Pulmonary embolism signs and symptoms, Treatment uptodate, Nursing Diagnosis, Risk Score, X-ray Pictures
Pulmonary embolism is the obstruction of pulmonary arteries – i.e, blood clot in pulmonary artery. Once the artery is blocked, usually by one or more emboli, blood oxygen level decreases and pulmonary pressure increases.
Pulmonary embolism caused by large thrombi may cause sudden death, usually within 30 minutes of symptoms. The smaller thrombi can cause irreversible damage to the heart and lungs.
Pulmonary Embolism Prophylaxis
Daily use of anticoagulants may be useful in preventing the recurrence of pulmonary embolism by preventing new thrombus formation and stopping the development of the existing thrombus.
Recent studies have shown that the risk of a new thrombus formation is bigger during the first 4-6 weeks after an initial episode of pulmonary embolism.
This risk decreases over time. However the risk remains significantly large for months and even years, depending on the cause that triggered the pulmonary embolism. People with recurrent thrombus or pulmonary embolism may be forced to follow anticoagulant therapy for the rest of their life, without pauses.
Anticoagulant drugs are frequently administered to persons who are to undergo surgical operations of the lower limbs, abdomen or pelvis.
There can also be used some other preventive methods. Among these include:
- Early mobilization after surgical interventions
- The use of compression stockings (elastic) by persons presenting the risk to develop this disease may prevent venous thrombosis
- Administration of small amounts of aspirin before taking a long journey by plane or car.
Aspirin may reduce your risk of a blood clot in Pulmonary Artery but it is not appropriate to treat pulmonary embolism.
Important to know about Pulmonary Embolism
Once the diagnosis of pulmonary embolism, the physician determines:
- If anticoagulant treatment is necessary
- The period the patient must undergo treatment with anticoagulants
Normally, if a recent stroke, recent surgery or active internal bleeding occurred the use of thrombocytes is not recommended. A filter placed in the vena cava may help reduce the risk of developing a new episode of pulmonary embolism.
Advice for people taking thrombolytic treatment:
- Medicines to be taken at the same time each day
- Doctor should be consulted about the administration of other drugs, especially those containing aspirin
- The emergence of signs of bleeding must be taken into account and the doctor must be announced at the appearance of the following symptoms:
- Blood in the urine, persistent red or black stool
- Nose bleeds that are hard to stop
- Vaginal bleeding new, abundant and for a long time
- Frequent and severe bruising or red or blue spots on the skin
- Depending on the medicine, patients will do take blood tests from time to time.
Pulmonary embolism is a total or partial blockage of the blood clot in pulmonary artery or of one of its branches by a migrated local embolus through the bloodstream.
It acts as a plug and reduces or interrupts the blood flow to the irrigated territory of the affected bowel. If the obstruction is complete, the lung tissue necrosis, generating a pulmonary infarct.
This is one of the most frequent cases of sudden death (unexpected death that occurs in apparent good health). The frequency is increased to the hospitalized patients and it also increases with age.
Pulmonary embolism symptoms may include:
- Dyspnea (sensation of lack of air) appeared suddenly
- The sudden stabbing chest appeared becoming worse when you inhale deeply or you cough
- Increased heart rate
- Increased respiratory rate
- Coughing with sputum sanguinolent (secretion with blood coming from the airways)
- Signs of shock.
Pulmonary embolism can be difficult to diagnose because its symptoms can be identical or similar to those of other diseases such as heart attack, panic attack or pneumonia.
Also, some patients with pulmonary embolism do not have any symptoms. There are many other causes that can cause symptoms identical to those of pulmonary embolism.
Approximately 60-70% of patients present the classic pulmonary embolism signs and symptoms: chest pain of an effusion type, dyspnea often associated with sweating. Sometimes symptoms are minimal and the diagnosis is missed.
- leg pain occurs in 25% of patients with pulmonary embolism
- palpitations (due to sinus tachycardia or due to atrial fibrillation)
- angina (“right heart angina” due to increased labor of the right heart + /- hypoxia)
- syncope (through low transient cardiac debit)
These heart diseases can be mistaken often with pulmonary embolism:
- Myocardial infarction
- Heart failure or pulmonary edema
- Cardiac arrhythmia (irregular heartbeat)
Other lung diseases which may be confused with pulmonary embolism:
- Lung Cancer
- Pleurisy (collection of fluid between the two foil effusion)
- Chronic obstructive pulmonary disease
- Pneumothorax (accumulation of air in the pleural cavity with partial or total lung colabation)
And other illnesses may be confused with thromboembolism:
- The dissecting aneurysm of the aorta
- Hyperventilation (excessive ventilation)
Pulmonary embolism can be suspected whenever syncope occurs (fainting) without an obvious cause.
