Symptoms, main methods of treatment and prevention of thromboembolism (thrombosis) of the pulmonary artery. Thromboembolism of the pulmonary artery - treatment. Excluded products also include

Great amount older people are prone to the formation of blood clots. This feature of the body can be explained by the most different factors and in the absence of adequate correction often leads to the development of a variety of pathological conditions, including those that pose a threat to health and even life. It is precisely the latter that can be attributed to ailments that develop as a result of blockage of large and vital vessels by blood clots. This is thromboembolism pulmonary artery, symptoms, the treatment of which will be discussed, as well as possible complications a little more detail.

Pulmonary embolism is a fairly critical condition, it is a sudden cessation of blood flow in the branch of the pulmonary artery, which is explained by its sudden blockage by a thrombus (blood clot). Due to such a blockage, blood stops flowing to that area. lung tissue, which is supplied by this branch. At the same time, the mentioned thrombus is only a fragment of another thrombus that was formed and located outside the pulmonary artery.

Symptoms, complications of pulmonary embolism

In most cases, thromboembolism develops suddenly - it is not preceded by any visible precursors. Manifestations given state are determined by the number and size of thrombosed vessels, as well as the rate of occurrence of thromboembolism, the degree of developed disorders of the blood supply to the lung tissues and the initial state of the patient. Sometimes pulmonary embolism is asymptomatic, and sometimes it causes a sharp and critical deterioration in well-being or even a sudden death.

The very first manifestation of this kind of thromboembolism is sudden shortness of breath - increased breathing, a feeling of lack of air, etc. The number of breaths can reach thirty to forty per minute, cyanosis develops, skin are painted in ash-gray tones and become pale.

Also, the victim may be disturbed pain in the chest - often sharp, of a different nature. This symptom can last for several minutes or several hours. Patients complain of palpitations, they swell neck veins, occurs strong decline blood pressure.

In some cases, pulmonary embolism leads to acute cerebrovascular insufficiency. The patient develops dizziness, he is disturbed by tinnitus, deep fainting. Nausea and vomiting often occur, bradycardia and coma are possible. Sometimes pathological processes lead to the development psychomotor agitation, hemiparesis, polyneuritis, meningeal symptoms.

In the elderly, hypoxia caused by this type of thrombosis often leads to the development of loss of consciousness, hemiplegia (unilateral paralysis) and seizures.

In some cases, pulmonary embolism leads to an increase in body temperature (with a not very pronounced course), a similar symptom is explained by inflammatory processes that have developed in the pleura and lungs.

Sometimes the disease causes painful swelling of the liver, which is accompanied by intestinal paresis, irritation of the peritoneum and hiccups. Patients complain of acute pain in the right hypochondrium, belching and vomiting.

Two to three weeks after the blockage has occurred, the patient may develop an immunological syndrome, which is manifested by pulmonitis, recurrent pleurisy, urticaria-like rash on the skin, etc.

Pulmonary embolism - treatment

If you suspect a pulmonary embolism, you should immediately call ambulance. Many patients with this disorder require prompt placement in intensive care unit and resuscitation. In general, the therapy of this condition is aimed at optimizing the processes of pulmonary circulation and preventing chronic pulmonary hypertension.

In the acute phase of the development of the disease, the patient can undergo an indirect heart massage and artificial respiration, defibrillation and pacing. Such procedures can restore heartbeat and bring the patient back to life.

To eliminate a pulmonary embolus, doctors may perform an intravascular embolectomy using a special catheter with a suction cup at the end. This design helps to eliminate the thromboembolus through the chambers of the heart and blood vessels.

But in most cases it is conservative therapy: first of all, fibrinolytic drugs are administered to the patient, for example, streptase, streptokinase, streptodecase, urokinase, cabikinase, etc. Such drugs are sometimes injected through a catheter into the pulmonary artery. The patient's condition improves after a couple of hours. After the patient is prescribed anticoagulants (usually heparin), which helps to prevent a recurrence of the disease.

All patients with pulmonary thromboembolism are indicated for oxygen therapy. They are prescribed a number of medicines of cardiac (glycosides, panangin, etc.), antispasmodic (papaverine, No-shpa, etc.) action. Also used are drugs for the correction of metabolism (ATP, vitamin remedies, especially preparations containing vitamins of group B). Of the drugs, anti-shock (Hydrocortisone), anti-inflammatory and expectorant drugs are also used. In addition, the doctor may prescribe antihistamines and analgesics.

Folk remedies

Recipes traditional medicine will not help to cure pulmonary embolism, however different herbs quite effectively prevent thrombosis, contributing to blood thinning.

So, traditional medicine experts advise combining equal shares of sweet clover, mountain arnica plant, wormwood, and also meadowsweet. All herbs must be chopped. Mix them together well. Brew a tablespoon of the resulting collection with a glass of boiling water. Cover the medicine with a lid and leave it for eight hours to infuse. After that, strain the finished infusion and drink it in a third of a glass three times a day. The recommended duration of such treatment is thirty days.

The condition in which the blood becomes too viscous and clots appear in it - blood clots, is called "thrombosis". This disease is very dangerous for a person, since the resulting clots can clog vital vessels.

A special nutrition program will help to prevent the disease, as well as significantly reduce the likelihood of developing thrombosis that has already appeared.

Experienced doctors at the same time as the appointment medicines be sure to recommend a diet aimed at improving the patient's well-being and improving the quality of life.

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First of all, it is proposed to moderately limit fluid intake and temporarily remove foods with high content vitamins C and K. Leaf salad, rose hips, tomatoes, currants, citrus fruits, liver, cabbage, along with the beneficial properties of the vitamins they contain, contribute to an increase in blood clotting.

When the patient's condition begins to improve, you can switch to good nutrition. The restriction is imposed on nuts. Smoked meats, fatty and salty food, as well as the use of sweets is excluded. The presence of plant products is mandatory in the diet.

