, as well as the number of vessels that were subject to blockage. In addition, if there are concurrent illnesses associated with the heart and lungs, symptoms atypical for the disease may appear.

The easiest way to diagnose the disease is in people with heart disease.

1. Painful sensations under the ribs.
2. The heart rate is increased.
3. Fever or chills.
4. Hard breath.
5. Panic attacks.
6. Cough, during which discharge in the form of blood clots is observed.

If it is “heart attack-pneumonia”, then the symptoms are less pronounced, there are no problems with breathing or rapid heartbeat. There are also no panic attacks of any kind, and if it is a micro-infarction, then it may not manifest itself at all, and it can only be detected by taking an x-ray.

Pulmonary infarction has generally accepted symptoms:

• sudden formation of shortness of breath, which intensifies every minute;
• cough, which is accompanied by blood discharge;
• coughing up blood clots;
• significant increase in temperature;
• the presence of sharp pain in the chest area and under the shoulder blade, which intensifies during coughing;
• the skin changes color and becomes grayish;
• fingers, lips and nose become bluish;
• the pulse slows down significantly;
• excessive sweating;
• the presence of peculiar wheezing in the chest;
• lowering blood pressure;
• painful sensations in the liver during palpation;
• increase in the size of veins in the neck area;
• difficulty breathing.

Consequences of pulmonary infarction

If you do not take any measures to get rid of a disease such as pulmonary infarction as soon as possible, you can expect the most serious consequences.

• bacterial pneumonia;
• inflammation in the pleura;
• purulent manifestations in the affected area.

It should be remembered that infarction pneumonia is the most common type of complications from the disease in question. This is due to the fact that the area of ​​the lung that was subject to a heart attack is no longer capable of life. Since blood is no longer supplied to the affected area and, accordingly, it does not take any part in respiration, this contributes to the development of various bacteria in the above area.

Moreover, the larger the area of ​​the lung that is affected, the greater the likelihood of bacterial pneumonia occurring.

Areas of the necrotic type can not only provoke the occurrence of pneumonia, but also cause the formation of post-infarction abscesses (possibly filling the cavity of the lung tissue with pus and necrotic masses).

In turn, the occurrence of post-infarction abscesses can lead to the development of pneumothorax - a rupture of the lung structure, which leads to disturbances in pressure indicators and the development of respiratory pathology.

The most dangerous consequence of such a disease as pulmonary infarction is considered to be the development of an abscess in the lung area. This pathology is characterized by an extensive inflammatory process, in which there is an accumulation and then release of pus, while the temperature rises to 39 degrees.

Diagnosis of infarction of the lung zone

Pulmonary infarction begins to be diagnosed with a visual examination by a doctor, and the patient is asked about the presence of various types of symptoms. The examination is carried out by doctors such as a cardiologist or pulmonologist.

Initially, the respiratory tract is listened to for the presence of various specific sounds (bubbling, wheezing). Then the patient's blood pressure is measured, the abdominal area is palpated, and at the same time the patient is asked about the sensations from a particular procedure.

• decreased breathing;
• noise during pleural friction;
• murmurs in the chest characteristic of this disease;
• shortening of percussion sound.

In order to completely eliminate errors in diagnosing the disease, you should tell the doctor in as much detail as possible about the existing symptoms, because quite often this disease is confused with pneumonia. Due to this, treatment is delayed, which can even lead to death. To prevent this, you should understand that painful sensations during a heart attack appear much earlier than chills or an increase in temperature, but with the development of pneumonia, chills or fever first appear, and only then pain and blood in the sputum.

It is worth noting that the process of diagnosing the disease also includes a general and biochemical blood test. If there is a normal number of leukocytes in the blood and an excessive amount of bilirubin with lactate dehydrogenase, then this is a heart attack.

1. X-ray. Refer any patient who complains of pain in the chest or who has characteristic sounds when listening.
2. CT. Thanks to this procedure, the structure of the human body is quite accurately displayed on the monitor screen, so the presence of pathology can be easily identified.