Sign Symptoms of Pulmonary Embolism
The pulmonary embolism signs and symptoms are not always at the forefront of the clinical picture but they are always present:
- Constant dyspnea, a form of superficial polypnea more intense, as pulmonary embolism is more severe,
- Chest pain, usually in the form of stitch basilar chest, sometimes in the form of angina-like chest pain,
- Hemoptysis, a late sign and very fickle, often limited to a few bloody sputum,
- Cyanosis is rare, and it is met only in severe forms of pulmonary embolism.
Extra-pulmonary embolism signs
- Syncope when you wake up, always a sign of severe pulmonary embolism
- Shock maiden
- Unexplained anxiety along with dyspnea,
- Fever, often delayed relative to the clinical onset,
- Acute pulmonary edema, rare, but particularly misleading,
- Abdominal pain, right upper quadrant, hepatitis can be mistaken for a surgical abdominal syndrome.
Pulmonary embolism clinical signs
These are signs that can be seen at the bedside of the patient.
Functional pulmonary embolism signs
- Dyspnea, a type of polypnea in general, present in 80% of cases,
- Chest pain (60%), pleural type 3 out of 4 times, sometimes pseudo-anginal,
- Cough: 50%
- Hemoptysis, later in general discrete (25%),
- Syncope, sometimes inaugural, in general being a criterion of severity (10%).
Sign and Symptoms of Physical Pulmonary Embolism
- Fever, moderate, 2 out of 3, sometimes with sweating,
- Cyanosis of the extremities (20%)
- Tachycardia 90/mn than 90% of cases,
- Pulmonary or pleural syndrome outbreak in 50% of cases,
- Signs of right heart failure in 30-50% of cases, producing an array of acute pulmonary heart, element of very severe pulmonary embolism,
- Hypotension, rare, maximum cardiovascular collapse with oligo-anuria, extreme gravity,
- For signs of phlebitis, particularly to the lower limbs, is systematic, but quite often negative.
Pulmonary Embolism in ECG
- It may be normal (30%) with the exception of sinus tachycardia more or less marked,
- Ischemia in epicardial anterior septal or less with negative T wave is the aspect most suggestive but not specific
- The right axis deviation is less common (10%)
- As well as the appearance of S1 Q3 (20%)
- And the right bundle branch block mat be complete or incomplete (30%)
- In all cases, Pulmonary Embolism ECG Change is important. Means the comparison with a previous ECG is important.
Radiological Pulmonary Embolism Signs
- The chest radiograph can be considered normal in 30% of cases,
- Elevation of a dome diaphragm,
- Pleural effusion in general discrete
- Hyperlucent parenchymal localized
- Dilation of the pulmonary artery, often right
- Triangular opacities (pulmonary infarction) or discoid atelectasis flat bases, evocative,
- Each of these abnormalities can occur in approximately 20% of cases.
If a massive thrombus blocks the pulmonary artery, blood flow can be completely stopped, causing sudden death. A smaller thrombus reduces the blood flow and can cause lung parenchyma. However if the thrombus is dissolved by itself, it could not produce major problems.
Pulmonary embolism symptoms usually occur suddenly. Reducing the blood flow in one or both lungs can cause shortness of breath and tachycardia (increased heart rate). Decreased oxygen levels can also cause damage such as stabbing chest and lung parenchyma. Pulmonary embolism may regress without treatment.
If pulmonary embolism is suspected you should announce your doctor or you should present to the hospital. Watchful waiting is not the right attitude in the case of pulmonary embolism.
Medical specialists recommended
The physicians who can make a diagnosis of pulmonary embolism are:
- Medical emergency
- Your cardiologist
- Surgeon: usually a general surgeon, orthopedist, vascular surgeon
- Your gynecologist: if pulmonary embolism is related to pregnancy
How to Treat Pulmonary Embolism?
Pulmonary embolism treatment uptodate
Pulmonary embolism treatment uptodate is based on the prevention of further episodes of pulmonary embolism by using anticoagulant medicines.
They prevent the already existing thrombus growth in size and the appearance of new ones.