After suffering thrombosis, the use of vinegar, pepper, garlic and horseradish can not be limited. In trophic disorders, alcohol and spicy food should be excluded.

Elements that must be present during the diet:

• polyunsaturated fats;
• vitamin E;
• cellulose.

It is better to cook food by steaming, stewing or boiling. It is permissible to sauté and bake products.

Healthy foods

A diet for thrombosis must necessarily include food containing polyunsaturated fats. Leading position in the number of these useful substances in the composition occupy fish fat and linseed oil. Fish must be on the table at least twice a week. Trout, mackerel and herring are essential components of the diet.

Recommended consumption of legumes, sunflower and pumpkin seeds, as well as dried fruits and oat bran. The inclusion of herbal decoctions in the diet is welcome: nettle and chamomile will have the right effect. healing action. Green tea is also useful for thrombosis.

Vegetable soups, potatoes, cereals, fruits, vegetables and berries (especially raspberries and cherries) in the diet for thrombosis will undoubtedly have positive action on the body. Sprouted grains of wheat, avocado, garlic and onions must be on the table of a patient with thrombosis.

Prohibited Products

It is advisable to exclude coffee and malt-based drinks (for example, beer) from the diet.

The use of the following products during the diet is unacceptable:

• bananas;
• dog-rose fruit;
• sausage, sausages, bacon, brisket increase blood pressure;
• citrus;
• pickles;
• bakery products;
• White bread;
• smoked meats;
• sweets;
• fatty varieties cheeses;
• canned food;
• offal;
• dairy products with a high percentage fat content;
• currant;
• animal fats.

The basics of the diet for vascular thrombosis

The principles of nutrition for patients with a diagnosis of thrombosis are aimed at reducing the number of foods that increase blood clotting. Conversely, blood-thinning foods should be present in the diet.

The diet for deep vein thrombosis of the lower extremities should be enriched with various cereals, cottage cheese, milk and low-fat kefir, lean meat, vegetables and fruits. Wholemeal bread, legumes and whole grain cereals are recommended.

Omega-3 Rich Foods unsaturated acids, such as salmon, mackerel, tuna, mullet, sardines, lower triglyceride levels and reduce blood viscosity.

The antioxidant action of vitamin E will prevent the degradation of polyunsaturated and monounsaturated fats. Therefore, it is necessary simultaneous reception with a diet. Vitamin E is rich in sunflower, flax and sesame seeds, wheat germ, wholemeal flour, avocado, olive and linseed oil (especially cold-pressed).

The presence of saturated fat in the diet should be limited. Chocolate, bacon, cakes and pastries, fatty meats, hard cheeses, various smoked meats, as well as butter are hardly processed by the body and contribute to blockage of receptors located in the liver, which leads to an increase in the level of cholesterol in the blood and clogging of the arteries with blood clots.

The use of refined flour, sugar, various sodas, sweet cereals, that is, simple carbohydrates, leads to the appearance excess weight and sudden fluctuations in blood glucose levels. Overconsumption sugar provokes an increase in the amount of triglycerides, which inevitably increases the risk of thrombosis.

Kidneys, liver are not recommended to be eaten too often by patients with thrombosis. Egg yolks should not appear on the table more often three times in Week. This limitation is due to the content of dietary cholesterol in these products.

A diet rich in vegetables and fruits will help to significantly reduce the risk of developing atherosclerosis of the vessels. Atherosclerosis is dangerous because the fatty plaque clogs the vessel and creates a blood clot. This, in turn, leads to the deprivation of part of the body of the flow of blood and oxygen. Swelling and pain appear in the affected area.

The presence of a large amount of fiber, combined with a minimum content of saturated fats, will insure against fatty deposits on the walls of blood vessels, thereby preventing atherosclerosis.

Blockage of a coronary artery leads to a heart attack, that is, it causes heart attack. A blood clot in the arteries of the brain will provoke a stroke.

Thrombosis of the veins of the legs is no less dangerous. Sometimes only surgical intervention can alleviate the patient's condition. When offset venous thrombosis embolism occurs. Pulmonary embolism is fatal.

Protects against appearance similar troubles immediate action, including medicines combined with diet and moderate exercise.

Factors provoking the occurrence of thrombosis:

• overweight and obesity;
• the use of hormonal contraceptives;
• smoking;
• sedentary lifestyle.

Drinking up to one glass of wine a day can dilate small blood vessels, which will reduce the likelihood of thrombosis.

Flavonoids found in dry red wine grape juice and in berries reduce the likelihood of blood clots in the vessels.

The diet for hemorrhoidal thrombosis is aimed at improving intestinal motility and eliminating constipation. In this case, it is especially important to follow the principles of proper nutrition, since only a well-chosen diet is able to maintain normal stools. In case of non-compliance with the diet, thrombosis and acute hemorrhoids cannot be avoided.

Be sure to include fiber (insoluble plant fibers) in the diet, which helps regulate bowel function. Eating foods rich in soluble plant fibers (algae, legumes, grains, fruits) will help lower cholesterol levels.

Soluble fibers are pectins. Dissolving in water, they swell and collect all the toxins from the intestinal walls. They also slow down the absorption of glucose and lower blood sugar levels. In the large intestine, pectins are broken down by microflora and maintain the necessary level of acidity in the body.

Three day menu

First day:

Second day:

Third day:

A strict diet is recommended in the acute course of the disease. When the condition improves, you can gradually expand the menu, while following the principles healthy eating. Fried potatoes are very tasty, but the benefits of their constant use in food are doubtful.

By putting into practice simple rules and adhering to the recommendations on proper nutrition, a person suffering from thrombosis can significantly alleviate his condition and significantly improve the quality of life.

At its core, a diet for thrombosis is proper nutrition and regular healthy food.

