Nutrition and treatment for thromboembolism. Pulmonary embolism, symptoms, treatment, complications

Date: 10.04.2019

Mortality from cardiovascular disease confidently holds first place. Older people are usually susceptible to such ailments, but often pathological processes are detected at an early age.

Thromboembolism of the pulmonary artery is especially difficult in diagnosis due to the absence of specific signs.

Pulmonary embolism (PE), what is it?

Pulmonary embolism (PE) is a blockage of the pulmonary artery or its branches, which forms (most often) in large veins lower limbs.

Embolism refers to a disorder accompanied by circulation in vessels unusual for normal state elements. A blood clot is a blood clot that results from clotting. The coagulation process is vital because it clogs up damaged vessels. But pathological coagulation is also possible, due to a number of reasons.

If a floating thrombus forms in the veins of the lower extremities or small pelvis (weakly attached to the vessel wall), it is likely to break off and move to the heart and into the pulmonary artery bed.

At large sizes lump is able to clog large vessels, and with small - reaches small capillaries, where it gets stuck. Thus, the essence of pulmonary embolism (PE) is the blockage of pulmonary vessels with blood clots.

Causes, symptoms and first signs of thrombophlebitis of the lower extremities:

The cause of the disease is one - a blood clot interferes with normal blood flow and gas exchange in the lungs. This provokes a reflex vasoconstriction and, as a consequence, an increase in pressure in the pulmonary artery and an increase in the load on the right ventricle. Doctors name 3 factors that contribute to the development of this pathology:

Too low blood flow velocity in the lower extremities and pelvis.
Damage to the endothelium of the vascular wall.
Increased blood coagulation.

Each of these factors (together or separately) provokes pulmonary embolism. Doctors see the reasons for the decrease in the speed of blood flow in primary diseases, which include the destruction of the valves of the veins. In addition, there is a likelihood of pressure on the vessels from the outside - for example, in the event of a tumor. Such a neoplasm is quite capable of pinching a vein and causing blood stasis.

It is impossible to write off the sedentary lifestyle - perhaps the only factor in the anamnesis, which is the result of a person's negligent attitude to health.

Violation of the integrity of the endothelium itself triggers coagulation. Damage can occur both during surgery and in the event of physical injury. A variant of the effect of leukocytes is possible, which are especially activated during the inflammatory process in the body. In addition, toxins and viruses can also damage the endothelium.

Increased blood clotting usually provokes high level fibrinogen - a special protein responsible for the formation of blood clots.

If the blood plasma contains little water and many corpuscles, the likelihood of coagulation increases significantly. In turn, the number of erythrocytes, platelets and other cells increases with polycythemia, therefore, PE can be considered a secondary disease.

What is fibrinogen, blood levels and what is the danger of its high level:

Acute pulmonary embolism occurs when a large blood clot is blocked, and the risk of death is 15%. But small blood clots are not so dangerous, although they, of course, cannot be ignored. In general, doctors divide pathology into 3 types, which are characterized by the degree of vascular lesions and the corresponding symptoms of PE:

1. Non-massive(clogged< 30% сосудов):

cough;
slight increase in temperature;
chest pain;
hemoptysis
lung infarction.

2. Submassive(30-50% of vessels are clogged):

increased pressure in the pulmonary artery;
failure of the right ventricle.

3. Massive(blocked> 50% of the pulmonary arteries, including the largest):

hypotension (pressure less than 90/50);
dyspnea;
tachycardia (heart rate over 100 beats / min);
fainting.

With a non-massive form of pulmonary embolism, symptoms are often absent, so the patient may not even be aware of his disease. More pronounced signs force you to go to the hospital, however, doctors do not immediately understand the cause of the disorder.

Diagnosis of pulmonary embolism

A quick examination and conversation with the patient will not provide any worthwhile information. The fact is that this pathology has no specific signs, therefore it is often confused with myocardial infarction, cor pulmonale, and other diseases. With such symptoms, doctors first of all prescribe electrocardiography, but even this method will not always give an unambiguous answer. ECG signs of PE (albeit indirect) are as follows:

Sinus tachycardia.
Overload of the right atrium and ventricle.

