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Lung infarction
Last reviewed: 17.10.2021
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Lung infarction is a disease that develops as a result of the formation of a thrombus in the pulmonary artery system or its introduction from the peripheral veins. Various diseases can provoke this phenomenon. All possible causes of the problem will be mentioned below.
Causes of myocardial infarction
The causes of myocardial infarction can hide in many problems. Pathophysiology can contribute to this. So, to provoke a heart attack in most cases is capable of tearing off a thrombus. Significantly, it develops against the background of an increase in the attached thrombus. An infarction can cover both a small fragment of the lung and 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 probability of getting a heart attack increases in people who have undergone chemotherapy. Epidemiology can contribute to the problem. Lung infarction is a rare pathological disorder in medical practice. With regard to mortality, it is from 5 to 30%. Everything depends on the severity of the patient's condition and timely assistance. Immediately after a heart attack, various complications can develop, ranging from cardiovascular complications to pulmonary hypertension. It should be noted that women suffer from a heart attack 40% more often than men.
Lung edema with myocardial infarction
Pulmonary edema in myocardial infarction is characterized by a typical clinical picture. In 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. Usually the attack begins with a feeling of tightness in the chest, a feeling of pain and weakness. Expressed shortness of breath, it is difficult to breathe. The patient takes a typical forced position, in which fixing the shoulder girdle facilitates breathing. The patient complains of a cough, which is initially dry, and eventually accompanied by a foamy sputum. Sometimes the shade of foam may be pink.
With percussion of lungs tympanic sound is determined, and in auscultation a large number of differently moist moist wheezes are heard - from creping, forming in the alveoli and terminal bronchioles, to large bubbles caused by the presence of foam in the large bronchi and trachea. When diagnosing a patient's condition, attention should be paid to changes in blood circulation. There are 2 types of changes in hemodynamics in patients with pulmonary edema-hyperdynamic and hypodynamic. At the heart of the first phenomenon lies an increase in the shock volume of the heart and the speed of blood flow, increasing pressure and increasing blood pressure. This condition is typical for patients with hypertensive disease, combined mitral valve defect, with unreasonable forced intravenous fluids. The second type of impairment is accompanied by a decrease in the shock volume of the heart, a slight increase in pulmonary artery pressure and a tendency to lower blood pressure. This type is characteristic for pulmonary edema, extreme degrees of stenosis of the mitral or aortic valves.
Symptoms of a heart attack
Symptoms of a lung infarction are typical, the person who has suffered can determine the appearance of this disease. So, a lot depends on the severity of the condition. The symptomatology is affected by the size, location and number of closed blood clots. Naturally, do not forget about the concomitant diseases of the lungs and heart.
The main signs include a sudden or sharply increased dyspnoea. There may be a cough that is accompanied by mucous or bloody sputum. In the chest there is a sharp pain. The skin becomes pale and often gets an ashy shade. Lips, nose and fingertips turn blue. The rhythm of the heart is greatly disturbed. This manifests itself in the form of a rapid pulse, the appearance of atrial fibrillation.
Often, everything is accompanied by a decrease in blood pressure, an increase in body temperature. Most often, the condition of a person is very bad. In severe cases, he dies almost instantly. Therefore, it is important to see strange changes in time and to help.
Hemorrhagic lung infarction
Hemorrhagic lung infarction occurs against the background of existing embolism or thrombosis of the pulmonary arteries. Because of this, a region of pulmonary tissue with a disturbed circulation is formed. The main feature of the disease is the presence of a section of ischemia soaked in blood, has clear boundaries and a dark red color.
Such a heart attack, in its shape resembles a cone, the base of which is turned to the pleura. Accordingly, the tip of the cone faces the lung root, and a thrombus can be found on it in one of the branches of the pulmonary artery.
Bring to this state can be a few key points. So, first of all it is a thrombosis of peripheral veins. Especially often there is thrombosis of deep femoral veins due to weak or delayed blood circulation in them. In this case, it is important that there is one condition - a tendency to increased coagulability of the blood in weakened patients who have been on bed for a long time.
Provoke the phenomenon can inflammatory thrombophlebitis. This group includes septic thrombophlebitis, which occurs with a variety of general and local infections, after trauma or surgery, with prolonged fever in the postoperative period.