Thrombophlebitis and thrombosis of deep veins of the lower extremities and any other vessels is a serious disease that, with insufficient attention from the patient and the doctor, in 3-15% of cases ends with pulmonary embolism and death of the patient.

The treatment includes several methods of therapeutic effect on the body, one of the components of which is proper nutrition and correction of the lifestyle of a patient with thrombosis.

There is no separate diet for this disease, but some restrictions are still introduced. Patients must be transferred to special treatment nutrition at .

Food should solve the following tasks:

• contribute to weight loss, since in a significant proportion of patients, thrombosis is caused by overweight body;
• reduce blood viscosity;
• normalize stool;
• clean the vessels and strengthen their walls;
• activate metabolism.

A diet for thrombophlebitis or deep vein thrombosis of the lower extremities is introduced for a limited period - approximately 3-4 weeks, and only this method can achieve a powerful therapeutic effect. It is recommended to arrange fasting days 2 times a week.

Nutrition is adjusted according to, since some products may interact with them chemical reaction and influence efficiency. For example, this occurs with the simultaneous use of warfarin and garlic. That's why the last word should always be followed by a doctor.

After the patient's condition stabilizes, they switch to good nutrition.

What you can eat: healthy foods

The diet includes foods rich in omega-3 fatty acids- oily sea fish, shellfish. Greatest Benefit brings fish caught in the sea, not farmed.

Necessary for vessels vitamin E or tocopherol. There is a lot of it in cashew nuts, sea buckthorn, dried apricots, germinated wheat, as well as in oatmeal and barley groats. It is also present in marine fish. This antioxidant protects against heart failure and prevents the formation of blood clots.

At the same time, it is important to remember that fats and bile are necessary for the assimilation of the vitamin, and its content is sharply reduced after freezing, heat treatment, and reheating the oil.

Recovery will bring the following products:

• Onion- in raw and cooked form, slows down the accumulation of platelets, activates the dissolution of blood clots, resists the thrombogenic effect fatty foods. According to studies, it is enough to eat half a cup of onions to completely block fats.
• Grape- resveratrol, which is found in red grapes, prevents the accumulation of platelets.
• Berries- fresh or frozen.
• Ginger- reduces blood clotting, presumably due to the substance gingerol, which chemical composition reminiscent of aspirin.
• Gingko biloba- improves blood circulation, expands the lumen of blood vessels, reduces their fragility, permeability.
• Fish fat– contains omega 3, 6 fatty acid, destroying fibrin, which provokes the formation of blood clots, and also thins the blood.

Be sure to include in the patient's menu vegetables, cereals. Studies by Swedish scientists have shown that in people who eat a lot of vegetables, blood clots dissolve faster. Fiber and vitamin C have this effect. By the way, the lowest level of fibrinogen (a protein that turns into fibrin, the basis of a blood clot) and the most liquid blood in vegetarians.

Meat (but only lean, boiled or steamed) should be in the diet no more than 3 times a week.

Prohibited products: what is impossible in any case?

Foods that impair blood flow, promote platelet growth, congestion, and the formation of blood clots are excluded from the diet. For some time, you will have to reduce the amount in the diet food containing vitamin K which causes blood to thicken and increased risk thrombus formation. The sources of this vitamin are green leaves, especially chestnut, and other parts of the plant that contain chlorophyll.

For the period of treatment, exclude from the diet:

• all types of nuts, except for cashews;
• smoked meats, canned food, too sweet or salty foods that retain fluid in the body, contribute to vasoconstriction;
• alcoholic drinks;
• purple berries;
• juice white grapes, grenade;
• mountain ash, bananas, black currants, rose hips, which increase blood clotting;
• strong meat broths;
• pork and beef liver, other liver products;
• fatty dairy products, cheeses, especially home-made;
• fast food and semi-finished products;
• products with trans fats and cholesterol;
• bananas;
• sausages;
• all kinds of cabbage, greens, spinach;
• legumes;
• strong coffee and green tea, as well as malt-based drinks;
• fatty foods - they make the blood thick, which is why platelets become more sticky and more easily combine into blood clots.

Sample diet menu

The patient can be offered the following menu for the day:

• Breakfast: any porridge boiled in purified water, with berries or fruits, a cup of weak black tea.
• Dinner: vegetable soup, baked fish, boiled potatoes.
• Dinner: light vegetable salad, fresh fruits, compote.

Excellent snacks between meals are fresh vegetables, fruits, berries. It is allowed to drink weak tea, juices, compotes.

The cause of a heart attack may be the refusal of breakfast. This pattern was discovered by American scientists. Turns out, people who skip morning meals are three times more likely to form blood clots. After lifting, the stickiness of blood clots increases sharply, and the morning meal significantly reduces this figure.

Is it possible to drink alcohol with thrombosis and thrombophlebitis?

The opinions of doctors regarding the intake of alcoholic beverages differ.. Many believe that alcohol is completely contraindicated. Others argue that limited alcohol consumption will not cause much harm to health. We offer to understand the mechanisms of the influence of alcohol on blood vessels and blood.

1. 15 minutes after alcohol enters the stomach, ethanol is absorbed into the bloodstream and distributed throughout the body. Given the ability of ethanol to affect the phospholipid layer cell membranes, it becomes clear why vascular endothelial cells undergo pathological changes.
2. As a result of a violation of the transmembrane transmission of ions, intracellular processes are disrupted and the free liquid (part of the cell plasma), according to the principles of the concentration gradient, enters the lumen of the vessels. As a result, the blood thins and its volume increases.
3. A large volume of blood puts pressure on the baroreceptors in the vascular walls, which leads to the expansion of the lumen. This process takes place without superior control. nervous activity, resulting in insufficient venous return to the heart, which increases the heart rate.
4. The increased heart rate sends signals to the brain, which in turn releases adrenocorticotropic hormone (ACTH). This hormone affects the adrenal cortex and stimulates the release of adrenaline and noradrenaline into the blood.
5. Adrenaline leads to sharp narrowing lumen of blood vessels and increase their permeability.
6. As a result, the blood plasma goes beyond the vessels into the tissue. Peripheral edema is formed and there is a thickening of the blood remaining in the arteries and veins.

