Lung infarction: causes, treatment and consequences

Lung infarction is a disease caused by thromboembolic processes in the vascular system of the lungs. This is a serious enough ailment, capable of leading to death in especially severe cases.

Causes of the disease

The disease can develop due to surgical intervention, abnormal heart function, bone fracture, malignant tumors, postpartum period, after prolonged bed rest. The formed thrombus closes the lumen of the vessel, as a result of which the pressure in the pulmonary artery system increases and a hemorrhage into the lung tissue occurs. Pathogenic bacteria enter the affected area, which leads to inflammation.

Development of a heart attack

Acute pulmonary hypertension with increased stress on the right heart can be caused by obturation of the lumen of the vessel, vasoconstriction associated with the release of biologically active substances: histamine, serotonin, thromboxane, and reflex spasm of the pulmonary artery. In this case, oxygen diffusion fails and arterial hypoxemia arises, which is exacerbated by the release of under-oxidized blood through intersystemic and pulmonary arteriovenous anastomoses. The development of a lung infarction occurs against the background of already existing stagnation in the veins. One day after the obstruction of the lung vessel, the infarction is formed, its full development ends approximately on the 7th day.

Pathological anatomy

The site of the lungs, affected by a heart attack, has the form of an irregular pyramid, its base is directed to the periphery. The affected area may be of different magnitude. In some cases exudative pleurisy or infarct pneumonia joins. Under the microscope, the affected lung tissue has a dark red color, it is dense to the touch and protrudes above the level of healthy tissue. Pleura becomes dull, dull, often in the pleural cavity is collected fluid.

Lung infarction: symptoms Diseases

The manifestations and severity of ailment depend on the size, number and location of blood vessels closed by blood clots, as well as on the concomitant diseases of the heart and lungs. Minor infarction Often does not give almost any signs and is detected by X-ray examination. More pronounced infarctions are manifested by pain in the chest, which often arises suddenly, shortness of breath, coughing, hemoptysis. A more objective examination reveals a frequent pulse and a rise in temperature. Symptoms of pronounced heart attacks are: bronchial breathing with wet rales and crepitus, blunting of percussion sound. There are also such signs as:

• Pale, often ashy shade of the skin;

• Blueing of the nose, lips, fingertips;

• Lowering blood pressure;

• Occurrence of atrial fibrillation.

The defeat of large branches of the artery of the lung can provoke right ventricular failure, asphyxiation. The blood shows leukocytosis, the reaction of erythrocyte sedimentation (ROE) is significantly accelerated.

Diagnostics

Often diagnosed hard enough. It is very important to identify diseases that can potentially complicate lung infarction. For this it is necessary to conduct a thorough examination of the patient (especially the lower limbs). In case of a heart attack, unlike pneumonia , the pain in the side occurs before fever and chills, sputum with blood appears also after severe pain in the side. To diagnose the disease, the following methods are used:

• X-ray examination - to detect the expansion of the root of the lung and its deformation.

• ECG - to identify signs of an overload of the right heart.

• Echocardiography - the manifestations of right ventricular overload are determined.

• Doppler ultrasound of the veins of the lower extremities - diagnosis of deep vein thrombosis.

• Radioisotope scanning of the lungs - to detect areas of decreased lung perfusion.

• Angiopulmonography - to detect obstruction of the branches of the artery of the lung, intra-arterial filling defects.

Lung infarction: consequences

This disease, as a rule, does not pose a great threat to human life. However, after such a malaise as an infarction of the lung, the consequences can be severe. Possible the development of a variety of complications. For example, such as postinfarction pneumonia, suppuration and spread of inflammation on the pleura, pulmonary edema. After a heart attack, there is a high risk of getting a purulent embolus (blood clot) into the vessel. This, in turn, causes a purulent process and contributes to the abscess at the site of the infarction. Pulmonary edema with myocardial infarction develops, primarily, with a decrease in the contractility of the heart muscle and with a simultaneous delay in the blood in a small circle. As the intensity of the heart rate decreases suddenly, an acute small-shot syndrome develops, which provokes severe hypoxia. In this case, there is excitation of the brain, the release of biologically active substances that contribute to the permeability of the alveolar-capillary membrane, and increased redistribution of blood to the small circulation from the large. The prognosis of a lung infarction depends on the underlying ailment, the magnitude of the affected area and the severity of the common manifestations.

Treatment of the disease

If the first signs indicating a lung infarction are revealed, treatment should be started immediately. The patient is required to be delivered as soon as possible to the intensive care unit of the medical institution. Treatment begins with the introduction of the drug "Heparin", this drug does not dissolve the thrombus, but it prevents the increase in thrombus and is able to suspend the thrombotic process. Medication "Heparin" is able to weaken the bronchospastic and vasoconstrictive action of thrombocyte histamine and serotonin, which helps reduce spasm of pulmonary arterioles and bronchioles. Heparin therapy is carried out for 7-10 days, with the control of activated partial thromboplastin time (APTT). Also used low molecular weight heparin - dalteparin, enoxaparin, fractiparin. In order to ease the pain syndrome, reduce the load on the small circle of blood circulation, reduce shortness of breath, use narcotic analgesics, for example, the drug "Morphine" (intravenously injected 1% solution). If the infarct of the lung Provokes pain of pleural nature, which is affected by breathing, body position, cough, it is recommended to use non-narcotic analgesics, for example "Analgin" (intravenous administration of 50% solution). When diagnosing pancreatic insufficiency or shock for treatment, vasopressors (dopamine, dobutomin) are used. If bronchospasm is observed (at normal atmospheric pressure), a 2.4-percent solution of euphyllin should be injected slowly intravenously. If an infarct is developing - pneumonia of the lung, For the treatment of antibiotics. Calm hypotension and hypokinesis of the right ventricle suggest the use of thrombolytic agents ("Alteplaz", "Streptokinas"). In some cases, surgery may be required (thrombectomy). On average, small infarcts are eliminated in 8-12 days.

Prevention of disease

To prevent a heart attack, It is necessary first of all not to admit venous stasis in the legs (thrombosis of the veins of the lower extremities). To do this, it is recommended to massage the limbs, for patients who have undergone surgery, myocardial infarction, apply an elastic bandage on the shins. It is also recommended to exclude the use of drugs that increase blood clotting and limit the use of the intravenous method of medication administration. According to the indications, it is possible to prescribe medications that lower blood coagulability. For the prevention of concomitant infectious diseases, a course of antibiotics is prescribed. In order to prevent pulmonary hypertension, the use of the drug "Eufillin" is recommended.