Due to the fact that the main cause of the development of the disease is the occurrence of a blood clot and blockage of blood vessels, therapy is mainly aimed at eliminating this particular cause. To do this, the patient is prescribed a number of medications (anticoagulants) that reduce blood clotting and resolve the blood clot.

As a rule, for such purposes the choice falls on the following drugs:

1. Heparin. Apply for 7-10 days. Diluted with sodium chloride.
2. Fraxiparine.
3. Streptokinase.

It is important to note that the use of this type of drug is carried out under strict control of coagulation parameters.

In addition to anticoagulants, the use of antiplatelet therapy is widely practiced. During this therapy, a drug known to almost everyone is used - Aspirin. Its main purpose is to prevent further development of blood clots.

If there is mild pain, the patient is prescribed non-narcotic analgesics. If the painful sensations are very strong and almost impossible to endure, then Morphine is used.

In order to prevent possible complications after a heart attack, antibiotics are administered intramuscularly, which are part of the 3rd generation. A striking example is Ceftriaxone.

As soon as the patient is admitted to the hospital, therapy begins with the injection of a drug such as Nitroglycerin into a vein. During its use, blood pressure should be monitored. After the swelling subsides, doctors transfer the patient to the use of Nitroglycerin by drip (30 drops per 60 seconds).

If the patient has low blood pressure, the use of all of the above diseases is strictly prohibited. For such people, there are medications for neuroleptanalgesia. In this situation, intravenous administration of Prednisolone is performed, and an IV is installed with drugs such as Strophanthin and Reopoliglucin.

In addition to treatment with medications, the patient may be prescribed surgical procedures. In the above form of heart attack, thrombectomy or installation of a special filter in the vena cava is most often used, which prevents blood clots from passing through the bloodstream.

At this stage of time, many people do not even understand what a heart attack is, much less what forms and symptoms it has. This is a huge disadvantage, since without studying the symptoms of the disease in detail, there is a high risk of confusing it with pneumonia and not taking appropriate measures. Even if you are sure that you are suffering from pneumonia, it is better to go to the doctor, because if it is a heart attack, you will have a chance to save your own life.

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Pulmonary infarction is very similar in nature to myocardial infarction. These two processes are characterized by the fact that due to a sudden cessation of blood flow in a certain area of ​​the organ, oxygen starvation begins and, as a result, part of the tissue atrophies. The only difference is that pulmonary infarction is not a fatal disease.

Pulmonary infarction develops due to the impact of thrombotic occlusions in the blood flow system of this organ. The disease is characterized by rapid progression (about a day) and varying degrees of tissue damage.

The appearance of thrombotic blockages in the pulmonary blood supply system is influenced by many factors, provoked by the appearance of thromboembolism, thrombosis, thrombophlebitis and other ailments.

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Causes

The main cause of pulmonary infarction is thrombus formation in the body's vascular system. An attack occurs when a blood clot (thrombus) clogs a vessel supplying a certain area of ​​lung tissue. Such a pathological process can also be caused by a detached blood clot that travels through the circulatory system into a vessel responsible for the blood supply to the lung.

Most often, an attack occurs against the background of thrombosis of the veins of the lower extremities, thrombophlebitis, as well as fat embolism of the pulmonary vessels in a certain area of ​​the organ.

Blood clot formation can be affected by surgery, especially if the operation was performed on the veins of the extremities. First, this pathology is characterized by pulmonary ischemia and then leads to a heart attack.

Many factors, called root causes, can trigger the process of thrombosis formation and further embolism, namely:

• hereditary predisposition;
• chronic infections;
• slow blood circulation (bradycardia, varicose veins);
• injuries of venous walls;
• blood composition disorder;
• drugs that increase blood clotting;
• obesity;
• congestive etiology;
• neoplasms that compress blood flow;
• rheumatism;
• inactivity;
• taking contraceptives, etc.

When small or medium-sized vessels feeding the lung tissue are clogged, no deaths occur. If the occlusion occurs in a large pulmonary vessel, then most often the thromboembolic lesion ends in the death of the patient.