For the implementation of all these processes, the body takes no more than 30 minutes.. Just imagine what a huge load on the vascular wall during short period time. First, expand sharply, and then just as sharply narrow. This leads to a decrease in vascular tone, which subsequently contributes to the development of varicose veins not only in the veins of the extremities, but also in the hemorrhoidal veins.

Important! Unlimited alcohol consumption will lead to a relapse compensatory mechanisms, as a result of which the blood will begin to stagnate in the vessels and thrombose them.

Long-term use of antiplatelet drugs and acute arterial thrombosis or thrombophlebitis is a direct contraindication for all alcoholic beverages.

As a prevention of thrombosis and thrombophlebitis, it is recommended to consume no more than one glass (200-250 ml) of dry red wine per week. Remember that natural wine is made from natural grape raw materials. Only a small amount of sugar is allowed. The cost of such wines is correspondingly high.

Is a massage worth it?

On the early stages thrombophlebitis massage is recommended to eliminate swelling of the legs and prevent lymphatic congestion. Doctors have identified five techniques that will not lead to complications - this is home self-massage, Thai, Tibetan, lymphatic drainage and water massage. The last four techniques are best left to professionals.

During the massage, muscle relaxation occurs, blood flow and its reverse outflow increase. Gentle massage methods do not injure the vascular wall and at the same time improve blood circulation. This effect is useful for initial stages venous insufficiency.

Reference! Before signing up for a massage, consult with a surgeon.

However, there are contraindications for massage.. These include thrombosis acute stage, severe thrombophlebitis of superficial and deep veins and advanced stages varicose disease. The risk of detachment of floating thrombi from vascular wall high even during normal physical activity, and increased blood flow only exacerbates the situation.

Is it allowed to play sports?

Physical activity in vascular diseases is as important as drug treatment. But under one condition - the load should be moderate.

Swimming, yoga, therapeutic gymnastics, running at an easy pace, skiing, Nordic walking and many other sports. However Intense running, jumping and power training(squats, deadlift, lunges).

A prerequisite for any sport is to wear compression underwear. You can buy it in any medical equipment stores and pharmacies. No need to be afraid to wear stockings, especially for men. Many athletes go to competitions in compression stockings, they understand that health is more important than public opinion.

Compression stockings for thrombophlebitis and thrombosis

For the complex treatment of thrombophlebitis, doctors recommend compression stockings. Their main function is to create physiologically necessary pressure on the veins of the lower extremities. Compression stockings create an outer frame to support the veins and prevent them from stretching. The force of pressure is distributed unevenly in the stockings. On the foot and lower leg, compression is maximum, approaching inguinal region the pressure decreases.

This type of pressure distribution improves blood and lymph flow, which prevents the development of edema on the lower limbs. Depending on the stage of the disease and the severity of clinical manifestations, doctors prescribe wearing stockings. different classes compression:

• 1st class - 18.4-21.1 mm. rt. Art. At initial manifestations varicose veins, a tendency to edema, for the prevention of thrombosis in pregnant women.
• Grade 2 - 25.2-32.3 mm. rt. Art. Varicose veins in pregnant women, prevention of deep vein thrombosis, acute thrombophlebitis, prevention of recurrence after phlebectomy or phlebosclerosis.
• Grade 3 - 36.5-46.6 mm. rt. Art. Trophic disorders on the background of varicose veins, lymphovenous diseases, post-thrombophlebitic disease.
• Grade 4 - more than 59 mm. rt. Art. It is rarely prescribed for severe elephantiasis (lymphedema) and arteriovenous malformation.

The choice of size is carried out by measuring the circumference of the lower leg and thigh at certain points. An experienced phlebologist will also help to understand this issue.

Is it worth it to fly a plane?

During the flight, atmospheric pressure changes and the concentration of oxygen in the air decreases. These factors create an additional risk of thrombosis. Patients in acute period travel diseases are prohibited during the first month.

As a prevention of thrombosis and thrombophlebitis, it is recommended:

• putting on compression underwear;
• change the position of the legs during the flight or walk around the cabin;
• wear loose shoes without heels;
• do not drink coffee on the day of the flight, as it has a diuretic effect and will lead to dehydration;
• observe the water regime.

What shoes to choose?

With thrombosis and thrombophlebitis, doctors give recommendations to prevent recurrence or progression of the disease. One of the points is to wear comfortable shoes. But no one tells how to choose it correctly. When buying new boots or shoes, be guided by the following points:

1. You should try on a new pair of shoes in the evening, as your feet swell and increase in volume.
2. Forget about tight shoes and don't listen to the advice of sellers that shoes will stretch over time. My legs hurt already now, why aggravate the condition.
3. Give preference to lace-up shoes. This will help to adjust it individually to your foot.
4. Eliminate high heels. Physiologically comfortable is a heel no more than four centimeters. Anything higher impairs blood circulation and leads to more pronounced edema.
5. Choose models from natural materials.
6. The feet may be different size. It's okay to be a little asymmetrical, but shoes should be sized for the larger foot.

Don't neglect your health, for the sake of beauty or fashion. Choose good quality and comfortable shoes.

intimate life

Sex is not prohibited for patients with thrombosis or thrombophlebitis during remission. However, before giving in to impulses of passion, evaluate your condition. Before having sex, you need to rest, replenish the fluid level.

Important! Do not drink alcohol before intercourse. Otherwise, an exacerbation of the disease or separation of a blood clot is provoked.

