Infarction pneumonia prognosis. Features, symptoms of pulmonary infarction and methods of its treatment. Pulmonary infarction: consequences

Pulmonary infarction is oxygen starvation of a section of lung tissue, which occurs due to the fact that oxygen-carrying blood does not reach the tissues. The obstruction to blood flow, in turn, occurs due to the appearance of a barrier in the blood vessel supplying blood to a certain area of ​​the pulmonary parenchyma.

The essence of the disease

Most often, oxygen starvation of the lung occurs due to thrombosis (formation of a blood clot on the inner wall of an artery, blocking its lumen) or embolism (blockage by a foreign body brought with the bloodstream from any part of the human body - in this case it is called an embolus). Less commonly, the pathological process occurs due to compression of a blood vessel from the outside. Pulmonary infarction is also called pulmonary embolism, meaning by embolism the blockage of a vessel in general, regardless of the occluding factor.

Due to anatomical features, pulmonary infarction occurs in a limited segment (area) of lung tissue, since individual arteries - lobar, segmental or smaller ones - are blocked by a thrombus or embolus. Small-caliber vessels can undergo multiple embolism, but they supply blood to a small area of ​​the lung - due to this, oxygen starvation of the organ is not total, but limited.

According to statistics:

• infarction of the right lung is observed 2 times more often than of the left;
• the lower lobes of the lungs are affected 4 times more often than the upper lobes.

Thus, the most common location for infarction is the lower lobe of the right lung. Any pathology that develops in them (in particular, with severe symptoms of tissue ischemia) should every time cause alertness to pulmonologists about whether a pulmonary infarction has developed there.

Causes

One of the main causes of the disease is (PE): because of it, from 10 to 25% of clinical cases of pulmonary infarction are observed. It has been suggested that there are actually many more of them - but often the pathology is not detected during life due to erroneous diagnosis and is not confirmed after death due to medical ethics (the need to react positively to the refusal of the relatives of the deceased to perform an autopsy). At the moment it is believed that due to pulmonary embolism death from pulmonary infarction occurs in 5-30% of patients with this disease.

PE is not only considered a pathology in itself with a high probability of oxygen starvation of the lung tissue, but the risk of fatal cases with a pulmonary infarction caused by it increases even more due to factors such as:

Blood diseases are considered one of the most dangerous background diseases in terms of the occurrence of pulmonary embolism and subsequent pulmonary infarction - in particular:

• sickle cell anemia (red blood cells are shaped like a sickle);
• (imbalance of the blood coagulation system, which leads to the formation of multiple blood clots).

In addition to PE, most clinical cases of pulmonary infarction develop in patients who suffer from other cardiovascular diseases (particularly chronic ones). First of all, these are heart pathologies such as:

In heart pathology, blood clots in most cases form on the inner surface of the right atrium appendage. They can be held at the site of formation for some time until the blood flow tears them off and carries them into the arteries of the pulmonary circulation, thanks to which the lungs are supplied with blood.

Of other causes not related to heart pathology, the following diseases and conditions most often lead to pulmonary embolism, which provokes pulmonary infarction:

note

Bed rest and immobilization of the limbs for even one week significantly increase the risk of thrombosis, leading to pulmonary infarction.

In the postoperative period, the risk of thrombosis with the development of pulmonary infarction is highest with:

• operations on the abdominal organs;
• gynecological interventions;
• surgeries on the chest organs;
• hemorrhoidectomy (removal );
• operations on the lower extremities, complicated by thrombosis or thrombophlebitis (inflammation of the vascular wall and the formation of a blood clot in this place).

Particularly dangerous are blood clots that are attached to the inner surface of the vessel with a very small surface (compared to the entire surface area). Such blood clots are called floating (floating). They almost always come off and are carried by the bloodstream into the lobar and segmental vessels of the lung.

In addition to a blood clot (thrombus), the following can serve as an embolus that clogs a vessel:

Fat embolism of the blood vessels of the lungs can occur when:

• erroneous introduction of fat suspensions (suspensions) into the bloodstream;
• fracture of tubular bones - especially with polytrauma (multiple traumatic injuries - for example, in severe road accidents), when several bones break, and the risk of embolization increases significantly.

Tumor embolism can theoretically be caused by cells of any tumor, but in the overwhelming majority of cases it is caused by clusters of cells formed during the disintegration of malignant neoplasms in the terminal stages.

If the place where the embolus came from is unknown, such a pulmonary infarction is called primary; if it is determined, it is called secondary.

Development of the disease

Classically, a pulmonary infarction can develop from 2-3 hours to a day. After the acute period, salt compounds are deposited in the affected tissues - a process called organization. It lasts no more than 7 days.

Due to the structure of the lung, the area affected by lack of oxygen is shaped like a pyramid (or wedge). Its apex is directed towards the root of the lung, and its base is directed in the opposite direction.

As the affected tissue suffers from a lack of oxygen, it becomes dark cherry in color, dense in consistency, and bulges above the adjacent healthy areas. Despite the fact that the blood supply to the pleura adjacent to the affected fragment of the lung does not suffer, it also changes - it becomes dull, and then completely dull; bloody contents can accumulate in the corresponding area of ​​the pleural cavity.

Oxygen starvation of a fragment of the lung, which occurs due to blockage of the branches of the pulmonary arteries, leads to the fact that the cells of the lung tissue begin to be damaged. It happens that blood rushes here from neighboring areas of the lung with a normal blood supply - the so-called hemorrhagic (blood) type of pulmonary infarction develops. An infection often rushes to the lesion, so with a lung infarction, so-called infarction-pneumonia can occur, which significantly complicates the course of the disease.

A pulmonary infarction is not the final result of impaired blood supply. Its possible outcomes:

• resorption (resorption of tissue changed due to oxygen starvation);
• infiltration changes (compaction);
• scarring;
• (suppuration) of the affected area of ​​the lung;
• (destruction) of lung tissue.

Symptoms of pulmonary infarction

Symptoms of a pulmonary infarction depend on the level at which the blood vessel is blocked. It comes in the following types:

• embolism of small branches of the pulmonary arteries;
• submassive (emboli clog the branches that are responsible for the blood supply to segments of the lung or its entire lobes);
• massive (blockage of the central trunk of the pulmonary artery or its main branches).

Based on these criteria, the following types of pulmonary infarction are distinguished:

• limited– those branches of the pulmonary artery that supply blood to segments of the lung and its smaller areas are clogged;
• extensive - larger vessels or many small ones are affected (multiple embolism).

Symptoms of a pulmonary infarction do not develop immediately from the moment of blockage of a blood vessel; they begin to clearly appear on average after 2-3 days from the moment of blockage. Main clinical signs of the disease:

Chest pain during pulmonary infarction has the following characteristics:

• acute;
• intense (somewhat similar to the pain of angina pectoris);
• worsens with activity - coughing, trying to breathe deeper, bending the body.

Painful sensations mean that the pleura is affected (the lung tissue itself does not hurt) - in the place of the affected fragment of the lung, a so-called reactive one develops, which affects about half of patients with pulmonary infarction.

Hemoptysis is observed in almost half of patients with pulmonary infarction. Pulmonary hemorrhage is possible in 5-6% of patients.