The presence of anemia, vasculitis, nephrotic syndrome, as well as the completed course of radiation and chemotherapy significantly increases the risk of developing the disease. A severe bruise can provoke hypoxia and tissue death; such a pathological process is called traumatic pulmonary infarction.

Symptoms

The clinical picture of pulmonary infarction depends on the location of the focus, the extent of the atrophic process and the number of vessels with thrombotic blockages. Also, symptoms can be supplemented based on concurrent heart and lung diseases.

It is easiest to recognize an attack of pulmonary infarction in patients with heart defects.

During the initial examination and interview, the following symptoms bring clarity to the diagnosis:

• pain in the hypochondrium;
• rapid heartbeat;
• fever or chills;
• dyspnea;
• panic attacks;
• cough with blood.

Often, a bloody cough appears immediately after the onset of pain in the side, and the fever is accompanied by cold sweat that has a sticky consistency.

In the presence of pneumonia, the signs of pulmonary infarction have less severe pain symptoms, there is no heart rhythm disturbance and shortness of breath. Panic attacks are also not observed; sometimes microinfarctions of the lung have no signs at all, and they can only be detected on an x-ray.

General symptoms:

• sudden shortness of breath that develops quite quickly;
• cough with bloody discharge;
• coughing up blood;
• fever;
• sharp pain in the chest and under the shoulder blade, aggravated by coughing;
• gray skin;
• blueness of lips, fingers and nose;
• slow pulse;
• heavy sweating;
• presence of wheezing;
• lowering blood pressure;
• liver pain on palpation;
• enlarged neck veins;
• increased body temperature;
• respiratory failure.

The presence of specific signs of envy depends on the degree of neglect of the disease and the type of pulmonary infarction:

Consequences of pulmonary infarction

If a pulmonary infarction is not stopped in a timely manner and treatment is not started, the complications can be very serious. These include post-infarction bacterial pneumonia, inflammation of the pleura and purulent processes at the site of the infarction.

Pneumonia is the most common complication of pulmonary infarction. The thing is that the area of ​​the lung affected by a heart attack is non-viable. Since blood no longer flows into the affected area and it does not take part in respiration, favorable conditions develop in it for harmful bacteria to enter and multiply.

The larger the area of ​​necrotic change in the lung, the greater the likelihood of developing bacterial pneumonia.

Necrotic areas can not only cause pneumonia, but also provoke the formation of post-infarction abscesses - filling the cavity of the lung tissue with purulent and necrotic masses. Such suppuration poses a threat of breakthrough and entry of contents into healthy areas of the organ.

Also, post-infarction abscesses can lead to spontaneous pneumothorax - rupture of the pulmonary structure, disrupting pressure in the lungs, which leads to pathological changes in respiratory function.

The most severe consequence of a heart attack is a lung abscess. The pathology is characterized by an inflammatory process of extensive etiology, accompanied by the accumulation and release of purulent contents, as well as an increase in body temperature above 39 °C.

How severe the consequences will be depends on the extent of the heart attack and timely treatment.

Scarring

Scarring after a pulmonary infarction is a classic consequence. After all, as is already known, a heart attack is the death of a certain area of ​​tissue suffering from a lack of blood supply.

The area that has experienced severe hypoxia is eventually replaced by connective tissue, which leads to the formation of post-infarction scars.

Scars are formed according to the extent of necrosis. Dense connective tissue is formed from 3 to 4 months after an attack. Smaller scarring can be seen on x-ray after 3-4 weeks. How quickly a scar forms depends not only on the size of the affected area, but also on the state of blood circulation in its nearby healthy areas.

Scars in the lungs are manifested by the following symptoms:

• difficulty breathing;
• severe shortness of breath with minor exertion;
• bluish skin under the nose;
• dry wheezing.

If nothing is done for a long time, the disease will develop into cardiopulmonary failure, which will significantly worsen the patient’s quality of life.

