Definition and cause
If a blood clot from a vein (vein) in the body to tear loose, it can be taken to heart, and from there pumped further into the lung blood vessels. Depending on the size may become lodged in a larger or smaller artery (artery) in the lungs. STOPPER called a pulmonary embolism. All material that can clog the blood vessels to form embolism (see arterial embolism).
When blood is blocked from coming to the lung, it can not oxygenation. Woven bythe tilstoppede artery supplies, will die from lack of oxygen, and there will be a so-called lungeinfarkt. Blood pressure in the lung will also increase. Increased lung blood pressure burdening the right heart half, and there may be heart failure and at worst, cardiogenic shock, which often leads to rapid death.
A pulmonary embolism in almost all cases from a blood clot in benets or bækkenets deep vein (a DVT).
Pulmonary embolism is relatively frequent, and in many cases no or very few symptoms, which were not detected, and therefore not diagnosed.
The reasons are predisposing to blood clot in the leg, predisposing simultaneously indirectly to pulmonary embolism. There may be blood clots in the legs and pelvic veins:
- By prolonged bed rental.
- After a major surgical operation.
- By tending to arteriosclerosis.
- By congenital defects in proteins which prevents blood clots.
- By dehydration.
- When hormone treatment, including contraceptive pill.
- During pregnancy.
- In severe heart disease as a myocardial infarction and heart failure.
- For certain cancers.
- When severe infection.
- By disease as systemic lupus erythematosus and polycythemia.
Overweight may also have an increased risk of developing deep venetrombe (DVT). A DVT occurs frequently in the leg after prolonged stillesidden, for example. after a long flight or bus ride.
There diagnosed between 5000 and 10,000 cases of DVT in Denmark a year, with a predominance of women. It is believed that up to half leads to pulmonary embolism. However, many symptom-free.
Symptoms of pulmonary embolism
As mentioned, the symptoms vary from none to quick death, depending on size embolism. Depending on the severity of the patient will develop the following symptoms:
- Shortness of breath.
- Rapid breathing.
- Cough (By lungeinfarkt there may be bloody opspyt).
- Chest pain when breathing.
- Palpitations, sometimes forkammerflimmer.
- Fainting or near-fainting.
- Blåfarvning of skin including lips (central cyanosis).
- Cardiogenic shock.
In patients who develop a lungeinfarkt, will be entitled fever.
It kardiogene shock will in most cases lead to death within minutes.
In the vast majority can be detected DVT, although only approximately. 10% have symptoms of deep vein thrombosis in the legs or bækkenvene.
Precautions and diagnosis
The measures are the same as in deep vein thrombosis.
The most important precaution is frequent exercise and avoiding obesity. It is important to avoid prolonged sedentary periods. If you are predisposed to DVT, it is especially important to make frequent venepumpe gymnastics (using benmuskulaturen) and avoid dehydration in the case of long trips and sedentary work.
Women aged over 35 who use the pill should consider some form of contraception, as the risk of DVT associated with contraceptive pill use increases with age.
Smoking is strongly associated with arteriosclerosis, which can lead to blood clots. Smoking cessation is an important measure.
Have we suspect a blood clot in the leg, and / or Monday experiencing any of the above-mentioned symptoms of lungemboli, you should consult a doctor.
Diagnosis is suspected by the classic symptoms, and possibly. by a history of prior DVT and long journey. The doctor will carry out various studies to determine the diagnosis. A blood test can rule out or reinforce the suspicion of pulmonary embolism. An electrocardiogram (ECG) will present the classic change of pulmonary embolism.
At the hospital can perform a so-called ventilation / perfusion-scintigrafi. In case of inhalation of a radioactive gas can take a picture of the areas of the lung, where the air is (ventilated) by inhalation. By co-administration of a radioactive substance in the bloodstream can form a picture of what areas of the lung comes to blood (which perfunderes). Added the two images on top of each other, it gives an idea of the area have closed clots blood supply to.
There may be a CT scan of the lungs and by co-injection of røntgentæt drug into the bloodstream, you can visualize the cork. An echocardiography of the heart can show whether blood clots have influenced cardiac pump function.
The doctor will often pay for DVT at the same time because there is a risk of another pulmonary embolism, where a DVT is not treated.
Treatment of pulmonary embolism
Treatment depends again the size of the embolism and is designed both to counteract the jam grow, and to disband it.
In the only suspected blood clot initiated treatment with so-called anticoagulant (AK) agent. In English, often called the often blood thinners. This reduces the blood's ability to solidify and lead to blood clots is not growing.
Priority will be given heparin, which is fast-acting, and vitamin K antagonists (eg. Maveran or Marc Oumar) whose effect only occurs after day. Heparin circuit, where the effect of vitamin K antagonists occurs. The treatment lasts for more than 6 weeks to 6 months. Has there been an increased risk of developing blood clots, used AK-treatment lifetime.
In large embolism lodge a substance into a vein, which caused the clot dissolves. The treatment called thrombolysis. Treatment should be given as soon as possible, and it is more effective than heparin therapy. On the other hand, there is an increased risk of bleeding elsewhere, since the coagulation of blood is greatly reduced.
If thrombolysis is ineffective, surgical treatment can be considered. Through a blood vessel attempts, using a balloon catheter, to pull clots out of the tank so that blood can flow again. It is a complicated operation, but if successful is the emergency rescue.
When the heart-lung circuit is inhibited, treated if necessary. deep vein thrombosis in the leg.
Complications and course
The course depends on the size of pulmonary embolism. In the worst cases, blood clots cover both the two major arteries to the lungs, and death will occur soon thereafter.
Death preceded by heart failure and cardiogenic shock may develop chronic high blood pressure in the lungs after a pulmonary embolism. This can strain the heart over time and lead to chronic heart failure.
Tissues that are not properly oxygenation are at increased risk for infection, so there can be pneumonia after an embolism.
Less pulmonary embolism may cause damage to lung tissue. This heal up with arvæv, and the feature is lost. The remaining lung tissue will in most cases be able to take over the function.
Most pulmonary embolism is, however, uncomplicated and gives no injury.