Hyperthermia ranges from 37.1 to 37.8 degrees Celsius. It can last for a long time - up to 2 weeks. If a heart attack-pneumonia develops, the body temperature can rise to 39 degrees Celsius.

It should be remembered that with a pulmonary infarction, symptoms may develop not only from the cardiovascular and respiratory, but also from other organs and systems - primarily:

• brain;
• digestive system.

Possible cerebral disorders:

• coma.

Symptoms of wasps in the gastrointestinal tract:

• , not related to food intake;
• (it occurs due to secondary changes in the liver tissue, which lead to the breakdown of hemoglobin).

If an area of ​​the lung located close to the diaphragmatic pleura is affected, symptoms may occur - primarily severe and disruption of intestinal function.

Pulmonary infarction occurs:

• uncomplicated;
• complicated.

The most common complications of this pathology are:

Diagnosis of pulmonary infarction

Pulmonary infarction is diagnosed jointly by a pulmonologist and a cardiologist. The diagnosis is made on the basis of complaints, physical examination data (examination, palpating the chest, tapping it and listening with a phonendoscope) and the results of additional research methods.

In case of pulmonary infarction, a number of instrumental research methods are informative - these are:

Laboratory research methods that are used in the diagnosis of pulmonary infarction are as follows:

• – a moderate increase in the number of leukocytes is diagnosed as a reaction to “spoiled” lung cells;
• – lactate dehydrogenase (formed during the process of cellular respiration) and total lactate dehydrogenase (due to the breakdown of hemoglobin in the secondary affected liver) will be increased in it;
• analysis of blood gas composition - a decrease in the amount of oxygen is recorded.

Differential (distinctive) diagnosis

Due to the similarity of symptoms, pulmonary infarction should be distinguished from diseases such as:

and some others.

Treatment of pulmonary infarction

Therapeutic measures for pulmonary infarction include:

• first aid;
• treatment in a hospital setting.

Due to the fact that oxygen starvation of the lungs is fraught with consequences for the entire body, treatment of a pulmonary infarction should be started as an emergency.

As first aid, pain is relieved - for this purpose, potent non-narcotic or narcotic painkillers are administered. The patient is immediately taken to the intensive care unit.

The primary treatment task for pulmonary infarction is:

• eliminate an existing blood clot;
• prevent subsequent thrombus formation;
• increase blood pressure, which has decreased due to blockage of the pulmonary artery.

To destroy (dissolve) already formed blood clots, fibrinolytics are used. For arterial hypotension, drugs that constrict blood vessels are administered, and intravenous drips of infusion solutions are also administered.

For the treatment and prevention of heart attack, a broad spectrum of action is prescribed.

An extremely important treatment method for pulmonary infarction is oxygen inhalation.

If all these methods do not produce the desired effect, the question is raised about surgical removal of the blood clot from the pulmonary artery - thrombectomy . During this operation, a special filter is also inserted into the inferior vena cava system, which will subsequently “screen out” blood clots.

When the branches of the pulmonary artery are blocked by other emboli, the treatment is almost the same. This includes administering drugs that prevent the formation of blood clots - with embolism of any origin, coagulopathy (blood clotting disorder) can develop.

Prevention

To prevent pulmonary infarction, you should avoid all factors that can cause blockage of the pulmonary artery. Since in the vast majority of cases embolization is caused by a blood clot, you should adhere to a lifestyle that eliminates thrombus formation or at least reduces its risk:

• provide timely medical care for signs of thrombophlebitis (especially with varicose veins of the lower extremities);
• for diseases of the veins of the lower extremities, use knitted underwear (special elastic stockings) or, at a minimum, bandage the legs with elastic bandages (an archaic method, but less expensive);
• after surgical interventions, do not ignore regular therapeutic exercises, relying only on medications;
• Whenever possible after surgery, practice getting up early;
• observe the timing of the use of intravenous catheters for drip administration of drugs;
• quit (by causing vasoconstriction, nicotine aggravates the course of a pulmonary infarction).

Prognosis for pulmonary infarction

The prognosis for pulmonary infarction is quite difficult: delay in diagnosis and treatment can lead to irreversible destruction of lung tissue . Threats to the health and life of the patient can be avoided through timely diagnosis and emergency treatment measures.

The risk to health and life from pulmonary infarction increases under the following conditions:

• the presence of severe chronic cardiovascular failure;
• complications that occur (heart attack-pneumonia, abscess and gangrene of the lung, sepsis);
• recurrent cases of pulmonary embolism.

Kovtonyuk Oksana Vladimirovna, medical observer, surgeon, consultant doctor

I26 Pulmonary embolism

Causes of pulmonary infarction

The causes of pulmonary infarction can be hidden in many problems. Pathophysiology may contribute to this. Thus, in most cases, a detached blood clot can provoke a heart attack. It develops much less frequently against the background of an increase in the attached thrombus. A heart attack can cover either a small fragment of the lung or a fairly large area. The risk of developing the disease increases if the patient suffers from the following problems: sickle cell anemia, nephrotic syndrome, malignant neoplasms, vasculitis. Also, the likelihood of having a heart attack increases in people who have undergone chemotherapy. Epidemiology can contribute to the problem. Pulmonary infarction is a rare pathological disorder in medical practice. As for mortality, it ranges from 5 to 30%. It all depends on the severity of the patient’s condition and timely assistance provided. Immediately after a heart attack, various complications can develop, ranging from cardiovascular complications to pulmonary hypertension. It should be noted that women suffer from heart attacks 40% more often than men.

Pulmonary edema due to myocardial infarction

Pulmonary edema during myocardial infarction is characterized by a typical clinical picture. With this phenomenon, there are a number of subjective and objective symptoms. The first thing to note is that this pathological condition can develop at any time of the day. Typically, an attack begins with a feeling of tightness in the chest, a feeling of pain and weakness. Severe shortness of breath appears, it is difficult to breathe. The patient takes a typical forced position, in which fixation of the shoulder girdle makes breathing easier. The patient complains of a cough, which is initially dry and eventually accompanied by foamy sputum. Sometimes the color of the foam may be pink.

Upon percussion of the lungs, a tympanic sound is determined, and upon auscultation, a large number of different-sized moist rales are heard - from crepitating rales, formed in the alveoli and terminal bronchioles, to large-bubble rales, caused by the presence of foam in the large bronchi and trachea. When diagnosing a patient's condition, it is necessary to pay attention to changes in blood circulation. In total, there are 2 types of hemodynamic changes during pulmonary edema - hyperdynamic and hypodynamic. The first phenomenon is based on an increase in stroke volume of the heart and blood flow velocity, an increase in pressure and an increase in blood pressure. This condition is typical for patients with hypertension, combined mitral valve disease, and unreasonable forced intravenous administration of fluids. The second type of disorder is accompanied by a decrease in stroke volume of the heart, a slight increase in pressure in the pulmonary artery and a tendency to decrease blood pressure. This type is characteristic of pulmonary edema, extreme degrees of stenosis of the mitral or aortic valves.

Symptoms of pulmonary infarction

The symptoms of a pulmonary infarction are typical; the victim himself can determine the occurrence of this disease. So, a lot depends on the severity of the condition. Symptoms are influenced by the size, location and number of closed blood clots. Naturally, we should not forget about concomitant diseases of the lungs and heart.

