Infarction of the lung

Pulmonary infarction is a disease that develops as a result of a thrombus forming in the pulmonary artery system or its introduction from the peripheral veins. This phenomenon can be provoked by various diseases. All possible causes of the problem will be mentioned below.

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Causes of pulmonary infarction

The causes of pulmonary infarction may be hidden in many problems. Pathophysiology may contribute to this. Thus, in most cases, a detached thrombus can provoke a heart attack. Much less often, it develops against the background of an increase in an attached thrombus. A heart attack 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 likelihood of getting a heart attack increases in people who have undergone chemotherapy. Epidemiology can contribute to the problem. Pulmonary infarction is a rare pathological disorder in medical practice. As for mortality, it is from 5 to 30%. Everything depends on the severity of the patient's condition and the timely assistance provided. Various complications can develop immediately after a heart attack, ranging from cardiovascular complications to pulmonary hypertension. It is important to note the fact that women suffer from heart attacks 40% more often than men.

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Pulmonary edema in myocardial infarction

Pulmonary edema in myocardial infarction is characterized by a typical clinical picture. This phenomenon is accompanied by a number of subjective and objective symptoms. First of all, it should be noted that this pathological condition can develop at any time of the day. Usually, an attack begins with a feeling of tightness in the chest, a feeling of pain and weakness. There is pronounced shortness of breath, it is difficult to breathe. The patient takes a typical forced position, in which fixation of the shoulder girdle facilitates breathing. The patient complains of a cough, which is dry at first, and over time is accompanied by foamy sputum. Sometimes the foam can be pink.

Percussion of the lungs reveals a tympanic sound, and auscultation reveals a large number of different-sized wet rales - from crepitant rales formed in the alveoli and terminal bronchioles to large-bubble rales caused by the presence of foam in the large bronchi and trachea. When diagnosing the patient's condition, it is necessary to pay attention to changes in blood circulation. In total, there are 2 types of hemodynamic changes in pulmonary edema - hyperdynamic and hypodynamic. The first phenomenon is based on an increase in the stroke volume of the heart and blood flow velocity, an increase in pressure and an increase in arterial pressure. This condition is typical for patients with hypertension, combined mitral valve defect, with unjustified forced intravenous fluid administration. The second type of disorder is accompanied by a decrease in the stroke volume of the heart, a slight increase in pressure in the pulmonary artery and a tendency to decrease arterial pressure. This type is typical for pulmonary edema, extreme degrees of mitral or aortic valve stenosis.

Symptoms of pulmonary infarction

The symptoms of pulmonary infarction are typical, and the victim himself can determine the occurrence of this disease. Thus, much depends on the severity of the condition. The symptoms are affected by the size, location and number of closed vascular thrombi. Naturally, one should not forget about concomitant diseases of the lungs and heart.

The main symptoms include sudden or sharply increased shortness of breath. A cough may develop, which is accompanied by mucous or bloody sputum. A sharp pain appears in the chest. The skin becomes pale and often acquires an ashen tint. The lips, nose and fingertips turn blue. The heart rhythm is significantly disturbed. This manifests itself in the form of increased pulse rate and the appearance of atrial fibrillation.

Often, everything is accompanied by a decrease in blood pressure, an increase in body temperature. Most often, the person's condition is very bad. In severe cases, he dies almost instantly. Therefore, it is important to see strange changes in time and provide assistance.

Hemorrhagic pulmonary infarction

Hemorrhagic pulmonary infarction occurs against the background of existing embolism or thrombosis of the pulmonary arteries. Because of this, a section of lung tissue with impaired blood circulation is formed. The main feature of the disease is the presence of an ischemic area soaked in blood, has clear boundaries and a dark red color.

Such an infarction, in its shape, resembles a cone, the base of which is directed towards the pleura. Accordingly, the tip of the cone is directed towards the root of the lung, and a thrombus can be found on it in one of the branches of the pulmonary artery.

Several key factors can lead to this condition. First of all, it is thrombosis of peripheral veins. Deep femoral vein thrombosis is especially common due to weak or slow blood circulation in them. At the same time, one condition is important - a tendency to increased blood clotting in weakened patients who are on bed rest for a long time.

The phenomenon can be provoked by inflammatory thrombophlebitis. This group includes septic thrombophlebitis, which occurs with various general and local infections, after trauma or surgery, with prolonged fever in the postoperative period.