Thrombosis in the heart and thromboendocarditis often provoke a hemorrhagic lung infarction. It is necessary to identify predisposing factors in which hemorrhagic lung infarction develops somewhat more often. These include myocardial infarction, nephrotic syndrome, obesity, congestive heart failure, operations in the lower abdominal cavity, pregnancy, prolonged immobility.
Symptoms of this disease, expressed, not to notice them is impossible. First, a painful sensation under the armpit, in the area of the scapula or a feeling of constriction in the chest. During the cough and breathing, the pain can increase. There is shortness of breath. At the same time, there are also vascular reactions - the skin becomes pale, a sticky cold sweat appears. When a massive lesion is not ruled out jaundice.
When the blood is examined, moderate leukocytosis is revealed. During the examination, the doctor discovers a jug of friction of the pleura, wet crepitic wheezing and muffled breathing. There may be an accumulation of fluid in the pleural cavity, which manifests itself by dulling percussion sound in the area of the lesion, weakening of breathing, swelling of the intercostal spaces, and vocal trembling.
Right lung infarction
An infarct of the right lung 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, cardiac chronic insufficiency, prolonged immobilization, malignant tumors. Thrombosis of the lung can cause pulmonary vasculitis, stagnation of blood flow in the lungs, stable pulmonary hypertension. Reflex spasm in the pulmonary artery system, as usual, accompanies the obturation of the vessel. This leads to an overload of the right heart and acute LH.
As a result, there is a violation of diffusion and arterial hypoxemia. Infarction of the lung occurs mainly against the background of already present venous congestion. This phenomenon is hemorrhagic in nature. Infection can lead to the appearance of the lung leads to the occurrence of perifocal pneumonia (candidiasis, bacterial), often with abscessing.
To understand that the infarction happened is not difficult. The main symptoms are chest pain, shortness of breath, foamy discharge during a cough and a significant increase in body temperature. Timely diagnosis and elimination of the problem is necessary.
Left lung infarction
The left lung infarction also develops against a background of thrombosis or embolism of the branches of the pulmonary artery. This phenomenon is not particularly symptomatic, rather it is typical. So, there is shortness of breath, fever, chest pain, dry cough, followed by the discharge of sputum or foam. There may be tachycardia, cyanosis, hemoptysis, cerebral disorders, signs of myocardial hypoxia, disturbance of the heart rhythm and weakened breathing.
Abdominal syndrome, caused by lesions of the diaphragmatic pleura, is observed occasionally. Bowel paresis, leukocytosis, vomiting, and loose stool are not excluded. Diagnosis of the problem should be carried out immediately.
The prognosis of this phenomenon depends entirely on the course of the underlying disease. It is possible to prevent the disease, but only if to treat heart decompensation and thrombophlebitis, to use anticoagulants among patients with myocardial infarction, mitral stenosis, in gynecology and surgery.
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Consequences of myocardial infarction
The consequences of a lung infarction can be severe. Usually, this disease is not particularly dangerous, but it needs to be eliminated quickly. It is possible that serious complications develop. These include postinfarction pneumonia, suppuration and spread of inflammation to the pleura.
After a heart attack, there is a high risk of getting a purulent embolus (blood clot) in the vessel. This phenomenon can cause a purulent process and contribute 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 the simultaneous retention of blood in a small circle. This is due to the fact that the intensity of heartbeats decreases suddenly, there is an acute small-shot syndrome, which provokes severe hypoxia.
With all this, 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.
[13], [14], [15], [16], [17], [18]
Scars after lung infarction
Scars after a lung infarction are a typical consequence. After all, the disease itself is characterized by the death of some of the contractile cells of the myocardium, followed by replacement of the dead (necrotic) cells with a coarse connective tissue. This process leads to the formation of a postinfarction scar.
Cell death (necrosis) occurs as a result of ongoing myocardial ischemia and the development of irreversible changes in cells due to a violation of their metabolism. Dense scar tissue in the place of necrosis is finally formed approximately 3-4 months and later. With fine-focal myocardial infarction scar can be formed at earlier times. The rate of scarring depends not only on the size of the focus of necrosis, but also on the state of coronary circulation in the myocardium in general and in the peri-infarction areas, especially.