The main signs include sudden or sharply increased shortness of breath. A cough may occur, which is accompanied by mucous or bloody sputum. A sharp pain appears in the chest. The skin becomes pale and often acquires an ashen tint. Lips, nose and fingertips turn blue. The heart rhythm is significantly disturbed. This manifests itself in the form of increased impulse speed and the appearance of atrial fibrillation.

This is often accompanied by a decrease in blood pressure and an increase in body temperature. Most often, the person’s condition is very bad. In severe cases, it dies almost instantly. Therefore, it is important to recognize strange changes in time and provide assistance.

Hemorrhagic pulmonary infarction

Hemorrhagic pulmonary infarction occurs against the background of existing embolism or thrombosis of the pulmonary arteries. Because of this, a section of lung tissue with impaired blood circulation is formed. The main feature of the disease is the presence of an ischemic area soaked in blood, which has clear boundaries and is dark red in color.

Such a heart attack is shaped like a cone, the base of which faces the pleura. Accordingly, the tip of the cone faces the root of the lung, and it can detect a blood clot in one of the branches of the pulmonary artery.

Several key points can lead to this condition. So, first of all, this is peripheral vein thrombosis. Thrombosis of the deep femoral veins is especially common due to weak or slow blood circulation in them. In this case, the presence of one condition is important - a tendency to increased blood clotting in weakened patients who are on bed rest for a long time.

The phenomenon can be provoked by inflammatory thrombophlebitis. This group includes septic thrombophlebitis, which occurs with a variety of general and local infections, after injury or surgery, and with prolonged fever in the postoperative period.

Thrombosis in the heart and thromboendocarditis often provoke hemorrhagic pulmonary infarction. It is necessary to identify predisposing factors under which hemorrhagic pulmonary infarction develops somewhat more often. These include myocardial infarction, nephrotic syndrome, obesity, congestive heart failure, surgery in the lower abdominal cavity, pregnancy, and prolonged immobility.

The symptoms of this disease are pronounced and impossible to ignore. First, painful sensations appear in the armpit, in the area of ​​the shoulder blade, or a feeling of tightness in the chest. During coughing and breathing, the pain may intensify. Shortness of breath is noted. At the same time, vascular reactions are observed - the skin becomes pale, sticky cold sweat appears. In case of massive damage, jaundice cannot be ruled out.

A blood examination reveals moderate leukocytosis. During the examination, the doctor detects pleural friction, moist crepitating rales and muffled breathing. There may be an accumulation of fluid in the pleural cavity, which manifests itself as dulling of percussion sound in the affected area, weakening of breathing, bulging of the intercostal spaces and vocal tremors.

Right lung infarction

Right lung infarction is a disease that is caused by thrombosis or embolism of the branches of the pulmonary artery. In 10-25% of cases, it develops in case of blockage of the pulmonary artery.

Peripheral phlebothrombosis is preceded by the postpartum period, surgical interventions, fractures of long tubular bones, chronic cardiac failure, prolonged immobilization, and malignant tumors. Pulmonary thrombosis can cause pulmonary vasculitis, stagnation of blood flow in the lungs, stable pulmonary hypertension. A reflex spasm in the pulmonary artery system, as usual, accompanies vessel obstruction. This leads to overload of the right side of the heart and acute PH.

As a result, diffusion disturbance and arterial hypoxemia occur. Pulmonary infarction occurs mainly against the background of already existing venous stagnation. This phenomenon is hemorrhagic in nature. Infection can lead to the development of a lung leading to the occurrence of perifocal pneumonia (candidiasis, bacterial), often with abscess formation.

It is not difficult to understand that a heart attack has occurred. The main symptoms are chest pain, shortness of breath, foamy discharge during coughing and a significant increase in body temperature. Timely diagnosis and elimination of the problem is necessary.

Left lung infarction

A left lung infarction also develops against the background of thrombosis or embolism of the branches of the pulmonary artery. This phenomenon does not have any special symptoms; rather, it is typical. Thus, shortness of breath, fever, chest pain, dry cough appear, followed by sputum or foam. There may be tachycardia, cyanosis, hemoptysis, cerebral disorders, signs of myocardial hypoxia, cardiac arrhythmias and weakened breathing.

Abdominal syndrome caused by damage to the diaphragmatic pleura is observed occasionally. Intestinal paresis, leukocytosis, vomiting, and loose stools cannot be excluded. Diagnosis of the problem must be carried out immediately.

The prognosis of this phenomenon depends entirely on the course of the underlying disease. The disease can be prevented, but only if cardiac decompensation and thrombophlebitis are treated, anticoagulants are used among patients with myocardial infarction, mitral stenosis, in gynecology and surgery.

Consequences of pulmonary infarction

The consequences of a pulmonary infarction can be severe. Usually, this disease does not pose any particular danger, but it must be eliminated quickly. The development of serious complications is possible. These include post-infarction pneumonia, suppuration and spread of inflammation to the pleura.

After a heart attack, there is a high risk of a purulent embolus (blood clot) entering the vessel. This phenomenon can cause a purulent process and contribute to an abscess at the site of a heart attack. Pulmonary edema during myocardial infarction develops primarily with a decrease in the contractility of the heart muscle and with simultaneous retention of blood in the pulmonary circle. This happens because the intensity of heart contractions suddenly decreases, and acute low-output syndrome develops, which provokes severe hypoxia.

With all this, there is excitation of the brain, the release of biologically active substances that promote the permeability of the alveolar-capillary membrane, and increased redistribution of blood into the pulmonary circulation from the large one. The prognosis of a pulmonary infarction depends on the underlying disease, the size of the affected area and the severity of the general manifestations.

Scars after pulmonary infarction

Scarring after a pulmonary infarction is a typical consequence. After all, the disease itself is characterized by the death of part of the contractile cells of the myocardium, followed by the replacement of dead (necrotic) cells with coarse connective tissue. This process leads to the formation of a post-infarction scar.

Cell death (necrosis) occurs as a result of ongoing myocardial ischemia and the development of irreversible changes in cells due to disruption of their metabolism. Dense scar tissue at the site of necrosis is finally formed after about 3-4 months or later. With small-focal myocardial infarction, a scar may form earlier. The rate of scarring depends not only on the size of the necrosis focus, but also on the state of coronary circulation in the myocardium in general and in peri-infarction areas especially.

A relatively small load during the formation of the primary scar (under certain conditions, of course) can lead to the development of a cardiac aneurysm (protrusion of the ventricular wall, the formation of a kind of sac), and after a month the same load turns out to be useful and even necessary for strengthening the heart muscle and the formation more durable scar. But let's continue talking about the heart attack. And now let’s talk about how acute large-focal (i.e., the most typical) myocardial infarction manifests itself.

Complications of pulmonary infarction

Complications of pulmonary infarction may include abscesses. It should be noted that minor manifestations of the problem are mostly asymptomatic. As for radiological changes, they completely disappear in 7-10 days.

Larger infarcts last longer and can lead to fibrosis; with thrombosis, the onset is gradual, collapse is not pronounced; marantic infarcts also occur without pronounced symptoms, often accompanied by hypostasis or pulmonary edema, and are often diagnosed as hypostatic pneumonia.