Possible complications

Pulmonary infarction can be complicated by the formation of abscesses, which, when small in size and in small numbers, are often asymptomatic. Upon X-ray examination, such abscesses completely disappear after 7–10 days.

Large lesions do not disappear on their own; they are always visible on x-rays and can lead to the formation of fibrosis.

Often the main complications are accompanied by hemorrhagic pleurisy - inflammation of the pleura, accompanied by the formation of a blood clot in its cavity. The disease has severe clinical manifestations and can be treated for quite a long time.

Possible complications also include pulmonary hypostasis and swelling. If a heart attack was caused due to congestive heart failure of the pulmonary circulation, then the syndrome can result in swelling of the lungs.

This complication is characterized by difficulty breathing, attacks of suffocation, pain in the sternum and other symptoms that threaten the patient’s life.

Diagnostics

Diagnosis of pulmonary infarction begins with an initial examination and interview of the patient admitted to the hospital. Diagnostics is carried out by a pulmonologist and a cardiologist.

The first step is to listen to the airways for the presence of wheezing and fluid. Next, the patient’s blood pressure and pulse are measured, the abdomen is palpated and, in parallel with the procedures, a survey is conducted to collect a complete medical history.

The above research methods for pulmonary infarction detect weakened breathing, pleural friction noise, fine rales, systolic murmurs and shortening of percussion sounds.

Palpation of the abdomen may reveal a significant enlargement of the liver and its tenderness.

To exclude a possible error in diagnosis, you should tell the doctor as clearly as possible about your symptoms. It is important to find out the exact location of the pain and its characteristics, because pulmonary infarction is often confused with pneumonia.

Remember that pain during a pulmonary infarction, unlike pneumonia, appears much earlier than chills and fever, and the presence of blood in the sputum shortly after the first leucorrhoea in the side.

Diagnosis of pulmonary infarction consists of taking blood for general and biochemical analysis. According to the results of such studies, a heart attack is determined by moderate leukocytosis, increased bilirubin and excessive lactate dehydrogenase activity.

Also important is the need to study the macroscopic specimen in detail with further examination of the microscopic specimen.

In addition, some hardware examination methods are carried out, which make it possible to determine changes in the lungs, the exact location of the outbreak and the extent of the attack:

Treatment

Since the main cause of pulmonary infarction is thrombotic occlusion of the artery, therapy is primarily aimed at eliminating it. To do this, the patient is prescribed a number of medications (anticoagulants) that prevent blood clotting and agents that dissolve blood clots.

For these purposes the following are most often used:

• heparin;
• fraxiparine;
• streptokinase;
• urokinase.

The administration of anticoagulants is carried out only under strict control of coagulation parameters. The duration of therapy is a maximum of 7 days. The drug Heparin is administered subcutaneously, diluted with sodium chloride. After 4–5 days of treatment, the dose of Heparin is significantly reduced, and subsequently it is replaced with an indirect anticoagulant drug such as Phenilin.

Thrombolysis therapy must be carried out by monitoring blood clotting parameters. The thrombolytic drug, as well as anticoagulants, is administered at the maximum dosage in the first days, then it is gradually reduced.

In parallel with the above treatment methods, antiplatelet therapy is also added. A drug quite often used for these purposes is Aspirin. It is prescribed to prevent further thrombus formation.

For mild pain, the patient is prescribed non-narcotic analgesics. If the pain is unbearable, then they resort to the administration of stronger painkillers such as Morphine.

Along with the main treatment, possible post-infarction complications are prevented. It consists of intramuscular administration of 3rd generation antibiotics, for example, Ceftriaxone.

To eliminate fluid accumulation in the lungs and normalize pressure, the patient is prescribed diuretics, for example, Furasimide intramuscularly. During the initial attack of a pulmonary infarction, the patient is recommended to take Nitroglycerin (1 tablet every 5 minutes), but you can take no more than 5 pieces.