Give preference to postures in which the load on the limbs will be the least. If you feel that your condition is getting worse, it would be appropriate to stop intercourse.

However, patients in the acute stage of the disease and during the first month should refrain from active sex.

Birth control pills

Most often, women suffer from varicose veins, this is directly related to the peculiarity hormonal background. The female sex hormone estrogen disrupts the tone of the venous wall and leads to the appearance or progression of existing varicose veins.

Not all women necessarily suffer from varicose veins. This is justified by the fact that a small amount of estrogen is released in the body, which is necessary for normal functioning reproductive system.

Oral contraceptives contain the hormones progesterone and estrogen. This combination of hormones improves the menstrual cycle, prevents pregnancy, reduces the severity of algomenorrhea, prevents the formation of ovarian cysts and the development of breast cancer. However, to side effects include the occurrence of thrombosis and thrombophlebitis of the superficial and deep veins of the extremities.

To avoid such a complication when taking contraceptives, the gynecologist prescribes blood tests and a consultation with a phlebologist. At high risk the occurrence of thrombosis, drugs containing estrogen should be abandoned.

There are progestogen-containing contraceptives (the second name is “mini-pills”), when taking which the risk of thrombosis is two times lower than that of estrogen-progestin ones. However, before taking oral contraceptives it is necessary to consult a doctor and pass all the prescribed examinations.,

Summing up

Proper nutrition for thrombophlebitis or deep vein thrombosis of the lower extremities usually brings results in combination with simple preventive measures. Attention should be paid light physical activity to prevent congestion in the veins. You can do dancing, swimming, fitness. Walking at a fast pace improves blood circulation.

However, avoid serious stress on the lower limbs- for example, squats with a barbell or other weights. Such patients should not take a shower or bath with hot water.

Tight clothes, corsets, socks, shoes harm the vessels. The heel in shoes or boots should not be higher than 4 cm. In order to prevent the aggravation of the disease and the development of inflammation (), you should stop smoking.

• You must wear loose clothing for the flight. Compression underwear is recommended.
• In flight (as in ordinary life), you should give up alcohol.
• You need to drink as much liquid as possible - water, juices, compotes.
• If after the flight there is pain in the legs, then immediately consult a doctor.

It is important to consume enough liquids, especially for athletes after training and competition, since a decrease in load leads to impaired blood flow and serious thickening of the blood.

Mortality from cardiovascular diseases confidently holds the first place. Elderly people are usually susceptible to such ailments, but often pathological processes are detected at an early age.

Pulmonary embolism is particularly difficult to diagnose due to the absence of specific signs.

Pulmonary embolism (PE), what is it?

Pulmonary embolism (PE) is a blockage of the pulmonary artery or its branches, which are formed (most often) in the large veins of the lower extremities.

An embolism is a disorder accompanied by circulation in vessels unusual for normal state elements. A thrombus is a blood clot resulting from clotting. The process of coagulation is vital, because it clogs damaged vessels. But pathological coagulation is also possible, due to a number of reasons.

If a floating thrombus is formed in the veins of the lower extremities or the small pelvis (it is weakly attached to the wall of the vessel), there is a high probability of its detachment and movement to the heart and into the bed of the pulmonary artery.

At large sizes who is able to clog large vessels, and with small ones - reaches small capillaries where it gets stuck. Thus, the essence of pulmonary embolism (PE) is the blockage of pulmonary vessels by blood clots.

Causes, symptoms and first signs of thrombophlebitis of the lower extremities:

The cause of the disease is one - a blood clot interferes normal blood flow and gas exchange in the lungs. This provokes a reflex vasoconstriction and, as a result, an increase in pressure in the pulmonary artery and an increase in the load on the right ventricle. Doctors call 3 factors that contribute to the development of this pathology:

1. Too low blood flow in the lower extremities and pelvis.
2. Damage to the endothelium of the vascular wall.
3. Increased blood clotting.

Each of these factors (together or separately) provokes pulmonary embolism. Doctors see the reasons for the decrease in blood flow velocity in primary diseases, which include the destruction of vein valves. In addition, there is a possibility of pressure on the vessels from the outside - for example, in the event of a tumor. Such a neoplasm is quite capable of squeezing a vein and causing blood stasis.

You can not write off a sedentary lifestyle - perhaps the only factor in the anamnesis, which is the result of a person's careless attitude to health.

Violation of the integrity of the endothelium itself triggers coagulation. Damage can occur both during surgical intervention and in the case of physical injury. A variant of exposure to leukocytes is possible, which are especially activated during the inflammatory process in the body. In addition, toxins and viruses can also damage the endothelium.

Increased blood clotting is usually provoked by high level fibrinogen - a special protein responsible for the formation of blood clots.

If the blood plasma contains little water and a lot shaped elements, the likelihood of coagulation is greatly increased. In turn, the number of red blood cells, platelets and other cells increases with polycythemia, so PE can be considered a secondary disease.

What is fibrinogen, blood levels and what is the danger of its high level:

Acute pulmonary embolism develops when the vessels are blocked by a large thrombus, while the risk of death is 15%. But small blood clots are not so dangerous, although, of course, they cannot be ignored. In general, doctors divide the pathology into 3 types, which are characterized by the degree of vascular damage and the corresponding symptoms of PE:

1. Non-massive(clogged< 30% сосудов):

• cough;
• a slight increase in temperature;
• chest pain;
• hemoptysis
• lung infarction.

2. Submassive(30-50% of vessels are clogged):

• increased pressure in the pulmonary artery;
• right ventricular failure.

3. Massive(blocked > 50% of the pulmonary arteries, including the largest ones):

• hypotension (pressure less than 90/50);
• dyspnea;
• tachycardia (heart rate over 100 beats / min);
• fainting.