It should be noted that hemorrhagic pleurisy is often associated with the problem. In general, it all depends on the severity of the condition. If you notice the problem in time and resort to eliminating it, there will be no serious consequences. Much depends on when the help was provided and what disease caused the pulmonary infarction. Only on the basis of these data can we make a further prognosis and talk about complications. It is important to prevent the lung from becoming infected.

Diagnosis of pulmonary infarction

Diagnosis of pulmonary infarction is carried out in several stages. So, first a comprehensive blood test is taken. This is followed by a chest x-ray. It allows you to highlight changes and detect pathologies. If nothing can be seen or the case is severe, computed tomography of the lungs is used. It gives a complete picture of what is happening.

Magnetic resonance imaging of the lungs, echocardiography and ECG are often used. All these diagnostic capabilities together give a complete picture of what is happening. Naturally, all procedures are not carried out at once. As mentioned above, it all depends on the complexity of the condition. In some cases, X-rays cannot provide all the necessary information. Other methods are used for this. In general, the presence of a problem can be determined by the symptoms. More precisely, based on the main features, everything becomes clear. But to determine the severity of the problem, you need to resort to other diagnostic methods.

X-ray for pulmonary infarction

X-rays for pulmonary infarction are of particular importance. So, in some cases, horizontal shadows are observed in the image. Typically, the disease is accompanied by the presence of pleural exudate. True, it can be established exclusively with the help of skiagraphy in the oblique position of the patient, located at an angle of 30° on the sore side. In this position, you can set the diaphragm to a higher position. The presence of pleural exudate was also observed in the embolic period, even before the development of a heart attack.

In unaffected areas, increased transparency is noticeable, they are swollen, or overstretching of the lung tissue is observed. The shadows of infarctions can be completely or largely blocked. In some cases, basal atelectasis develops.

When the diaphragm is high, a stripe-like shadow may form, reminiscent of flat atelectasis. A similar shadow can sometimes be produced by an incomplete, resolving, or healed infarction. It must be emphasized, however, that not every heart attack can be detected by X-ray examination. In addition, during periods of serious illness, children are usually not subjected to x-ray examination.

CT scan for pulmonary infarction

CT scanning for pulmonary infarction is an important procedure. Thus, computed tomography is an analysis that allows you to visualize the structures of the body. During the process, the patient is placed on a table to which a scanner is attached. It is this device that sends X-ray radiation to the tomograph through the area of ​​the body being examined and transmits the image to a computer monitor.

In the chest, this test helps diagnose underlying problems in the lungs, heart, esophagus and main blood vessel (aorta), as well as tissue in the chest area. The most common diseases developing in the chest that can be detected by CT are infection, lung cancer, pulmonary embolism, and aneurysm.

Computed tomography allows you to see changes in organs. Thanks to this study, a clear diagnosis can be made and treatment can begin. But one picture is not enough; you should also take a blood test and, if necessary, undergo other procedures. Computed tomography takes a leading place in diagnosing pulmonary infarction.

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If there is no pain, neurolepsy is indicated with Droperidol - 2.5% solution, 2-4 ml. Naturally, the drug is administered intravenously. To destroy the foam, inhalation of oxygen with vapors of 20-50 degrees alcohol or a 10% alcohol solution of Antifomsilan is used.

If the blood pressure is normal or elevated, Furosemide is administered at a rate of 1 - 2.5 mg/kg. Immediately after using the drug, its extrarenal effect immediately appears - a decrease in the volume of circulating blood in the lungs due to its redistribution. When a pulmonary infarction begins, it is worth taking sublingual Nitroglycerin. It is used 1 tablet every 2 minutes 3-5 times.

If treatment is carried out in a hospital, then Nitroglycerin dissolved in 20 ml of isotonic solution is first administered intravenously. In this case, you need to carefully monitor your blood pressure. If the swelling does not stop, it is worth repeating the administration of the drug after 5-15 minutes. Subsequently, they proceed to the drip application of Nitroglycerin in a dose of 6 ml of 1% solution per 400 ml of isotonic solution at a rate of 8-10 drops per minute.

Pentamin is also used; it is injected slowly into a vein. In this case, it is necessary to measure the pressure every 3 minutes. The effect of pentamine is particularly rapid in pulmonary edema, which occurs with a significant increase in blood pressure.

Another method of treatment is associated with the use of a peripheral vasodilator - Sodium Nitroprusside. It is administered intravenously in a dose of 50 mg, dissolved in 500 ml of 5% glucose solution. The rate of administration also depends on the blood pressure numbers (on average 6-7 drops/min). In patients with normal blood pressure, treatment should begin with the administration of Nitroglycerin in the amount of 1-2 ml of a 1% solution diluted in 200 ml of isotonic sodium chloride solution. Everything is injected at a rate of 20-30 drops per minute. Lasix (80-120 mg) is also used and 0.25 ml of a 0.05% strophanthin solution is administered intravenously over 4-5 minutes.

If a person has low blood pressure, then all the drugs described above are prohibited. He is prescribed drugs for neuroleptanalgesia. 90-150 mg of Prednisolone is administered intravenously, and a drip infusion of 0.25 ml of a 0.05% solution of strophanthin in 200 ml of rheopolyglucin is established. To this solution you can add 125 mg (5 ml) of hydrocortisone acetate (infusion rate 60 drops/min).

Dopamine 200 mg (5 ml of 4% solution) is injected intravenously into 400 ml of 5% glucose solution or isotonic sodium chloride solution (initial rate of intravenous infusion - 5 mcg/kg per minute), or 10 drops of 0.05% solution per minute . Naturally, these treatment regimens for heart attack are used only in a hospital setting.

Prevention of pulmonary infarction

Prevention of pulmonary infarction involves preventing the disease. It is necessary to eliminate cardiac decompensation and thrombophlebitis in a timely manner. It is advisable to use anticoagulants in the environment of patients with myocardial infarction, mitral stenosis, in gynecology and surgery.

It is important for heart attack patients to remain completely at rest. Therapeutic measures usually include the elimination of reflex influences, which can lead to serious consequences. Naturally, it is necessary to relieve pain with the use of Morphine and eliminate collapse.

Considering the main causes of pulmonary infarction, we can talk about preventive measures. First of all, if possible, you should not get up for several days after the operation. Even seriously ill patients are recommended to provide the necessary minimum of movements. Naturally, unnecessary use of medications that can increase blood clotting is excluded. Intravenous administration of drugs is limited whenever possible. For thrombosis of the veins of the lower extremities, a surgical method of vein ligation is used in order to avoid repeated embolisms. Compliance with the above measures will help reduce the likelihood of developing vein thrombosis and the risk of developing consequences.

Prognosis of pulmonary infarction

The prognosis of a pulmonary infarction depends entirely on the underlying disease that caused it. Naturally, all this is influenced by the severity of the problem and its course. The size of the infarction and general manifestations are also included in their number.

Typically, a pulmonary infarction is not particularly dangerous. It can be easily eliminated, but at the same time determining the reason for its development. The prognosis is usually favorable. But, as mentioned above, it all depends on how quickly the problem was diagnosed and quality treatment started.

In general, this disease is easier to prevent than to cure. Therefore, if you have problems with the heart and blood vessels, it is worth addressing them. After all, they are the ones who lead to the development of consequences in the form of lung damage. If everything is done correctly, the disease will not develop and the prognosis will be most favorable. Naturally, there is a possibility of negative developments. To prevent this from happening, you need to seek help when typical symptoms appear.