Relatively small load during the formation of the primary scar (under certain conditions, naturally), can lead to the development of an aneurysm of the heart (protrusion of the ventricular wall, the formation of a peculiar bag), and within a month the same load is useful and even necessary for strengthening the heart muscle and forming more lasting scar. But we will continue the conversation about a heart attack. And let's talk now about how an acute large-focal (ie, the most typical) myocardial infarction is manifested.
Complications of myocardial infarction
Complications of myocardial infarction may be the manifestation of abscesses. It should be noted that the small manifestations of the problem mostly pass asymptomatically. As for radiographic changes, they completely disappear in 7-10 days.
Large-scale infarctions last longer and can lead to fibrosis, with thrombosis beginning gradual, collapse is not pronounced, and heart attacks also occur without significant symptoms, often accompanied by a hypostasis or pulmonary edema, are often diagnosed as hypostatic pneumonia.
It should be noted that hemorrhagic pleurisy is often associated with the problem. In general, everything depends on the severity of the condition. If you notice the problem in time and resort to it, there will be no serious consequences. Much depends on when the help was rendered, and what disease caused the lung infarction. Only on the basis of these data can we build a further forecast and talk about complications. It is important to prevent infection of the lung.
Diagnosis of myocardial infarction
Diagnosis of myocardial infarction is carried out in several stages. So, first a complex blood test is taken. Then the chest radiograph is performed. It allows you to identify changes and discover pathologies. If you can not see anything, or if the case is difficult, use a computer tomography of the lungs. It gives a complete picture of what is happening.
Often used magnetic resonance imaging of the lungs, echocardiography and ECG. All these are capable of diagnosing in combination give a complete picture of what is happening. Naturally, all procedures are not immediately carried out. As mentioned above, it all depends on the complexity of the state. In some cases, using X-rays, it is not possible to obtain all the necessary information. To do this, use other methods. In general, the presence of a problem can be determined by the symptomatology. More precisely, according to the main features, everything becomes clear. But to determine the severity of the problem, you need to resort to other methods of diagnosis.
[24], [25], [26], [27], [28], [29]
X-ray for lung infarction
X-rays with a lung infarction is of particular importance. So, in some cases, there are horizontal shadows in the picture. Usually, the disease is accompanied by the presence of pleural exudate. True, it can be established exclusively with the help of a skiography in the oblique position of the patient, which is at an angle of 30 ° on the patient side. In this position, you can set the diaphragm to a higher position. The presence of pleural exudate was observed in the embolic period, even before the development of a heart attack.
In unaffected areas, increased transparency is noticeable, they are swollen, or there is a hyperextension of the lung tissue. Shadows of infarcts can be completely or largely blocked. In some cases, basal atelectasis develops.
When the diaphragm is high, a striped shadow may appear, recalling flat atelectasis. Such a shadow can sometimes give an incomplete, resorptive or a healed infarction. It must be emphasized, however, that not every infarct can be detected by X-ray examination. In addition, in a period of severe illness, children usually do not undergo X-ray examination.
CT scan with a lung infarction
CT in lung infarction is an important procedure. Thus, computed tomography is an analysis that allows you to visualize the structure of the body. During the process, the patient is placed on the table to which the scanner is attached. It is this device that sends the x-ray ray to the tomograph through the area of the body being inspected and transfers the image to the computer monitor.
In the chest, this study helps diagnose the underlying problems of the lungs, heart, esophagus, and major blood vessel (aorta), as well as tissues in the chest. The most common diseases developing in the chest, which can be identified with CT: infection, lung cancer, pulmonary embolism, and aneurysm.
Computer tomography allows you to see changes in organs. Thanks to this research, you can clearly diagnose and begin treatment. But one picture is not enough, it is necessary to give another blood test and, if necessary, to undergo other procedures. In the diagnosis of lung infarction, computed tomography takes a leading place.
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Treatment of myocardial infarction
Treatment of a pulmonary infarction is a long process involving a mass of medications. It all starts with neuroleptanalgesia. A person is intravenously injected with Fentanyl. It is enough 1-2 ml of 0,00% solution. Then, Droperidol - 2-4 ml of a 2.5% solution. If this mixture is absent, 1 ml of 1% morphine solution is intravenously administered. For old people, the dosage is halved, and is 0.5 ml.