With a non-massive form of pulmonary embolism, symptoms are often absent, so the patient may not even be aware of his disease. More pronounced signs make you go to the hospital, but doctors do not immediately understand the cause of the disorder.

Diagnosis of pulmonary embolism

A cursory examination and conversation with the patient will not give any worthwhile information. The fact is that this pathology has no specific signs, so it is often confused with myocardial infarction, cor pulmonale, and other diseases. At similar symptoms physicians primarily prescribe electrocardiography, but this method will not always give an unambiguous answer. ECG signs TELA (albeit indirect) are as follows:

1. Sinus tachycardia.
2. overload of the right atrium and ventricle.

More informative is x-ray examination. The picture usually highlights the dome of the diaphragm, elevated on the side of the lung in which the blockage of blood vessels occurred. In addition, there is a noticeable increase in the right heart, and the largest pulmonary arteries. If the picture shows a cone-shaped seal (Hampton's triangle), then there is every reason to suspect a lung infarction.

ECG and radiography are usually used to exclude other pathologies, but modern medicine also has special methods in its arsenal:

1. Determination of the amount of d-dimer (fibrin breakdown product):

• if the concentration of the substance is less than 500 μg / l, then the disease is unlikely to be PE;
• the method does not give an exact answer.

2. Echocardiography:

• detect violations of the right ventricle;
• there is a chance to find blood clots right in the heart;
• discovered oval window explains the hemodynamic disturbance.

3. Computed tomography:

• apply contrast;
• create a three-dimensional image of the lungs;
• effectively detect thrombi.

4. Ultrasonography:

• study the speed of blood flow in the veins of the lower extremities;
• consider the cross section of the veins.

5. Scintigraphy:

• identify areas of the lungs into which blood is poorly supplied;
• used when CT scans are prohibited;
• rules out PE in 90% of cases.

6. Angiography of pulmonary vessels:

• the most accurate method;
• reveals blood clots and constricted vessels;
• invasion is required, so there are certain risks.

Signs of pulmonary embolism do not always indicate this pathology - doctors need time to conduct a full examination of the patient. And only after confirming the diagnosis, they begin treatment.

The prothrombin test is part of a blood clotting test that evaluates the rate of clotting:

If a person is admitted to the hospital in fainting, With reduced pressure, rapid pulse and severe shortness of breath - he is immediately placed in the intensive care unit.

For suspected pulmonary embolism urgent care is to normalize gas exchange within the respiratory system. This requires artificial ventilation lungs with oxygen, and as additional measures vasopressors (for example, adrenaline) are administered intravenously to somehow increase the pressure.

After primary care, the patient is comprehensively examined. If PE is confirmed, treatment is as follows:

1. Reduce blood clotting:

• non-fractional heparin (intravenously);
• fondaparinux and heparin low molecular weight(administered subcutaneously, contraindicated in renal failure);
• direct anticoagulants are treated for at least 5 days;
• dosages are individual and depend on the weight of the patient;
• indirect anticoagulant Warfarin is used 3 months after the end of the intensive course.

2. Reperfusion therapy(removal of blood clots in a medical way):

• drugs - Streptokinase, Alteplase, etc.;
• the danger lies in the high risk of bleeding, incl. and intracerebral.

3. Surgery:

• in the area of ​​​​the renal veins, special cava filters are installed to trap blood clots;
• filters are inserted into the femoral or jugular vein through the skin.

First of all, they try to help the patient with medicines, however, medicines have a number of contraindications that must be observed without fail. There may also be such a situation that drugs simply do not lead to desired result. In such cases, only surgical intervention remains.

Conclusion

Although pulmonary embolism is difficult to diagnose, there are still effective methods treatment of TELA. But, in some cases, the patient's condition is so neglected that it cannot be saved. Therefore, with chest pain, palpitations and shortness of breath, you should immediately go to the hospital.

Pulmonary embolism, or PE, is one of the most common cardiovascular diseases. Pathology is expressed in the clogging of one of the pulmonary arteries or their branches with blood clots ( blood clots), which are often formed in the large veins of the legs or pelvis. Rarely enough, but still, blood clots appear in the right heart chambers and veins of the hands.

The disease develops, as a rule, rapidly, often ends sadly - leads to the death of the patient. TELA ranks third ( after pathologies such as coronary heart disease and stroke) among the causes of death associated with cardiovascular disease. Most often, the pathology occurs among the elderly. According to statistics, mortality from the consequences of PE among men is almost a third higher than among women.

The probability of death of the patient is possible after pulmonary embolism, which developed due to surgical intervention, injuries, labor activity. With pulmonary embolism, treatment started on time can achieve a significant (up to 8%) reduction in the death rate.

Reasons for the development of PE

The essence of thromboembolism is the formation of blood clots and their subsequent obstruction of arterial lumens.

In turn, blood clots develop against the background of some conditions, among which the main causes of PE are distinguished:

• Violation of the movement of blood. Failures in the blood supply occur as a consequence of:

1. varicose veins,
2. squeezing blood vessels external factors(cyst, tumor, bone fragments),
3. transferred phlebothrombosis, the consequence of which is the destruction of the valves of the veins,
4. forced immobility, which disrupts the correct functioning of the muscular and venous systems of the legs.

In addition, the movement of blood in the body slows down, as its (blood) viscosity increases.. Polycythemia, dehydration or an abnormal increase in red blood cells in the blood are factors that affect the increase in blood viscosity.

• Damage to the inner wall of the vessel, accompanied by the launch of a series of blood coagulation reactions. The endothelium can be damaged due to vein prosthetics, catheter placement, operations, and injuries. Viral and bacterial diseases sometimes provoke damage to the endothelium. This is preceded by the active work of leukocytes, which, attaching to inner wall vessel, injure it.
• Also, with pulmonary embolism, the cause by which the disease can develop is inhibition natural process dissolution of blood clots (fibrinolysis) and hypercoagulability.