The lungs need a regular supply of oxygen and nutrients. When the pulmonary arteries are blocked, the trophism of the functioning alveoli is disrupted. Persistent ischemia over time leads to tissue necrosis, which is fraught with the appearance of a focus of vascular necrosis. Blood clots enter the respiratory system due to drift from the peripheral veins of the lower extremities.

What is a pulmonary infarction and why is it so dangerous?

Prolonged ischemia inevitably leads to tissue necrosis. During myocardial infarction, similar changes occur when the heart muscle succumbs to necrosis due to blockage of the coronary arteries.

Pulmonary infarction - develops after the appearance of a blood clot in the arteries of the lungs or peripheral veins

Attention! It is worth remembering that this is a pathological condition that occurs as a result of vascular thrombosis or embolism. Lobar, segmental and smaller arteries are susceptible to thrombosis.

An extensive infarction causes a significant reduction in the respiratory area of ​​the parenchyma and the number of functioning alveoli.

The following diagnostic methods exist:

• radiography (swelling of one or both lungs in the root area is observed, it becomes wider, a special sign is pneumonia followed by pleurisy);
• selective angiopulmography (instrumental study of vascular patency);
• scintigraphy (using the introduction of radioactive isotopes).

Since the disease is more common in old age, the risk of complications in the absence of vascular treatment in older people is much higher.

Important! The death of lung tissue causes hypertrophy of the right side of the heart, which an experienced doctor can trace in the form of changes in the electrocardiogram.

An increase in blood pressure in the pulmonary circulation is very dangerous in old age, when the heart risks not being able to withstand excessive stress.

Pressure in the artery increases and leads to hemorrhage in the lungs

What is the prognosis for pulmonary infarction?

In contrast to necrosis of myocardiocytes, necrosis of the pulmonary parenchyma has a much lower mortality rate. Pathological changes largely depend on the diameter of the vessel that has been blocked.

Attention! The most dangerous is when a blood clot enters a large artery; blockage of segmental vessels is much easier for patients to tolerate.

The likelihood of a negative outcome increases when:

• severe form of heart failure;
• repeat pulmonary embolism;
• significant pulmonary edema;
• post-infarction pneumonia;
• pleurisy and the formation of purulent inflammation.

It is very important to start preventive treatment on time if you suspect the presence of blood clots or embolism in the bloodstream.

Attention! Patients with thrombosis of the veins of the lower extremities are prohibited from sudden movements or excessive dynamic loads, since increased blood flow increases the risk of developing pulmonary embolism.

People need to take thrombolytics and anticoagulants to slow the progression of the disease. It is recommended to wear compression garments.

Causes of pulmonary infarction – vessels blocked by blood clots

Pulmonary infarction: main causes and risk factors

Ischemia of pulmonary tissue is often associated with various diseases of the cardiovascular system. The composition of the blood changes, it becomes thicker, and blood circulation in the large and small circles slows down. A significant role in the disease is played by the formation of immune complexes, which are formed due to excessive activity of the human immune system. A lung infarction in a newborn occurs as a result of defects in the circulatory system or a severe infectious disease suffered after pneumonia.

Vascular pathologies include:

• heart rhythm disturbances (atrial fibrillation, atrial fibrillation or ventricular fibrillation);
• mitral stenosis (narrowing of the mitral valve);
• acute and chronic heart failure;
• systemic vasculitis;
• coronary heart disease (angina pectoris or history of myocardial necrosis);
• various inflammatory processes in the heart (endocarditis, myocarditis, pancarditis).

There are thromboembolism and fat embolism. Thromboembolism of an artery occurs as a result of a blood clot entering it from the veins of the systemic circulation, most often from the lower extremities. Fat embolism sometimes occurs after severe long bone fractures.

Important! The development of a pulmonary infarction can be triggered by prolonged labor, DVD syndrome, extensive trauma, old age, or a hereditary predisposition to pulmonary embolism.

The size, location and number of blood vessels with blood clots characterize the severity of pulmonary infarction

Symptoms of pulmonary infarction

Timely treatment can significantly reduce the risk of severe complications and save a large number of functioning alveolocytes. It is quite difficult to detect the formation of a focus of necrosis when small arteries are blocked, while thrombosis of large pulmonary vessels can quickly lead to respiratory arrest.

The first signs of pulmonary infarction:

• shortness of breath not associated with physical activity or anxiety, which quickly worsens;
• pressing chest pain;
• blanching of the skin and mucous membranes;
• with the development of ischemia, the face acquires a bluish tint;
• Auscultation of the heart reveals various disturbances in its rhythm (tachycardia, atrial fibrillation and flutter, extrasystoles);
• arterial hypotension;
• anxiety, fear, increased heart rate;
• chills, increased body temperature, manifestations of intoxication;
• productive cough mixed with blood.

An important research method for suspected development of a necrotic process is auscultation of the chest.

In patients with heart defects, a heart attack can be recognized by slight shortness of breath and rapid heartbeat

Attention! When listening to the affected area of ​​the parenchyma, pleural friction noise and fine bubbling rales are observed.

Pulmonary infarction: treatment and prevention

The necrotic process is always accompanied by severe pain, which is sometimes very difficult to cope with. In this case, narcotic analgesics are prescribed. After complete necrosis of the affected area and the formation of connective tissue in its place, pain decreases.

Therapy for a heart attack includes:

• narcotic analgesics for pain relief;
• enzymatic agents to accelerate the resorption of blood clots (fibrinolytics);
• anticoagulants (thin the blood, reduce its ability to voluntarily clot);
• drugs whose action is aimed at regeneration and improvement of tissue trophism (angioprotectors, antianginal agents).

In case of damage to a large pulmonary vessel, ischemia occurs in a significant area of ​​the parenchyma. Often patients, especially older ones, lose consciousness due to oxygen starvation. To bring a person out of a critical condition, it is necessary to resort to emergency medical care.

Treatment of pulmonary infarction is based on drugs that dissolve blood clots (fibrinolytics) against vascular collapse (rest, adrenaline, heat)

Resuscitation after a heart attack includes:

• administration of painkillers to avoid painful shock;
• if there is a sharp drop in blood pressure, it is necessary to administer adrenaline or dopamine intravenously;
• to treat pulmonary edema in this case, a diuretic must be administered parenterally;
• blockage of the pulmonary artery by a thrombus requires inhaled oxygen;
• in case of pulmonary embolism, it is appropriate to use surgical methods to clean the lumen of the vessel from blood clots.

The addition of a bacterial infection provokes the development of pneumonia. To combat inflammation it is necessary to take antibiotics. In severe cases of the disease, pleurisy occurs with the formation of pus. To avoid severe complications, it is important to start antibacterial therapy in a timely manner.

What are the consequences of the disease?

The younger the person, the higher the chances of a quick recovery from illness. A small focus of necrosis is not capable of causing significant harm to its owner. Much more dangerous are changes in the body associated with a decrease in the respiratory surface.

Important! After an illness, it is necessary to carefully monitor your own health, since shortness of breath and fatigue are often associated with a reduced respiratory surface area.