Thrombosis in the heart and thromboendocarditis often provoke hemorrhagic pulmonary infarction. It is necessary to highlight the predisposing factors in which hemorrhagic pulmonary infarction develops somewhat more often. These include myocardial infarction, nephrotic syndrome, obesity, congestive heart failure, operations in the lower abdominal cavity, pregnancy, and prolonged immobility.

The symptoms of this disease are pronounced and impossible to miss. At first, painful sensations appear in the armpit, in the shoulder blade area, or a feeling of constriction in the chest. During coughing and breathing, the pain can intensify. Shortness of breath is noted. At the same time, vascular reactions are observed - the skin becomes pale, sticky cold sweat appears. In case of mass defeat, jaundice is not excluded.

Blood examination reveals moderate leukocytosis. During the examination, the doctor detects pleural friction rubs, moist crepitant rales, and muffled breathing. Fluid accumulation in the pleural cavity may be noted, which manifests itself as dullness of percussion sound in the affected area, weakening of breathing, bulging intercostal spaces, and vocal tremor.

Infarction of the right lung

Right lung infarction is a disease caused by thrombosis or embolism of the pulmonary artery branches. In 10-25% of cases, it develops in the case of pulmonary artery blockage.

Peripheral phlebothrombosis is preceded by the postpartum period, surgical interventions, fractures of long tubular bones, chronic cardiac failure, prolonged immobilization, malignant tumors. Pulmonary thrombosis can cause pulmonary vasculitis, pulmonary congestion, stable pulmonary hypertension. Reflex spasm in the pulmonary artery system, as usual, accompanies vessel obstruction. This leads to overload of the right heart and acute pulmonary hypertension.

As a result, diffusion is impaired and arterial hypoxemia occurs. Pulmonary infarction occurs mainly against the background of already existing venous congestion. This phenomenon is hemorrhagic in nature. Infection can lead to the occurrence of lung leads to the occurrence of perifocal pneumonia (candidal, bacterial), often with abscess formation.

It is not difficult to understand that a heart attack has occurred. The main symptoms are chest pain, shortness of breath, foamy discharge during coughing and a significant increase in body temperature. Timely diagnosis and elimination of the problem are necessary.

Left lung infarction

Left lung infarction also develops against the background of thrombosis or embolism of the pulmonary artery branches. This phenomenon does not have any special symptoms, rather they are typical. Thus, shortness of breath, fever, chest pain, dry cough appear, followed by the release of sputum or foam. Tachycardia, cyanosis, hemoptysis, cerebral disorders, signs of myocardial hypoxia, heart rhythm disturbances and weakened breathing may be present.

Abdominal syndrome caused by damage to the diaphragmatic pleura is observed rarely. Intestinal paresis, leukocytosis, vomiting, and loose stools are possible. The problem should be diagnosed 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 you treat cardiac decompensation and thrombophlebitis, use anticoagulants among patients with myocardial infarction, mitral stenosis, in gynecology and surgery.

Consequences of pulmonary infarction

The consequences of a pulmonary infarction can be severe. Usually, this disease does not pose a particular danger, but it must be eliminated quickly. The development of serious complications is not excluded. These include post-infarction pneumonia, suppuration and the spread of inflammation to the pleura.

After a heart attack, there is a high risk of a purulent embolus (blood clot) entering a vessel. This phenomenon can cause a purulent process and contribute to an abscess at the site of the infarction. Pulmonary edema during myocardial infarction develops, first of all, with a decrease in the contractility of the heart muscle and with simultaneous retention of blood in the pulmonary circulation. This occurs because the intensity of heart contractions decreases suddenly, and acute low output syndrome develops, which provokes severe hypoxia.

With all this, there is excitation of the brain, release of biologically active substances that promote permeability of the alveolar-capillary membrane, and increased redistribution of blood into the pulmonary circulation from the systemic. The prognosis of pulmonary infarction depends on the underlying disease, the size of the affected area, and the severity of general manifestations.

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Scars after pulmonary infarction

Scars after a pulmonary infarction are a typical consequence. After all, the disease itself is characterized by the death of part of the contractile cells of the myocardium, with subsequent replacement of the dead (necrotic) cells with coarse connective tissue. This process leads to the formation of a post-infarction scar.