Upon admission of the patient to the hospital, treatment begins with the administration of Nitroglycerin intravenously. When using it, you must carefully monitor blood pressure readings. After the swelling subsides, proceed to drip use of Nitroglycerin at a rate of 30 drops per minute.

If the patient is admitted with low blood pressure, then the above medications cannot be used. Such patients are indicated for neuroleptanalgesia. Prednisolone is administered intravenously and a drip of a solution of Strophanthin and Reopoliglucin is placed. You can also add a solution of Hydrocortisone acetate to the dropper at a rate of 60 drops per minute.

In addition to conservative treatment, the patient may be prescribed a surgical procedure. In case of a pulmonary infarction, they most often resort to thrombectomy or install a special filter in the vena cava that does not allow blood clots to pass further along the bloodstream.

Remember, treatment of pulmonary infarction is carried out only in a hospital setting. Under no circumstances should you resort to using the medications listed above on your own.

Prevention

A pulmonary infarction can only be avoided by preventing diseases that affect the formation of thrombosis. To do this, it is necessary to promptly take a course of drugs that protect against thrombophlebitis and eliminate cardiac decompensation.

People suffering from hypertension or increased blood clotting are recommended to use blood thinners. Among patients with myocardial infarction or mitral stenosis, the use of anticoagulants is advisable.

Patients at risk of developing thromboembolism should avoid taking medications that increase blood clotting. In case of surgery, it is important to adhere to bed rest after several days.

In case of vein thrombosis in the legs, surgical ligation is used to avoid possible or repeated embolisms.

Forecast

What the prognosis will be after a pulmonary infarction depends on the cause that caused the attack and timely seeking medical help. In addition, the extent of the necrotic area is of great importance.

Most often, an attack of pulmonary infarction ends safely. As for mortality, it ranges from 5 to 30% of all cases.

If you start treatment in a timely manner, you can avoid many complications, which are a common cause of death. Therefore, for a favorable prognosis, it is necessary to go to the hospital at the first symptoms that arise and in the future strictly follow the doctor’s therapeutic recommendations.

Pulmonary infarction is a pathological condition that develops as a result of blockage of small or medium-sized vessels of the lung by a thrombus formed in the pulmonary circulatory system or brought from peripheral veins. This disease is similar in nature to myocardial infarction - it has the same rapid development and is characterized by the death of tissue in the affected area.

Causes

A blood clot that causes blockage of blood vessels in the lung can form both in the organ itself and in other vessels and even in the heart, and then with the blood flow it is carried into the pulmonary arteries, clogging them. This process is called, and the reasons for its development are various pathological conditions and external influences.

In particular, pulmonary infarction is often a complication of various surgical interventions on the lower extremities. In addition, this pathological condition can be caused by such reasons as frequent fractures of the bones of the extremities, leading to the development of fat embolism.

Other causes of this pathology are as follows:

• long bed rest;
• disturbances in the functioning of the heart;
• period after childbirth;
• the presence of malignant neoplasms in the body.
• and vessels of the lower extremities.

Pathogenesis

Regardless of the cause of the development of such a pathological condition as pulmonary infarction, blockage of blood vessels by a thrombus causes the same pathological reactions. First of all, vascular occlusion is noted, that is, blockage with an embolic mass.

Next, the nutrition of the area of ​​organ tissue to which the clogged vessel supplied blood is disrupted and even completely stopped. As a result of a lack of oxygen and nutrients, a certain area of ​​the lung undergoes degenerative changes and dies.

But disruption of the lungs is not the only phenomenon in this pathology - the general gas exchange in the body is also disrupted, as a result of which other organs and systems suffer.

As for the clogged vessel itself, pressure increases in it, which leads to the development. As this pathological condition progresses, the vessel cannot withstand it and ruptures - in this case, a hemorrhagic pulmonary infarction develops, characterized by saturation of the affected area of ​​the lung tissue with blood and its rapid necrosis. In case of hemorrhagic infarction, it is impossible to restore damaged tissue.