Serious complications of the necrotic process include:

• pneumonia with bacterial infection;
• pulmonary edema leading to chronic tissue hypoxia;
• if a heart attack occurs against the background of reduced immunity, fluid may form in the lungs and pleurisy;
• dead tissue nearby increases the likelihood of purulent formations.

Hemorrhagic pulmonary infarction occurs due to insufficient oxygen flow, as a result of which the damaged tissue is filled with blood. Thus, the body tries to compensate for ischemia. Such an environment is favorable for the development of bacteria with the subsequent development of pneumonia and purulent formations. A microslide for this form of the disease will contain a dense cone-shaped area of ​​cherry-colored lesions and fibrous formations on the nearby pleura.

29.04.2017

A pulmonary infarction is similar to a myocardial infarction. They are characterized by such a situation: in a certain area, the blood supply stops, because of this, tissue begins to die.

But there is one defining difference: you cannot die from a pulmonary infarction.

The development of a pulmonary infarction occurs because the lumen of the blood vessels is blocked, and does not allow the blood flow to function normally. This disease develops too quickly, it only takes a day. In addition, the degree of damage may vary.

The reasons for blockage of the lumen of a vessel can be different; they cause all sorts of diseases, thrombophlebitis, thrombosis and many others.

Possible causes and factors of the disease

Appeared The first cause of pulmonary infarction is the appearance of blood clots in the blood vessels. When the lumen of a vessel is blocked by a blood clot, a person begins to have an attack. At the site of the clot, there may be a detached thrombus.

Attacks mainly appear with pulmonary fat embolism, leg thrombosis or thrombophlebitis.

The cause of a blood clot can be surgical intervention, in particular if it was performed on the blood vessels of the extremities. This situation causes a lung infarction and then a heart attack.

Factors that can give impetus to the development of the disease are called:

• Genetic predisposition.
• Chronic diseases.
• Poor circulation.
• Injuries to the walls of blood vessels.
• Changes in blood composition.
• Medicines for blood clotting.
• Excess weight.
• Heart diseases.
• Tumors that put pressure on blood vessels.
• Passive lifestyle.
• Use of contraceptives.

If the lumens of medium-sized or small-sized vessels located in the lungs are clogged, then the patient cannot die from such a disease. But if such a situation occurs in a large blood vessel, then in most cases, the patient dies.

But there are other reasons, these are diseases, vasculitis, anemia, nephrotic syndrome, or completed courses of radiation and chemotherapy procedures. A severe bruise can also cause blockage of a vessel. In this case, the disease will be called traumatic pulmonary infarction.

Signs of illness

Symptoms of pulmonary infarction will appear depending on the location of the lesion, the degree of development and the number of blocked vessels. In addition to these signs, symptoms of other lung and heart diseases will be added.

A pulmonary infarction is easier to detect if a person simultaneously suffers from heart disease.

During a consultation with a doctor, he will conduct a visual examination of the patient and question him about existing symptoms that can confirm the presence of the disease.

And they are:

• Pain under the ribs.
• Cardiopalmus.
• Fever or body chills.
• Panic attacks, shortness of breath.
• Coughing up blood.

Very often, it is the presence of blood when coughing that appears after pain in the hypochondrium. And with a fever, a person becomes covered in cold, sticky sweat.

During pneumonia, a lung infarction that appears manifests itself in severe pain, but there is no shortness of breath or rapid heartbeat. The person does not panic. In some cases, pulmonary infarction does not manifest itself. And it can be diagnosed using x-rays.

An emerging pulmonary infarction exhibits the following symptoms:

• Rapid development of shortness of breath, which has not been observed before.
• Coughing up blood.
• Coughing up blood.
• The appearance of fever.
• Sudden sharp pain under the shoulder blade, which gets worse when coughing.
• Pale skin.
• Blue discoloration of fingertips, nose and lips.
• Weak pulse.
• Increased sweating.
• The appearance of wheezing.
• Low pressure.
• Pain in the liver on palpation.
• Heat.
• Lack of air.

All signs appear depending on the degree of development of the disease (infarction pneumonia) and its type, and there are several of them:

Hemorrhagic

This type of disease occurs due to arterial thrombosis and embolism. In this case, heart attack pneumonia shows the following signs: shortness of breath appears suddenly. And after a short time there is a burning pain in the sternum, which radiates to the shoulder blade or armpit.

As already mentioned, this type occurs due to thrombosis, and this, in turn, is due to infectious diseases, bruises, previous operations on blood vessels, or too long rehabilitation after surgery.

The symptoms of this type of disease are too pronounced, so they cannot be ignored.

The onset of the attack is characterized by the appearance of cold sweat and the appearance of chills. Then pain begins to appear in the area of ​​the shoulder blade or in the armpit. The more advanced the disease, the stronger the pain will be, and then there will be compression in the chest. There may be a cough and shortness of breath, pale skin, and profuse sweat. And if the damage to the blood vessels is too severe, then jaundice will appear.

The cough with such pneumonia is initially dry, and then blood appears. In advanced cases, the blood changes color and becomes dark brown.

When listening, the doctor may hear wheezing and heavy breathing.

Right lung

Almost always, this type of disease occurs when the blood vessels through which blood enters the right lung are blocked. And this also happens due to thrombosis of the pulmonary artery. In addition, a heart attack on the right side may occur due to:

• During the period after childbirth.
• After surgery.
• The resulting fracture of tubular bones.
• Heart failure, chronic.
• Development of a cancerous tumor.
• Stagnation of blood in the lungs.

There are reasons that directly indicate that an attack has begun: pressure on the chest, shortness of breath, foamy cough and high body temperature.

The pain usually appears on the right side and the person may begin to choke.

You can’t ignore these signs, and you shouldn’t try to take any medicine to get rid of them on your own. A person in this situation must be immediately hospitalized so that he can be given an accurate diagnosis and prescribed effective treatment, which should take place in a hospital setting under the supervision of doctors.

Left lung

Pulmonary infarction on the left side also develops due to embolism of blood vessels or thrombosis. All signs of a heart attack on the left side are the same as on the right. Only the pain is felt more on the left side. Signs of this type of heart attack are: shortness of breath, high fever, coughing and coughing up blood. The heart rate also increases and breathing becomes weaker.

This type is characterized by panic attacks, anxiety and lack of coordination. In some cases, diarrhea and vomiting appear. To save a person’s life, or reduce the risk of complications, he must be urgently sent to the hospital. There he will receive qualified assistance in diagnosis and treatment.

Possible consequences of the disease

If a pulmonary infarction is detected and its treatment is started on time, then complications may arise that can be quite serious. This is how the appearance of bacterial pneumonia and pus is observed in the area where the heart attack occurs.

The appearance of pneumonia is considered the most common complication of pulmonary infarction. And all because after a heart attack, the affected area becomes non-viable. During the disease process, blood does not flow into this area, it does not function during breathing, and infectious diseases arise as a result. The larger the affected area, the more likely pneumonia is to occur.

However, pneumonia is not the only complication; pus may also appear and fill the lungs. As a result, a breakthrough is possible, after which healthy tissues will also fill.

The most severe consequence is called a lung abscess. Inflammation of a large part of the organ occurs, a lot of pus accumulates and the temperature rises greatly.

The occurrence of complications will depend on the area of ​​the lesion and the time of treatment started.