If there is no pain, neurolepsy with droperidol - 2.5% solution, 2-4 ml. Naturally, the drug is administered intravenously. For the destruction of foam, inhalation of oxygen is used with vapors of 20-50 degrees alcohol or 10% alcohol solution of Antifemcilan.
If the pressure is normal or elevated, Furosemide is administered at a rate of 1 to 2.5 mg / kg. Immediately after the application of the drug, its extrarenal effect immediately manifests itself: a decrease in the volume of circulating blood in the lungs due to its redistribution. When starting a lung infarction, sublingual Nitroglycerin should be taken. It is used for 1 tablet, every 2 minutes 3-5 times.
If treatment is performed in a hospital, then initially injected Nitroglycerin, dissolved in 20 ml of isotonic solution. In this case, you need to carefully monitor blood pressure. If the edema does not stop, it is worth repeating the introduction of the drug in 5-15 minutes. Later on they pass to the dropwise application of Nitroglycerin in a dose of 6 ml of a 1% solution to 400 ml of isotonic solution at a rate of 8-10 drops per minute.
Pentamine is also used, it is injected slowly into the vein. It is necessary to measure pressure every 3 minutes. The effect of pentamine is particularly rapid in swelling of the lungs, which proceeds with a significant rise in blood pressure.
Another method of treatment is associated with the use of a peripheral vasodilator - sodium nitroprusside. It is administered intravenously drip in a dose of 50 mg dissolved in 500 ml of a 5% solution of glucose. The rate of administration also depends on the numbers of blood pressure (an average of 6-7 cap / min). In patients with normal pressure, treatment should begin with the administration of nitroglycerin in the amount of 1-2 ml of a 1% solution of diluted in 200 ml isotonic sodium chloride solution. Introduced all at a speed of 20-30 drops per minute. Lazix (80-120 mg) is also used and intravenously struino for 4-5 minutes 0.25 ml of a 0.05% solution of strophantine
If a person has low blood pressure, then all of the above drugs are prohibited. He shows drugs for neuroleptanalgesia. Intravenous 90-150 mg of prednisolone is injected, 0.25 ml of a 0.05% solution of strophanthin in 200 ml of rheopolyglucin is adjusted. To this solution, 125 mg (5 ml) hydrocortisone acetate (infusion rate 60 cap / min) can be added.
Dopamine 200 mg (5 ml of 4% solution) is injected intravenously into 400 ml of a 5% solution of glucose or isotonic sodium chloride solution (the initial intravenous infusion rate is 5 μg / kg per minute), or 10 drops of 0.05% solution in 1 minute . Naturally, these infarct treatment regimens are used only in a hospital setting.
Prevention of pulmonary infarction
Prevention of myocardial infarction is to prevent the disease. It is necessary to eliminate decompensation of the heart and thrombophlebitis in time. It is advisable to use anticoagulants in the environment of patients with myocardial infarction, mitral stenosis, in gynecology and surgery.
It is important to fully observe the peace of sick infarction. Treatment measures usually include the removal of reflex effects, which can lead to serious consequences. Naturally, it is necessary to relieve pain with the use of Morphine and eliminate the collapse.
Considering the main causes of myocardial infarction, one can talk about preventive measures. First of all, if possible, you can not get up after a few days after the operation. Even seriously ill patients are recommended to provide the necessary minimum of movements. Naturally, it is excluded without unnecessary necessity to take medications that are capable of increasing blood coagulability. If possible, intravenous administration of medicines is limited. In 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 venous thrombosis and the risk of development of consequences.
Prognosis of myocardial infarction
The prognosis of a lung infarction depends entirely on the underlying disease, because of which it arose. Naturally, all this is affected by the severity of the problem and its course. The magnitude of the infarction and common manifestations are also included in their number.
Usually, a lung infarction does not carry a particular danger. It can easily be eliminated, but at the same time determining the cause of its development. The outlook 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 eliminate. Therefore, if there are problems with the heart and blood vessels, it is worth tackling eliminating them. After all, they lead to the development of consequences in the form of lung lesions. If everything is done correctly, the disease will not develop and the forecast will be most favorable. Naturally, there is a possibility of a negative development of events. To avoid this, when you have a typical symptomatology you need to seek help.