If symptoms are severe and are life-threatening for the patient, it is required immediately an aggressive treatment. Aggressive Pulmonary embolism treatment uptodate may include thrombolytic medicines that can quickly dissolve the thrombus, but may also increase the risk of severe hemorrhage. Another option for serious cases is surgical removal of the thrombi, called embolectomy surgery, but this procedure is performed only in some large hospitals.
Some people may benefit from placing a filter in the vena cava. It can prevent thrombi to reach the lungs. The filter is used when anticoagulants can not be used, when thrombi form despite the existence of anticoagulant treatment or when there is an increased risk of death if a new episode of embolism would occur.
Outpatient Pulmonary Embolism treatment (at home)
No pulmonary embolism treatment is recommended to start at home. However it is important to prevent formation of thrombus and deep vein thrombosis because they can lead to recurrent pulmonary embolism.
The measures which decrease the risk of deep vein thrombosis are:
- Physic exercise: it can maintain good blood circulation, by bringing the feet fingertips closer to the head, so that the legs are stretched, then you relax and repeat the operation; this exercise is important especially when you sit on a chair for a long period of time (for example during long trips by car or plane)
- Mobilizing as early as possible after surgery or after an illness which required prolonged bed rest is very important; if the mobilization is not possible the exercises for calves must be carried out as described above at every hour to help the blood circulate
- Quitting smoking: this is especially important for people who follow treatment with estrogen (such as oral contraceptives)
- Use of elastic stockings to prevent deep vein thrombosis, in individuals at risk.
Pulmonary Embolism Medication choices
Drug therapy may prevent the recurrence of the pulmonary embolism episode by preventing thrombus formation and an increase in dimensions of the existing ones.
Anticoagulant drugs: are prescribed when pulmonary embolism is diagnosed or strongly suspected. Normally the appearance of a wound that causes bleeding, the body sends signals that result in the formation of a thrombus site. Thrombi dissolve as the wound heals.
A person with coagulopathy (clotting disease) shows an imbalance between production and dissolvent of thrombus. Anticoagulants prevent the production of some necessary proteins for blood to clot. Although anticoagulants can prevent new thrombus formation and their increase in size, they can not dissolve the already formed thrombi.
Heparin and warfarin are anticoagulants used in the treatment of major pulmonary embolism.
Pulmonary embolism surgery treatment
Surgical removal of thrombus is called embolectomy. This treatment method is rarely used in cases of pulmonary embolism. It is considered that thrombi from the main pulmonary artery are very large and very dangerous and can cause serious symptoms. Embolectomy may also be an option for those whose clinical condition is stable but they have signs of significant reduction of the blood flow in the pulmonary artery.
Other Pulmonary Embolism Cure ways
Some people can not follow pulmonary embolism cure with anticoagulants or they may continue to produce thrombi despite medical treatment. If it can not be used any drugs or surgery, one can use other methods for preventing pulmonary embolism, one of them being the use of vena cava filters.
The filter can be inserted in the vena cava, the vein that crosses the abdomen and brings everything back to the heart blood. This filter can prevent thrombi from the legs and from the pelvic veins to reach the lungs, thrombi which are permanent or removable.
Studies show that these filters help prevent pulmonary embolism but are more effective when used in combination with anticoagulant Pulmonary Embolism Medication.
Saddle Pulmonary Embolism
A “horse” pulmonary embolism on a bifurcation is rare and it may occur to all levels of the pulmonary arterial tree and saddle pulmonary embolism can be interlobar, inter-segmental or inter-sub-segmental.
It can also be a “horse” on the bifurcation of the pulmonary artery trunk. Symptoms are also misleading in the other pulmonary emboli but are more often signs of a suffering with a right dilatation of the atrium and of the right ventricle.
Saddle pulmonary embolisms, on “horse” on the bifurcation of the trunk of the pulmonary artery were significantly larger on the right than on the left: the length of these emboli can be very large, up to several tens of centimeters, indicating their source from a thrombosis from a large profound vein. Paradoxically, this is the kind of situation that a lower limb Doppler ultrasound may be negative, because the long thrombus may migrate into the pulmonary circulation.
Saddle Pulmonary Embolism Treatment
The natural history of saddle pulmonary embolism is determined by many factors: size and number of clots, the absence or presence of underlying cardiopulmonary disease, the appellant thromboembolism, precocity of diagnosis and correct treatment.