Cell death (necrosis) occurs as a result of ongoing myocardial ischemia and the development of irreversible changes in cells due to disruption of their metabolism. Dense scar tissue at the site of necrosis is finally formed in about 3-4 months and later. In case of small-focal myocardial infarction, the scar may form earlier. The rate of scarring depends not only on the size of the necrotic focus, but also on the state of coronary circulation in the myocardium in general and in peri-infarction areas in particular.

A relatively small load during the formation of the primary scar (under certain conditions, of course) can lead to the development of a cardiac aneurysm (bulging of the ventricular wall, formation of a kind of sac), and after a month the same load turns out to be useful and even necessary for strengthening the heart muscle and forming a stronger scar. But let's continue talking about a heart attack. And now we will talk about how acute large-focal (i.e. the most typical) myocardial infarction manifests itself.

Complications of pulmonary infarction

Complications of pulmonary infarction may include the appearance of abscesses. It should be noted that minor manifestations of the problem are mostly asymptomatic. As for radiographic changes, they completely disappear in 7-10 days.

Large infarctions last longer and can lead to fibrosis; with thrombosis, the onset is gradual, collapse is not pronounced; marantic infarctions also occur without pronounced symptoms, often accompanied by hypostasis or pulmonary edema, and are often diagnosed as hypostatic pneumonia.

It should be noted that hemorrhagic pleurisy often joins the problem. In general, everything depends on the severity of the condition. If you notice the problem in time and resort to eliminating it, there will be no serious consequences. Much depends on when assistance was provided and what disease caused the pulmonary infarction. Only on the basis of this data can we make a further prognosis and talk about complications. It is important to prevent infection of the lung.

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Diagnosis of pulmonary infarction

Diagnosis of pulmonary infarction is carried out in several stages. So, first, a comprehensive blood test is taken. After that, chest X-ray is performed. It allows you to highlight changes and detect pathologies. If nothing can be seen or the case is severe, computed tomography of the lungs is used. It gives a complete picture of what is happening.

Magnetic resonance imaging of the lungs, echocardiography and ECG are often used. All these diagnostic methods together provide a complete picture of what is happening. Naturally, all procedures are not carried out at once. As mentioned above, everything depends on the complexity of the condition. In some cases, X-rays do not provide all the necessary information. Other methods are used for this. In general, the presence of a problem can be determined by symptoms. More precisely, everything becomes clear by the main signs. But to determine the seriousness of the problem, you need to resort to other diagnostic methods.

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X-ray for pulmonary infarction

X-rays are of particular importance in pulmonary infarction. In some cases, horizontal shadows are observed on the image. Usually, the disease is accompanied by the presence of pleural exudate. However, it can only be established using skiagraphy in an oblique position of the patient, located at an angle of 30° on the diseased side. In this position, an increased position of the diaphragm can be established. The presence of pleural exudate was also observed in the embolic period, even before the development of infarction.

In unaffected areas, increased transparency is noticeable, they are swollen, or overstretched lung tissue is observed. Infarction shadows may be completely or significantly covered. In some cases, basal atelectasis develops.

When the diaphragm is high, a stripe-like shadow may form, resembling flat atelectasis. A similar shadow may sometimes be produced by an incomplete, resolving or cured infarction. It should be emphasized, however, that not every infarction can be detected by X-ray examination. In addition, children are usually not subjected to X-ray examination during a severe condition.

CT in pulmonary infarction

CT in pulmonary infarction is an important procedure. Thus, computed tomography is an analysis that allows visualization of the body structures. During the process, the patient is placed on a table to which a scanner is attached. It is this device that sends X-rays to the tomograph through the area of the body being examined and transmits the image to the computer monitor.

In the chest, this test helps diagnose major problems in the lungs, heart, esophagus, and major blood vessel (aorta), as well as tissues in the chest area. The most common chest conditions that can be detected with CT include infection, lung cancer, pulmonary embolism, and aneurysm.

Computer tomography allows you to see changes in the organs. Thanks to this study, you can clearly make a diagnosis and begin treatment. But one picture is not enough, you should also take a blood test and, if necessary, undergo other procedures. In diagnosing pulmonary infarction, computer tomography takes a leading place.

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Treatment of pulmonary infarction

Treatment of pulmonary infarction is a long process, including a lot of medications. It all starts with neuroleptanalgesia. Fentanyl is administered intravenously to a person. 1-2 ml of a 0.00% solution is enough. Then, Droperidol - 2-4 ml of a 2.5% solution. If this mixture is not available, 1 ml of a 1% morphine solution is administered intravenously. For older people, the dosage is halved, and is 0.5 ml.