Symptoms

The symptoms of a pathological condition such as pulmonary infarction depend on the severity of the disease, which, in turn, depends on the presence of various concomitant pathologies of the lung or heart in a person. In addition, the severity of the course depends on the number of affected vessels.

The main symptoms of the development of this pathology are as follows:

• sudden onset of shortness of breath;
• the appearance of a cough, which may be accompanied by the release of bloody or mucous sputum;
• sharp chest pain;
• blueness of the nasolabial triangle, as well as blueness of the fingertips;
• pallor of the skin (often with a predominance of an ashen tint);
• decrease in blood pressure;
• disruptions in the functioning of the heart (, increased heart rate).

Note that all of the above symptoms appear instantly, against the background of a person’s general good health. It is very important to distinguish the symptoms of a pathology such as pulmonary infarction from, since they are initially identical.

Anamnesis is of important diagnostic importance, during the collection of which a person can tell about the presence of thrombophlebitis and other venous pathologies. In this case, a person complains of symptoms of thrombophlebitis, even if the disease was not diagnosed in a timely manner.

In most cases, with timely treatment, the prognosis for the course of the pathology is favorable, but in some cases, with a severe course, the person dies almost instantly.

Treatment

Diagnosis of such a pathological condition as pulmonary infarction is carried out using an X-ray examination of the organ, possibly with staining of the pulmonary vessels. In addition, ECG plays an important diagnostic role.

Specific methods for diagnosing this pathology are selective pulmonary angiography, which involves inserting a special catheter into the pulmonary arteries, as well as lung scintigraphy, which involves injecting a specific substance into a vein.

Treatment of a pulmonary infarction, the symptoms of which are pronounced, must be timely - the patient is hospitalized in a hospital and complex therapy is immediately started, since any delay can cause the patient’s death.

Since the cause of this pathological condition is blockage of blood vessels by a thrombus, the primary task of doctors is to prescribe anticoagulant therapy to such patients.

If a person is diagnosed with a pulmonary infarction, treatment will also consist of the administration, under the strict supervision of a physician, of heparin or other medications that help dissolve the embolic mass and restore normal blood flow in the affected area of ​​the lung. Typically, these medications are prescribed for a week, with a gradual reduction in the dose of the drugs.

In addition, simultaneous administration of drugs that promote blood clot resorption is necessary. For this purpose, Streptokinase or Urokinase is used - these medications must be administered under the control of blood clotting parameters.

To prevent the re-formation of blood clots, a proven remedy is used - Aspirin, and to relieve the pain syndrome that often accompanies this pathological condition, patients are given injections of non-narcotic analgesics.

At the same time, it is necessary to prevent possible complications. As mentioned above, a pathological condition such as pulmonary infarction has various consequences, the most common of which is bacterial pneumonia, which develops as a result of the addition of a secondary bacterial infection.

To prevent this complication, antibacterial therapy is necessary; for this purpose, the administration of 3rd generation cephalosporins, such as Ceftriaxone, is indicated.

In some cases, doctors resort to surgery. Thrombectomy is performed, with the installation of a vena cava filter in the inferior vena cava, which prevents the passage of blood clots further.

It should also be said about other serious consequences of a pulmonary infarction:

• development of post-infarction abscesses;
• the occurrence of spontaneous pneumothorax;
• acute respiratory failure.

Note that the consequences of the disease depend on the type of affected vessels - if small vessels are affected, they may be completely absent, and if medium ones are affected, they will be multiple and pronounced.

The prognosis depends on the timely administration of adequate treatment, as well as on the severity of the patient’s condition. Therefore, at the first signs of a pulmonary infarction, a person must be immediately hospitalized.

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Diseases with similar symptoms:

Pulmonary failure is a condition characterized by the inability of the pulmonary system to maintain normal blood gas composition, or it is stabilized due to severe overstrain of the compensatory mechanisms of the external respiration apparatus. The basis of this pathological process is a violation of gas exchange in the pulmonary system. Because of this, the required volume of oxygen does not enter the human body, and the level of carbon dioxide constantly increases. All this causes oxygen starvation of organs.