• Prolonged immobilization (traveling long distances, prolonged and forced bed rest), respiratory and cardiovascular insufficiency, as a result of which the movement of blood through the body slows down, venous congestion is observed.

• It is believed that immobility for even a relatively short time increases the risk of so-called "venous thromboembolic disease".
• The use of a considerable amount of diuretics. Against the background of taking such drugs, dehydration develops, the blood becomes more viscous. It also increases the intensity of blood coagulation by taking certain hormonal drugs.
• Cancer formations.
• Varicose veins of the legs. The development of this pathology of the lower extremities contributes to the occurrence of blood clots.
• Diseases accompanied by incorrect metabolic processes in the body ( diabetes, obesity).
• Surgical intervention, installation of a catheter in a large vein.
• Trauma, broken bones.
• Childbearing, childbirth.
• Age over 55, smoking, etc.

Classification of PE and the mechanism of development of pathology

• Massive. This type of PE is characterized by the fact that it affects more than half of the vessels of the lungs. Consequences - shock, systemic hypotension (lowering blood pressure).
• Submassive. It is accompanied by a lesion of more than 1/3, but less than half of the volume of the vessels of the lungs. The main symptom is right ventricular failure.
• Non-massive. Less than 1/3 of the pulmonary vessels are affected. With this type of pulmonary embolism, there are usually no symptoms.

Let's pay more attention to the pathogenesis of PE. Embolization is provoked by blood clots located in a vein and unreliably held by its wall. Separated from the vein wall, a significant size thrombus or a small embolizing particle, together with the movement of blood, pass through right side heart, then ending up in the pulmonary artery and closing its passage. Depending on the size of the detached particles, how many of them and the response of the body, the consequences of blockage of the lumen of the pulmonary artery are diverse.

Trapped in the area of ​​the lumen of the pulmonary artery, particles of small size do not provoke almost any symptoms. Larger particles impede the passage of blood, which entails improper gas exchange and the occurrence of oxygen starvation(hypoxia). As a result, pressure rises in the arteries of the lungs, the degree of congestion of the right ventricle increases significantly, which can result in its (ventricular) acute failure.

Clinical picture of the disease

With pulmonary embolism, symptoms, treatment of pathology depend on the initial state of the patient's body, the number and size of clogged pulmonary arteries, the rate of development pathological process, the degree of pulmonary circulatory disorders that have appeared. PE is characterized by various clinical conditions. The disease can proceed without showing almost any noticeable signs, but can also lead to a sudden death.

In addition, the symptoms of PE are similar to those that accompany other diseases of the heart and lungs. In this case, the main difference between the symptoms of pulmonary embolism is their abrupt onset.

With the standard variation of PE, the symptoms are often the following:

• From the side of the cardiovascular system:

1. vascular insufficiency. It is accompanied by a decrease in blood pressure, tachycardia.
2. Acute coronary insufficiency. She is accompanied by strongly felt and with varying duration of pain behind the sternum.
3. Acute cor pulmonale (a pathology that occurs in the right cardiac region). As a rule, it is typical for a massive variant of PE. It is accompanied by a rapid heartbeat (tachycardia), while the veins of the cervical region swell strongly.
4. Acute cerebrovascular insufficiency. It is characterized by malfunctions of the brain, insufficient blood supply to the brain tissues. The main symptoms are vomiting, tinnitus, loss of consciousness (often accompanied by convulsions), sometimes falling into a coma.

• Pulmonary:

1. . She is accompanied by pronounced shortness of breath, cyanotic skin or a change in their color to ash-gray, pale.
2. bronchospastic syndrome. The main distinguishing feature is the presence of dry wheezing with whistling.
3. Lung infarction. It is accompanied by shortness of breath, cough, chest pain during breathing, fever, hemoptysis. During auscultation of the heart with a stethoscope, characteristic rales of a wet nature, weakening of respiration are heard.

• Fever. Increased body temperature (from subfebrile to febrile). develops as a response to inflammatory processes in the lungs. Lasts up to 2 weeks.
• abdominal syndrome. Appears due to acute swelling of the liver. She is accompanied by vomiting, belching, pain in the region of the right hypochondrium.

Diagnosis of the disease

Diagnosing PE is quite difficult, since the pathology has non-specific symptoms, and diagnostic methods are far from perfect. However, in order to exclude other diseases, first of all, it is customary to carry out a number of standard diagnostic methods: X-ray of the sternum, ECG, laboratory research, including the measurement of the level of d-dimer.

At the same time, the doctor faces a difficult task, the purpose of which is not only to find out the presence of PE as such, but also to determine the place of blockage, the extent of damage and the patient's condition from the point of view of hemodynamics. Only if the obtained data is available, it is possible to create a competent and functional program for patient therapy.

Patients with possible pulmonary embolism often undergo following methods diagnostics:

• Clinical and biochemical blood tests.
• Measurement of the level of d-dimer (protein in the blood after the destruction of a blood clot). With an adequate indicator of d-dimer, the patient is said to have a low risk of PE. However, it should be noted that the determination of the d-dimer level is still not entirely accurate. diagnostic method, since an increase in d-dimer, in addition to the likely development of pulmonary embolism, can also indicate many other diseases.

• ECG, or electrocardiography in dynamics. The purpose of the examination is to exclude other heart diseases.
• X-ray of the sternum organs in order to remove suspicions of rib fracture, tumor, pleurisy, primary pneumonia, etc.
• Echocardiography, which reveals incorrect work of the right ventricle of the heart, pulmonary hypertension, blood clots in the heart.
• Computed tomography, thanks to which it is possible to detect the presence of blood clots in the pulmonary artery.
• Ultrasound of deep veins. Allows you to detect blood clots that have appeared in the legs.
• Scintigraphy - detects ventilated, but not supplied with blood areas of the lung. This method is indicated in the presence of contraindications to CT.
• Angiography (contrast x-ray examination). One of the most accurate diagnostic methods.