If there is no pain syndrome, neurolepsy with Droperidol is indicated - 2.5% solution, 2-4 ml. Naturally, the drug is administered intravenously. To destroy the foam, oxygen inhalations with vapors of 20-50 degree alcohol or a 10% alcohol solution of Antifomsilane are used.

If the pressure is normal or elevated, Furosemide is administered at a rate of 1 - 2.5 mg/kg. Immediately after the drug is administered, its extrarenal effect is immediately apparent - a decrease in the volume of circulating blood in the lungs due to its redistribution. At the onset of pulmonary infarction, it is worth taking sublingual Nitroglycerin. It is used 1 tablet, every 2 minutes 3-5 times.

If the treatment is carried out in a hospital, then first Nitroglycerin is administered intravenously, dissolved in 20 ml of isotonic solution. In this case, it is necessary to carefully monitor blood pressure. If the edema is not relieved, it is worth repeating the administration of the drug after 5-15 minutes. Then they switch to drip administration of Nitroglycerin at a dose of 6 ml of 1% solution per 400 ml of isotonic solution at a rate of 8-10 drops per minute.

Pentamin is also used, it is injected slowly into a vein. In this case, it is necessary to measure the pressure every 3 minutes. The effect of pentamin is especially rapid in pulmonary edema, which occurs with a significant increase in arterial pressure.

Another method of treatment is associated with the use of a peripheral vasodilator - Sodium Nitroprusside. It is administered intravenously by drip in a dose of 50 mg, dissolved in 500 ml of 5% glucose solution. The rate of administration also depends on the arterial pressure figures (on average 6-7 drops/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 diluted in 200 ml of isotonic sodium chloride solution. All is administered at a rate of 20-30 drops per minute. Lasix (80-120 mg) is also used and 0.25 ml of a 0.05% strophanthin solution is administered intravenously by jet over 4-5 minutes.

If a person has low blood pressure, all the above-described drugs are prohibited. He is prescribed drugs for neuroleptanalgesia. 90-150 mg of Prednisolone is administered intravenously, a drip infusion of 0.25 ml of a 0.05% solution of strophanthin in 200 ml of rheopolyglucin is established. 125 mg (5 ml) of hydrocortisone acetate can be added to this solution (infusion rate 60 drops/min).

Dopamine 200 mg (5 ml of 4% solution) is administered intravenously by drip in 400 ml of 5% glucose solution or isotonic sodium chloride solution (initial rate of intravenous infusion is 5 mcg/kg per minute), or 10 drops of 0.05% solution per minute. Naturally, these treatment regimens for infarction are used only in hospital settings.

Prevention of pulmonary infarction

Prevention of pulmonary infarction consists of preventing the disease. It is necessary to eliminate cardiac decompensation and thrombophlebitis in time. It is advisable to use anticoagulants among patients with myocardial infarction, mitral stenosis, in gynecology and surgery.

It is important for patients with heart attacks to remain completely at rest. Treatment usually involves eliminating reflex influences that can lead to serious consequences. Naturally, it is necessary to relieve pain using Morphine and eliminate collapse.

Taking into account the main causes of pulmonary infarction, we can talk about preventive measures. First of all, if possible, you should not get up for several days after the operation. Even seriously ill patients are advised to ensure the necessary minimum of movement. Naturally, the use of drugs that can increase blood clotting is excluded without unnecessary need. If possible, intravenous administration of drugs is limited. In case of thrombosis of the veins of the lower extremities, a surgical method of ligation of the veins 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 developing consequences.

Prognosis of pulmonary infarction

The prognosis of a pulmonary infarction depends entirely on the underlying disease that caused it. Naturally, all of this is affected by the severity of the problem and its course. The size of the infarction and general manifestations are also among them.

Usually, a pulmonary infarction does not pose a particular danger. It can be easily eliminated, but at the same time, the cause of its development must be determined. The prognosis is usually favorable. But, as mentioned above, everything depends on how quickly the problem was diagnosed and quality treatment was started.

In general, this disease is easier to prevent than to cure. Therefore, if you have problems with your heart and blood vessels, you should start eliminating them. After all, they lead to the development of consequences in the form of lung damage. If you do everything correctly, the disease will not develop and the prognosis will be most favorable. Naturally, there is a possibility of a negative development of events. To avoid this, when typical symptoms appear, you need to seek help.