Pulmonary embolism
What is a pulmonary embolism?
Pulmonary thromboembolism occurs after an episode of deep vein thrombosis (usually in the lower limbs) when blood clots migrate and clog small lung vessels. The disease ranks third in the list of fatal cardiovascular diseases along with acute myocardial infarction and stroke, which causes deaths at European level representing, a major medical emergency.
What are the causes of pulmonary embolism?
After the formation of the thrombus in the deep peripheral vessels, it is mobilized in circulation in the presence of a sudden effort (cough, sneezing, defecation, mobilization after prolonged rest) and reaches the pulmonary circulatory system where, depending on size, the clot can clog larger arteries (arterial trunk) or smaller (arterial branch).
Risk factors that predispose us to pulmonary embolism are prosthetic surgeries (hip, knee), prolonged bed rest, prolonged immobilization after various surgeries, use of estrogen-based contraceptives, pregnancy, neoplastic diseases or long trips by plane ( or other small vehicles in which we do not have the necessary space to stretch, to take a few steps or to stretch our legs).
As a result of the "clogging" of the pulmonary artery, blood transport is disrupted and edema is accompanied by tissue hypoxia (decreased gas exchange at the alveolar-capillary level), heart failure being secondary to primary lung damage.
How the disease manifests itself
The clinical picture of the disease varies depending on the size of the obstructed vessel so we can meet a variety of symptoms that include:
- Chest pain especially in a deep breath (when we take a deep breath in the chest);
- Dyspnoea (shortness of breath);
- Hemoptysis (coughing up blood);
- Syncope (loss of consciousness due to cerebral hypoxia);
- Tachypnea (rapid breathing);
- Tachycardia (acceleration of the heart rate).
Along with the specific symptoms of the respiratory and cardiac system, it is important to recognize and follow the changes that suggest the existence of deep venous thromboembolism in the lower limbs: leg pain, unilateral local inflammation (leg is red and hot), unilateral edema (we observe an enlargement of the affected leg or lower limb).
What is the treatment of the disease
The treatment of pulmonary thromboembolism is done depending on its severity so that we can adopt several therapeutic schemes:
Low PET requires the initial administration of anticoagulants (injectable and then coumarin anticoagulants) under INR monitoring;
Massive PET, which is often associated with cardiogenic shock and life-threatening hypotension, is indicated for thrombolysis to destroy the clot migrated to the lungs (using injectable drugs such as Streptokinase) followed by the administration of anticoagulant medication to limit the initial vascular damage.
Surgical treatment is addressed to patients in whom no improvement in the pulmonary circulation is obtained after administration of the medication already mentioned and can be performed by the classic method - embolectomy followed by venous patch arteriography (removal of the thrombus with arterial wall reconstruction). Embolectomy and percutaneous fragmentation can be an option also in the frame in which a catheter (minimally invasive technique) is inserted at the femoral or jugular level, with the help of which the thrombotic material is aspirated.
In the case of recurrent embolic accidents, it is recommended to place a filter at the level of the vena cava, which prevents the migration of thrombi to the pulmonary arteries.