Diagnosis

Upon admission to the clinic, the doctor begins to examine the patient and collects anamnesis. This procedure involves two specialists - a cardiologist and a pulmonologist.

The first procedures involve listening to the chest for fluid and wheezing. After this, the patient’s blood pressure and pulse are measured, and the abdomen is palpated, which may indicate an enlarged liver.

To make a correct diagnosis, the manifestation of all symptoms should be clearly explained, and exactly where the patient experiences pain should be indicated. He must also indicate the nature of the pain, because a heart attack can easily be confused with pulmonary inflammation.

In addition, laboratory and hardware tests are carried out. The latter include:

• X-ray. This diagnostic method is mandatory, because it is considered the main one.
• CT scan. This method is also important because, in combination with x-rays, it confirms or refutes the diagnosis.

Treatment of the disease

During treatment, it is necessary for pulmonary vascular occlusion to disappear, so all therapy is aimed at this. The doctor prescribes medications to the patient that thin the blood and dissolve blood clots.

These means can be:

• Heparin.
• Urokinase.
• Fraxiparine and others.

The course of treatment lasts no more than seven days, at first a large dose is administered, and then it is gradually reduced. During treatment, aspirin may be added to these drugs to prevent thrombosis.

If the pain is severe and the patient cannot tolerate it, then morphine is prescribed.

In parallel with these drugs, the patient is prescribed drugs to prevent complications. It could be ceftriaxone. To prevent fluid from collecting, furosemide is administered intramuscularly.

At the beginning of the attack, when the patient is still at home, he needs to be given a nitroglycerin tablet and call an ambulance. At the hospital, he is given the drug intravenously. Doctors also monitor blood pressure there.

But if the patient has low blood pressure upon admission, then the above drugs are not used, but other means are used.

In addition to medications, surgery is also used.

Prevention

It must be remembered that it is always easier to prevent a disease than to treat it later. Therefore, experts advise regular prophylaxis with medications to prevent the formation of blood clots.

If a person has high blood pressure and too thick blood, thinners should be taken.

If the human body is prone to the formation of blood clots, clotting agents should not be taken. And if an operation was performed, you need to spend several days in bed.

And pulmonary infarction is an acute process accompanied by a violation of the integrity of the blood vessel of the small circle. The arteries are usually affected.

The reason is always approximately the same: thrombosis, blockage of a hollow structure with a blood clot, critical increase in pressure at the local level, rupture, hemorrhage, compression of the organ parenchyma.

Then there are options. Even at the bleeding stage, the patient’s death is likely, almost instantaneously. If you are lucky, you need to monitor the person’s condition. Possible gangrene, abscess, compression of the lung with the development of respiratory failure and asphyxia.

Treatment is urgent. Conservative or surgical. Often in combination. Forecasts are vague because there are so many factors to consider.

It is based on two processes. The first and most common is thrombosis. That is, blockage of the pulmonary artery with a blood clot.

Most often it forms far from the localization of the lesion. Limbs as the main place of development. Slightly less heart. For example, after suffering injuries or other conditions.

The second option is atherosclerosis. It itself is divided into two more types. The formation of cholesterol plaques on the walls of the vessel, deposits of fatty compounds that radially envelop the endothelium, create a mechanical obstacle and prevent blood from moving at a normal pace.

Narrowing or stenosis is also a type of atherosclerosis. Accompanied by spontaneous spasm and a change in the diameter of the lumen of the vessel. Other causes, such as inflammation (arteritis) with scarring and fusion of the wall, are less common.

Be that as it may, in any case, a pronounced increase in pressure develops at the local level. Because blood has to overcome more resistance.

The risk remains during each cycle of heart contraction, that is, continuously, as long as the pathological condition is present.

The deviation involves one vessel or several at once. The further stage of development is accompanied by rupture of the artery.

This is usually not a spontaneous or random phenomenon. It is caused by stretching and thinning of tissues.

Blood pours abundantly into the intercellular space, possibly entering the chest, which will inevitably provoke inflammation.

If the patient does not die from massive leakage of liquid tissue, many complications arise. The reason is compression of the respiratory structures, blood entering the alveoli (hemorrhagic consolidation of the pulmonary parenchyma), into the chest and other damaging factors.

At each stage of therapy, you need to carefully monitor the condition of the victim so as not to miss an important moment and stop the impending threat in time.

Pulmonary infarction does not develop overnight, except in acute cases. Pathology is formed secondarily, as a response to the current disease. Usually we are talking about hypertension, abnormalities in the heart (CHD, other variants), atherosclerosis, cholesterolemia.

Symptoms are present in most cases, but they are subtle, weak, and do not motivate the person to go to the hospital.

Classification

There is no generally accepted typification of the disease in question. Pulmonary infarction can be divided into several aspects.

• The first is the number of affected vessels. Moreover, a multiple process is not always more dangerous than a single one. Depends on the type and diameter of the blood supply structures. It is clear that a rupture of an artery will be more fatal than the destruction of several smaller vessels.
• Next, etiology or origin. As a rule, pulmonary infarction is secondary to a particular disease.

But primary deviations are possible. With direct blockage of a vessel after an injury, with spontaneous formation of blood clots.

Finally, the pathological process can be classified according to the nature of its development. Acute or chronic.

The first is fatal in 95% of cases. The patient, others and even doctors do not have time to react. Massive bleeding leads to the rapid death of a person.

In the second case, progression occurs over months, years, ending in hemorrhage and dangerous bleeding. At this point, the difference is no longer great and the probability of death is identical.

Symptoms

The disease is characterized by an acute, sudden onset. An approximate clinical picture includes a group of well-being disorders:

• Unbearable chest pain. Usually on the side of the affected lung, although not always.

Doctors and patients are confused about the location of the discomfort.

During a heart attack, a reflected nature of the syndrome is possible, a diffuse type, when it is not possible to determine the localization at all: the entire chest hurts.

The nature of the sensation is pressing, pulling, bursting, burning. There are almost no shootings. Possible pulsation, with increasing discomfort with each heartbeat.

• Dyspnea. Accompanies a person throughout the entire acute period and after it. If complications develop, the likelihood of the symptom persisting increases many times over.

The manifestation may worsen. The symptom of pulmonary infarction is present even at complete rest, it becomes more complicated with minimal physical activity, and with a change in body position it develops into suffocation and asphyxia.

This is a deadly condition. Risk of death from respiratory failure. In milder cases it gives minimal discomfort.

• Hemoptysis. The cough almost immediately becomes productive, with the discharge of liquid scarlet connective tissue, possibly with foamy sputum. In severe cases, we are talking about full-fledged bleeding, fatal for a person.
• Weakness, drowsiness, feeling tired. Asthenic manifestations arise at one moment. Associated with sudden blood loss.
• Collaptoid reaction. In response to the same factor. Accompanied by sweating, pallor of the skin, a feeling of cold, chilliness, confusion, tremor (trembling of the limbs, chin).

These are specific signs of a pathological process. In approximately 86% of cases or even more, additional manifestations develop. The reason is the formation of secondary myocardial infarction.

Why is destruction of the heart muscle also added? Since the lungs are not able to supply the blood with oxygen, ischemia of all systems occurs. This includes the organ not receiving enough nutrition. Coronary insufficiency develops.