Treatment of the disease

The main tasks of physicians in the treatment of patients with pulmonary embolism are to resuscitation aimed at saving human life, as well as the maximum possible resumption of the vascular bed.

Elimination of the consequences of the acute stage of PE consists in the elimination of the pulmonary embolism or lysis (destruction) of a thrombus, expansion of the collateral (lateral, not main) pulmonary arteries. In addition, symptomatic therapeutic measures, aimed at preventing the occurrence of consequences formed as a response to impaired blood circulation and respiration.

Conservative treatment

Successful conservative treatment of pathology consists of prescribing fibrolytic or thrombolytic drugs ( thrombolytic therapy - TLT) by introducing them through a catheter into the pulmonary artery. These drugs are able to dissolve blood clots inside the vessels due to streptase, which, penetrating into the blood clot, destroys it. That is why, after a few hours after the start of taking the drugs, there is an improvement general condition person, and a day later - almost complete dissolution of blood clots.

Fibrolytic drugs are indicated for rapidly flowing pulmonary embolism, massive pulmonary embolism with minimal circulation.

At the end of therapy with fibrolytic drugs, the patient is shown taking heparin. Initially, the drug enters the body in smaller doses, and after 12 hours, the amount of the heparin preparation is increased by 3-5 times compared to the initial one.

As a prophylactic, heparin (an anticoagulant direct impact), together with phenylin, neodecoumarin or warfarin (anticoagulants of indirect effect) prevents the occurrence of blood clots in the victim lung site, minimizes the risk of occurrence and growth of other venous thrombi.

In the case of a submassive pulmonary embolism doctors prefer heparin because it can block blood clotting almost instantly (unlike indirect anticoagulants, which don't work as quickly).

Nevertheless, despite the "slowness" of indirect anticoagulants, it is recommended to connect Warfarin at the beginning of treatment. As a rule, Warfarin is prescribed with a maintenance, small dose, which subsequently, taking into account the results special analysis, is under review. The use of Warfarin should last at least 3 months. Indirect anticoagulants can cross the placenta and adversely affect the development of the fetus, so taking Warfarin is contraindicated during pregnancy.

All patients with pulmonary embolism are shown to undergo a massive combined,

Treatment aimed at restoring the whole body and pulmonary arteries:

• cardiac therapy (Panangin, Obzidan);
• the appointment of antispasmodics (No-shpa, Andipal, Papaverine);
• metabolism correction (vitamin B);
• antishock treatment (hydrocortisone);
• anti-inflammatory therapy (antibacterial drugs);
• the appointment of expectorants, antiallergic drugs and analgesics (Andipal, Diphenhydramine).

Many of the drugs presented, for example, Andipal, have a number of contraindications. Therefore, Andipal and therapeutic drugs are prescribed carefully to pregnant women and other categories of patients at risk.

Therapy is carried out mainly by drip intravenous infusion of drugs (with the exception of drugs such as Andipal, which is taken orally). Fibrinolytic treatment involves injections into the system to intravenous administration, because the intramuscular injections can cause large hematomas.

Surgical intervention

In situations where, despite the ongoing thrombolytic therapy for PE, the expected result from the treatment is not observed within an hour, embolectomy is indicated (elimination of the embolus surgically). The operation is performed in a specially equipped clinic..

The prognosis of treatment depends, first of all, on the severity of the patient's condition and the massiveness of the pathology.

• Usually, with grades 1 and 2 of PE, the prognosis is favorable, with the minimum amount deaths and high probability almost complete recovery.

It should be noted that thromboembolism of small branches of the pulmonary artery is likely to cause repeated lung infarctions and as a result, the development of the so-called chronic cor pulmonale.

• However, pathology of 3 or 4 degrees is capable, when timely therapeutic or surgical care is not provided, to lead to instant death.

Video

Video - pulmonary embolism

Prevention of pathology

Prevention of PE is necessary for all patients with a high probability of complications from this pathology. At the same time, the degree of risk of thromboembolism is assessed individually for each patient and the surgical intervention. Accordingly, primary and secondary prevention TELA are also selected individually.

Bedridden patients are shown regular prevention of phlebitis and phlebothrombosis of the legs and pelvis through walking, getting up as early as possible, and the use of special devices that improve blood flow in such patients.

Among medications allocate:

• Subcutaneous administration of heparin in small doses. A similar method of preventing pathology is prescribed a week before surgery and continues until the patient is fully physically active.
• Reopoliglyukin. Introduced during surgery. Not recommended due to possible anaphylactic reactions allergic patients and patients with bronchial asthma.

Preventive surgical methods include the installation of special clips, filters, special sutures on the vena cava instead of ligation. People who are likely to have a recurrence of the disease can use such methods to minimize the likelihood of recurrence of the disease.

Today, the consequences of thromboembolism cannot be completely eliminated. However, competent rehabilitation, including sanatorium and spa treatment, subsequent medical examination, (it is necessary to be registered at the dispensary at the clinic) and prevention can minimize the clinical manifestations of the pathology.

Patients prone to blood clots in the lower extremities are strongly advised not to neglect the wearing of compression stockings. These items of clothing promote better blood circulation in the legs and prevent the appearance of blood clots.

And, of course, an excellent prevention not only of thromboembolism, but also of many other diseases will be proper nutrition, and, if necessary, adherence to a certain diet. Properly selected, balanced nutrition in PE contributes not only to the formation normal consistency blood, but also the fact that in the presence of excess weight a person loses weight and feels much better.

Healthy lifestyle, constant control body weight (if necessary - weight loss), as well as timely treatment of various infectious diseases are no less important.

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