The saddle pulmonary embolism evolution is favorable, spontaneous regression or after an anticoagulant treatment. Pulmonary heart regresses and disappears after 7-14 days, as post-embolic pleurisy. On cardiac’s, the average congestive heart failure may worsen or trigger refractory tachyarrhythmias, both factors contributing to death.
Massive pulmonary embolism is a serious trend in the short term, but a relatively good long-term trend. Sudden death, instantaneous in 30-60 minutes after the accident embolism, accounts for two thirds of embolic death. Patients who survive the initial incident may evolve with cardiogenic shock, low cardiac output syndrome or right heart failure, for the next 1-3 days. Regression of these pathological conditions is relatively rapid, with appropriate treatment (anticoagulants).
Whatever the form of saddle pulmonary embolism small, medium or large, the recurrence is possible, usually within days after the initial episode, rarely a few weeks or months. Rates of recurrence were 20% -25% on the persons treated with anticoagulants, the risk is substantially reduced if adequate anticoagulant treatment, but greatly increased in people who are not in correct formation and expansion factors of venous thrombosis.
Pulmonary Embolism Nursing Diagnosis
Pulmonary embolism diagnosis is based on clear identification of risk factors, of deep vein thrombophlebitis, of signs and symptoms and imaging tests (venous Doppler ultrasound, echocardiography, chest radiography, computed tomography, CT, MRI, pulmonary angiography, lung scintigraphy), ECG- ECG determination (PDF of fibrin degradation products) or D-dimers in blood.
Is administered IV or albumin microspheres labeled Y. They arrive in the pulmonary capillaries and fix preferential in areas with good perfusion. A Y camera is used to scan the lungs in different incidents detecting segmental perfusion defects. A separate ventilation examination can determine if the perfusion defect corresponds to an athelectasy. Perfusion scintigraphy can give false results in case of chronic pulmonary disease, pulmonary edema or pleural exudates. Regarding the probability of pulmonary embolism scans are graded as: normal, low (<20%), intermediate or high (> 80%), depending on the number and size of the observed infusion defects.
Infusion scintigraphy must be interpreted in clinical context, when a pulmonary embolism is suspected. A careful and proper medical history and clinical examination but with a low probability scan for pulmonary embolism may correspond to the pulmonary embolism diagnosis in 40% of cases.
Pulmonary Embolim Angiography
This is an invasive diagnostic method performed by catheterization of the straight cavities and placing a catheter in each pulmonary artery. Although it involves the risk of intervention in the right cavities and hypotension to the contrast substance it has some advantages over other diagnostic methods, namely: to allow measurement of pulmonary artery pressure, help to differentiate secondary pulmonary hypertension of pulmonary embolism to pulmonary primitive hypertension, allows mechanical fragmentation of thrombus present in the pulmonary artery. Occlusions of the vascular branches can be observed or intraventricular filling defects in acute pulmonary embolism, in the chronic disease revealing the artery dilatation with small distal vessels. It requires a very precise knowledge of the pulmonary circulation to detect small pulmonary embolisms.
Pulmonary CT or the contrast substance
It is a new pulmonary embolism diagnosis method, non-invasive, the technique involving peripheral injection of contrast substance quickly followed by a spiral CT lung scan. It is useful to detect proximal pulmonary embolism because the small peripheral embolism can be omitted.
It allows the detection of pulmonary embolism without using the contrast substance. It requires a vast experience of the examiner and it is not a first line method of diagnosis.
Diagnosis of pulmonary embolism is difficult because symptoms can be attributed to other causes such as heart attacks or panic.
Correct diagnosis is based on a well-performed history and the exclusion of other diseases.
The doctor should be informed about the symptoms and other risk factors such as history and physiological hypercoagulability or recent surgery. This information, combined with a well done exam, can lead to finding the best solutions for diagnosis of deep vein thrombosis or pulmonary embolism.
The tests which are performed if the patient accuses the absence of air (dyspnea) or stabbing chest are:
- Chest radiography: its outcome removes the suspicion of dilated heart or lung injury, leading to other examinations
- Electrocardiogram (ECG) follows the electrical activity of the heart and can exclude a possible heart attack
- Blood gas measurements: rapid decrease of oxygen level may suggest a pulmonary embolism.
The results of these initial tests may rule out other causes such as heart attack and pneumonia.