Additional symptoms of myocardial infarction confuse the entire clinical picture and can throw the doctor off the scent, especially if there is insufficient experience. It is necessary to differentiate the conditions; you cannot hesitate. The minutes count down.

Attention:

When coronary insufficiency is added, the risk of death increases by almost 60%, regardless of the extent of the lesion.

Among other signs:

• Change in heart rate. According to the type of bradycardia. Heart rate decreases to critical levels, below 50 beats per minute.
• A sharp drop in blood pressure. Also to minimum values, which only complicates the general condition. The contractility of the myocardium decreases, the organ does not even provide itself with nutrients and oxygen.
• Nausea, vomiting. Short-term.
• Loss of consciousness.

The process continues to move along the chain. Within a matter of minutes, there is a risk of developing multiple organ failure and death of the patient.

It's not always so bad. In some cases, if the extent of the lesion is not large, there may be no symptoms at all.

At the same time, spontaneous recovery occurs quite quickly. It takes from 4 to 12 days. Treatment speeds up the process. But the violation is discovered by chance.

A picture resembling tuberculosis or pneumonia is possible. Hemorrhage is detected during an x-ray.

The clinical picture may also include neurological signs: pain, dizziness, nausea, vomiting, loss of consciousness, fainting. Generalized dysfunction of the whole organism develops. This is an extremely dangerous process.

Causes

The factors are varied. At the early stage of care, etiology plays a secondary role, apart from the immediate immediate connection between the underlying disorder and pulmonary infarction.

Then deciding on the factor is vitally important: no one can guarantee that a fatal relapse will not occur. This is a key point in therapy.

• Cardiomyopathy. Abnormal thickening of the walls of the muscular organ, as well as expansion of the chambers (dilatation).

• Arterial hypertension. It is somewhat less likely to provoke the disorder in question.
• Excessive amount of cholesterol in the blood. Develops as a result of metabolic disorders and endocrine diseases.
• Tumors of any location. Especially malignant, infiltrating other tissues and causing hemorrhages. Also benign, compressing blood vessels and causing hemorrhage.
• Rheumatism. Autoimmune process. Accompanied by severe inflammation of the cardiac structures.
• Anemia is also the opposite phenomenon, with excess hemoglobin and thickening of the blood.

• Excessively rapid coagulation of liquid tissue. Hypercoagulation.
• Fractures, injuries of the chest bones. Other structures with the development of bleeding. The key point is mandatory hemorrhage. Because the basis in the vast majority of the described situations is the formation of a blood clot, its separation and further movement towards the small circle.

Another option is due to cholesterolemia. It develops as a result of metabolic disorders. The classic disease is atherosclerosis.

Other factors, such as arteritis, occur, but are much less common, so they are excluded last. It accounts for 3-4% of the total mass.

PE is often a factor in the development of a heart attack.- . The disease is mostly fatal; the chances of survival if a vessel ruptures are minimal, if not non-existent.

Consolidation of lung tissue (filling of the alveoli with blood instead of air) is fatal in 98% of cases or more in a matter of minutes. The rest die within a day, maximum two.

Diagnostics

It is carried out under the supervision of a cardiologist or vascular surgeon. Often a whole council works on such a “complex” patient. This may include the help of a thoracic specialist or pulmonologist.

Examinations are carried out urgently upon admission of the patient to the hospital. There is no time for long research.

They are limited to an initial examination, which includes an assessment of symptoms, a complete clinical picture, blood pressure, and heart rate. A combination of a collaptoid reaction with hemoptysis is typical. X-ray is required. Then first aid is provided.

Only then can you begin a more thorough diagnosis. It pursues two goals: to identify the consequences of an emergency condition, to determine the root cause of the disorder in order to prevent the development of relapse in the future.

The list of events is quite wide:

• Oral interview and history taking to determine key factors.
• Measurement of blood pressure, heart rate.
• Chest X-ray.
• MRI of the same area. A more preferable technique is aimed at identifying the smallest anatomical defects. Considered the gold standard.
• Coronography.
• Electrocardiography. To determine arrhythmic disorders and possible functional disorders.
• Echocardiography. Visualizes tissue, essentially an ultrasound. Used as part of early diagnosis. In a system with an ECG it gives a lot of information.
• General blood test, biochemical with determination of low- and high-density lipoproteins (bad and good cholesterol, respectively), and atherogenic index. Used for indirect confirmation of atherosclerosis.

Diagnosis is carried out quickly in order to begin to restore the patient’s original position, as far as possible within the framework of the life-threatening condition suffered.

Treatment

Early treatment is conservative. A large group of different means is used.

As soon as a person is admitted to the hospital in acute condition, the use of a number of medications is indicated:

• Thrombolytics. The clot is dissolved and the patency of the vessel is normalized. Streptokinase, Urokinase. Some contraindications need to be taken into account.
• Antiplatelet agents, anticoagulants. Aspirin, Heparin. Normalizes the rheological properties of blood. First of all, fluidity.
• Narcotic painkillers. To relieve severe, painful discomfort.
• Antispasmodics. With the same goals. Papaverine as an option.
• A critical drop in blood pressure and heart rate, collapse is stopped with Dopamine, Epinephrine. These are dangerous means, but there are not many options.

Once completed, you can think about correcting subsequent deviations. Medicines of other groups are used:

• . Anavenol. To strengthen blood vessels.
• Means for restoring normal blood flow: Actovegin and analogues.
  Eufillin, Prednisolone to improve respiratory activity.
• Antihypertensive urgent action (as part of the relief of elevated blood pressure). It is better to limit yourself to diuretics like Furosemide.
• Cardiac glycosides are also administered to normalize myocardial contractility.

It is mandatory to use broad-spectrum antibiotics after the acute period of pulmonary infarction: cephalosporins, fluoroquinolones, macrolides and anti-inflammatory hormonal drugs (Prednisolone, Dexamethasone).

Surgical treatment consists of installing a vena cava filter in the vascular bed (inferior vena cava) to prevent blood clots from moving through the system.

Against the background of complications, resection of the lung tissue or total removal of the organ if it is inoperable is performed.

Forecast

Fog. With early initiation of treatment, good health, young age, absence of bad habits and concomitant diseases - from conditionally favorable to neutral. The risks are still too high.

With the development of negative phenomena (necrosis of parenchyma, etc.), rapid progression - negative. If we speak on average, the survival rate is 30-40%. Or less. The data varies.

Complications

All consequences of a pulmonary infarction carry the risk of death or at least severe disability with delayed death.

• Abscess, gangrene of the lung. In the first case, a well-encapsulated area of ​​necrosis is formed. In the second - focal, and then general disintegration of the paired organ.
• Pneumothorax. The release of air from the destroyed alveoli into the chest. It has a closed character, which is not typical for this condition.
• Formation of calcifications, respiratory failure due to tissue scarring.
• Massive bleeding. As a result of further progression of the disorder or subsequent relapse.
• Sepsis. Blood poisoning with generalized inflammation of all tissues.

Complications are prevented through secondary prevention.

Pulmonary infarction is a dangerous, fatal emergency condition in most cases. Requires hospitalization and prompt treatment.

Rarely develops spontaneously. More often there is a preliminary stage, which few people pay attention to. With an integrated approach, there is a chance for recovery.