The tests made for pulmonary embolism diagnosis are:
- D-dimer measurement: this is a test that measures a substance that is released when the thrombus is off; usually in patients with pulmonary embolism the D-dimer level is increased
- CT scan: is often used to diagnose pulmonary embolism
- Perfusion lung scan: This test detects an abnormal blood flow in the lungs after intravenous injection of a tracer and inspired a radioactive gas
- Pulmonary angiogram: is the surest way of diagnosing a pulmonary embolism, it is not available in smaller hospitals and is more invasive than other methods of diagnosis
- Echocardiogram: This test detects abnormalities of right ventricular size and function, which may be due to pulmonary embolism
- Doppler ultrasound: uses reflected waves to determine the presence of a thrombus in a vein of the lower limb
- Magnetic resonance imaging (MRI) may be useful in detecting thrombus in deep veins and lungs.
Pulmonary Embolism Risk Score
The presence of a thrombus in a deep vein in the legs and the existence of a previous episode of pulmonary embolism are the most important risk factors for pulmonary embolism.
Pulmonary embolism risk factors for the development of a thrombus (blood clot in pulmonary artery) are venous stasis (slow blood flow), abnormal thrombogenesis and trauma of the vessel walls. The pulmonary embolism risks are:
- Venous stasis
Thrombi grow especially when blood flow is not normal. Decreased blood circulation rate may be due to:
- Prolonged bed rest: after operations, injuries or serious diseases
- Stay in the chair for a long time, as in the case of long trips by plane
- Leg paralysis because the legs can not be moved without help.
- Abnormal thrombogenesis
Some people show a condition in which blood coagulates too fast or too easy. These people are prone to develop large thrombi which break and travel to the lungs. Conditions that may increase thrombus formation are:
- Hereditary factors (inherited) that some people inherit a tendency to hypercoagulability, which can lead to pulmonary embolism
- Heart failure
- Severe burns
- Severe infections
- Use oral contraceptives or other drugs that contain estrogen or estrogen-like hormones (similar to the structure and function of estrogen)
- Trauma to the walls of blood vessels
The blood coagulates in the arteries or in the veins probably after they were injured. Vein damage can be caused by:
- Major surgery to the legs, abdomen or pelvis
- Introduction of a central venous catheter (placing a tube into a large vein).
Other risk factors include:
- Pregnancy: risk of developing thrombi in a woman is increased during pregnancy and immediately after birth
- Age: along with age increases the probability of developing thrombi (especially over 70 years)
- Weight: overweight people have higher risk of developing thrombi
- Failure of anticoagulant treatment prescribed by a doctor.
In order for the thrombus to form, some conditions are needed, united as the Virchow’s triad:
- Blood vessel wall damage
- Slowing of blood flow speeds
- Hypercoagulability state
There are diseases that meet one of these conditions, so they can cause / precipitate a pulmonary embolism, considered risk factors:
- Genetic Diseases: Leyden factor 5 deficiency, antithrombin 3, protein C, S, antiphospholipid syndrome, others (such substances are involved in preventing thrombus formation or their decomposition)
- Hip surgery, small pool, knees, abdomen
- Multiple traumatisms
- Femoral neck fracture
- Prolonged restraint in medical services by neurological surgery, pneumonia, heart failure, myocardial infarction, hemiplegic
- Chronic obstructive pulmonary disease, hematological diseases
- Contraceptive or hormone therapy, pregnancy, birth
- Long journeys by plane
- Obesity, hypertension, diabetes
- Old age
Complications of pulmonary embolism may include:
- Sudden death
- Cardiac arrhythmia (irregular heartbeat)
- Pulmonary infarction
- Pleurisy (accumulation of fluids between the two foil the pleura)
- Paradoxical embolism
- Myocardial infarction
An aggressive stance will be taken into account when a pulmonary embolism is considered life-threatening for the patient. Death by pulmonary embolism usually occurs within 30 minutes of symptoms.
Important notes about pulmonary embolism
Pulmonary embolism is given by a thrombus (most commonly), air, fat, pieces of plaque buildup, fluid. It is a disease with high mortality level.
Oral anticoagulant therapy has as side effects bleeding, so present yourself to the doctor when you notice blood in the urine, a new heavy vaginal bleeding, red or dark stool, bleeding from the nose that does not stop, various frequent bruises.
In people with chronic pulmonary embolism oral treatment is necessary for the entire life. Inferior vena cava filter is indicated only if there is a high risk of death by pulmonary embolism or when the anticoagulant treatment is not able to be taken due to the bleeding that can occur.
What Causes Blood Clots in Legs and Lungs
Pulmonary embolism is caused by obstruction of blood clot in pulmonary arteries. The main cause of this obstruction is represented by emboli which are formed in a deep vein of the lower limbs and which circulates to the lung, where it remains stuck at a lower pulmonary artery.
Over 95% of the emboli which causes pulmonary embolism is formed proximal in the deep veins of the legs (the thigh). Emboli can also come from the deep veins of the legs – distal – (from the calf and foot), but also from the deep veins of the pelvis or upper limbs. However only 20% of emboli of the thigh increase in size, become detached and move towards the proximal areas.
Emboli rarely form in the superficial veins, but these are rare pulmonary embolism causes.
In exceptional cases pulmonary embolism can be caused by other substances than thrombi:
- Tumors resulting from the rapid growth of cancer cells
- Gaseous embolism (air bubbles in the blood resulting from trauma or surgical maneuvers)
- Amniotic fluid resulting from a normal or complicated birth (exceptional)
- Infectious substance
- Fat, which can reach the bloodstream after fractures, surgery, trauma, severe burns or other conditions
- Foreign substances such as catheter needles (which may break during surgery), mercury, iodine, cotton.
What causes pulmonary embolism?
Emboli are established bodies, most often a blood clot in pulmonary artery, more rarely, from other components:
- Detached fragment of a plaque buildup
- A group of cancer cells
- An air bubble
- Fat, cholesterol crystals
- Amniotic fluid during birth (rare)
- Some organisms (microbes, parasites)
Thrombus is composed of cells responsible for stopping the bleeding in case of cuts, wounds, called platelets or platelets and / or oxygen carrier cells, red blood cells. They are connected by a network of fibrin. It is formed, usually in the network of deep venous leg deep-vein thrombosis (DVT). Sometimes it can come off the formation place and is trained by the moving blood, meaning that it embolus towards the bloodstream of the lungs. Here it is impacting in a bowl, which shrank so much still no longer afford to move on. This situation is characteristic of pulmonary embolism.
Pulmonary embolism etiology largely overlaps with that of venous thrombosis (VT), pulmonary embolism is, in most cases, complication of deep vein thrombosis (DVT). In almost 90% of cases of pulmonary embolism its source is located in a DVT, especially located in the lower limbs.
In a proportion of cases, not exceeding 10-15%, the source of pulmonary embolism is found in the inferior vena cava thrombosis – often resulting from the extension of thrombosis in venous thrombosis in the basin and less frequently in cava thrombosis located in the upper limb higher veins or neck.
The source of pulmonary embolism may be, at less than 10% of patients, the thrombi located right in the heart, especially in cases of chronic atria fibrillation, right ventricle heart attack, cardiomyopathy, intracardiac thrombosis often coexist with VT.
Pulmonary thrombosis in situ is a rare cause of MET. It may complicate pulmonary hypertension (PAH) primitive, chronic obstructive bronchopneumonia, tumor infiltration of the arterial wall.
Pulmonary venous thrombus dislocation and embolisation is often unpredictable: after a sudden muscle contraction, when all the sudden increase of venous pressure (sneezing, coughing, defecation), after a fracture reduction maneuvers to the affected leg or after massage performed intempensively.
Since MET is preceded in most cases of the venous thrombosis, etiological factors responsible for the two pathological conditions are: venous stasis, venous wall injury and blood hypercoagulability.
Pulmonary Embolism Vs Thrombosis
The thrombi (clots) that cause thrombosis pulmonary embolism may dissolve on their own. However, after an episode of thrombosis pulmonary embolism increases the risk of relapse if the treatment is not prescribed and taken.
If the diagnosis of thrombosis pulmonary embolism is as soon as the first symptoms appear, treatment with anticoagulants (usually with warfarin and heparin) can prevent new thrombus.
The risk of developing a new episode of thrombosis pulmonary embolism (recidivism) is different at the other thrombogenic substances. Substances that are reabsorbed such as air, fat, amniotic fluid, do not increase the risk of thrombi relapsing but the cancer can significantly increases this risk.
After multiple episodes of thrombosis pulmonary embolism blood flow can be significantly reduced to the lungs and heart. This phenomenon can lead to increased pulmonary pressure (increased pressure in the pulmonary artery), right heart insufficiency and, in some cases, even death.
Signs and Symptoms of Thrombosis Pulmonary Embolism
Signs and symptoms vary in intensity and frequency and they are not specific to this disease, that means that they can occur in many other illnesses, which delays diagnosis and treatment more.
If the lung area affected is very high, death occurs before the doctor has a chance to examine the patient. Signs and symptoms depend on the size and location of the thrombi, meaning the affected tissues, the existence of cardiopulmonary disease and the association of pulmonary infarction.
The signs and symptoms are:
- Dyspnea (sensation of suffocation)
- Chest pain
- Cough with or without expectorations with blood
- Syncope (unconsciousness)
- Leg pain and / or swelling of her
- Tachycardia and tachypnea (the increased amplitude and the number of breaths per minute)
- Pallor or cyanosis
- Heavy sweating
- Anxiety and fatigue
- Wheezing (whistling expiration)
- Other evidence discovered by doctors during examination.
Pulmonary Embolism in Pregnancy PPT
During pregnancy, all clotting factors are increased, except factors XI and XIII, and antithrombin III, a major inhibitor of coagulation, is low. Pulmonary embolism pregnancy occurs in about 1 of 750 cases of pregnancies. Due to the immediate need to prevent embolism and other long-term complications of deep vein thrombosis (DVT), the latter is important to be recognized. DVT can occur during pregnancy due to iliac vein compression by the enlarged uterus and, equally, due to changes in coagulation and fibrinolysis systems that favor thrombosis.
DVT also occurs in postpartum period. Pletismography impedance and Doppler ultrasound techniques are un-radio-logical, non-invasive, useful documentation of DVT. When suspected pulmonary embolism pregnancy, lung perfusion scanning can be achieved with smaller amounts of isotopes, and pulmonary angiography can be performed if the stomach is protected. Despite the potential hazard than that entailed by the latter technique, it is extremely important to diagnose pulmonary embolism when the woman is pregnant.
Pulmonary embolism pregnancy treatment
Anticoagulant therapy is indicated in pregnant women with DVT to prevent pulmonary embolism. Heparin, which crosses the placenta and therefore does not cause fetal complications, can be administered by continuous injection at a dose of 1000 units per hour until the early period of labor. Then can be used to neutralize the effects of protamine and heparin can be restarted at 2 h after the birth and continue for 3-4 days, then subcutaneous heparin or oral treatment with warfarin may be imposed for six months. When venous thrombosis or pulmonary embolism occurs early in postpartum, treatment with heparin should be set for 7 to 10 days, followed by warfarin for approximate 3 months.
The information that I think it should be mentioned is the general risk of developing venous thrombosis or pulmonary embolism in case of treatment with oral contraceptives, which is 15-25 in 100,000 women following treatment. Risk decreases with the duration of treatment, a maximum in the first three months. As a comparison, the risk of thrombosis during pregnancy is somewhere in the hundreds (200-300) of 100,000 women, so much higher than treatment with oral contraceptives.
Intrauterine devices and only treatment with progesterone (not estrogen) does not influence the risk of venous thrombosis or pulmonary embolism pregnancy.
For some women during pregnancy is not recommended for sports, are those with thrombophlebitis, recently pulmonary embolism, those with heart disease and pregnancy “of high risk”. Depending on the disease history, your doctor may decide.
Multiple pregnancy increases the risk both for the mother and product design to develop problems during pregnancy.
With each additional fetus it raises the risk of miscarriage, preterm labor, gestational diabetes, preeclampsia, premature detachment of the placenta, placenta inserted below, urinary tract infections, anemia, birth by cesarean, pulmonary embolism (sudden occlusion of blood vessels pulmonary emboli: thrombi, amniotic fluid, etc..) and high postpartum hemorrhage.
Thromboembolism is important because it represents one of the three main causes of maternal death (except for eclampsia and bleeding). Thromboembolism risk is increased six times in pregnancy and is known for an overall incidence of 0.3-l 6% of which 20-50% occurs ante-natal. It is more common in older women with prolonged bed rest, and after cesarean. Women with lupics antibodies risks thrombosis pressure and venous (veins may occur in irregular, for example, portal vein, upper limb veins).
Small emboli may cause pulmonary embolism unexplained fever, cough, chest pain, shortness of breath. Pleurisy should be considered only in the absence of pulmonary embolism secondary high fever and purulent sputum abundant. Embolism is also manifested by the collapse of chest pain, dyspnea and cyanosis. PVJ growth can occur after the third heart sound and breath.
Pulmonary Embolism X-Ray pictures