X-ray examination is more informative. The picture usually shows the dome of the diaphragm, increased on the side of the lung, in which there was a blockage of blood vessels. In addition, an increase in the right heart and the largest pulmonary arteries is also noticeable. If the image shows a cone-shaped seal (Hampton's triangle), then there is every reason to suspect a pulmonary infarction.

ECG and radiography are usually used to exclude other pathologies, but modern medicine also has special methods in its arsenal:

1. Determination of the amount of d-dimer (degradation product of fibrin):

if the concentration of a substance is less than 500 μg / l, then it is unlikely that the disease is pulmonary embolism;
the method does not give a precise answer.

2. Echocardiography:

reveal a violation of the right ventricle;
there is a chance of finding blood clots right in the heart;
discovered oval window explains the violation of hemodynamics.

3. Computed tomography:

apply contrasting;
create a volumetric image of the lungs;
effectively detect blood clots.

4. Ultrasonography:

study the speed of blood flow in the veins of the lower extremities;
the cross-section of the veins is examined.

5. Scintigraphy:

identify areas of the lungs in which blood does not flow well;
used when computed tomography is prohibited;
excludes pulmonary embolism in 90% of cases.

6. Angiography of the vessels of the lungs:

the most accurate method;
reveals blood clots and constricted vessels;
invasion is required, therefore there are certain risks.

Signs of pulmonary embolism do not always indicate this pathology - doctors need time to conduct a full examination of the patient. And only after confirming the diagnosis, they start treatment.

The prothrombin test is part of a blood clotting test to assess the rate of clotting:

If a person is admitted to the hospital in a fainting state, with reduced pressure, rapid pulse and severe shortness of breath - he is immediately placed in the intensive care unit.

If pulmonary embolism is suspected urgent care consists in the normalization of gas exchange within the respiratory system. This requires artificial ventilation of the lungs with oxygen, and as additional measures vasopressors (for example, adrenaline) are injected intravenously to somehow increase the pressure.

After primary care the patient is thoroughly examined. If PE is confirmed, treatment is prescribed as follows:

1. Reduce blood clotting:

non-fractional heparin (intravenous);
fondaparinux and low molecular weight heparin (administered subcutaneously, contraindicated in renal failure);
direct anticoagulants are treated for at least 5 days;
dosages are individual and depend on the patient's weight;
indirect anticoagulant Warfarin is used 3 months after the end of the intensive course.

2. Reperfusion therapy(removal of blood clots by medication):

drugs - Streptokinase, Alteplase, etc.;
the danger lies in the high risk of bleeding, incl. and intracerebral.

3. Surgical intervention:

in the area of the renal veins, special cava filters are installed to trap blood clots;
filters are inserted into the femoral or jugular vein through the skin.

First of all, they try to help the patient with medications, however, medications have a number of contraindications that must be followed without fail. There may be such a situation that the drugs simply do not lead to the desired result. In such cases, only surgical intervention remains.

Conclusion

Although pulmonary embolism is difficult to diagnose, there are effective methods treatment of pulmonary embolism. But, in some cases, the patient's condition is so neglected that it cannot be saved. Therefore, if you have chest pains, rapid heartbeat and shortness of breath, you should immediately go to the hospital.

Thrombosis is dangerous disease vessels, in which blood clotting increases, clots form in the vessels, blood circulation is disturbed. Thrombosis is often confused with a disease such as thrombophlebitis.

In the absence of proper treatment vascular disease causes dangerous complications (), up to death.
Vascular disease is treated in a comprehensive manner, one of the main points of therapeutic effect is diet. Proper nutrition is necessary to correct weight, reduce blood viscosity, cleanse and strengthen blood vessels.

Diet principles

Diet for thrombosis is designed to solve the following problems:

Weight loss in overweight patients.
Stool normalization.
Cleansing blood vessels, increasing their strength.
Stimulating metabolism.

Patients are transferred to a special diet for 3 to 4 weeks. With the help of a diet, you can achieve a significant improvement in the patient's condition. In addition, doctors recommend arranging fasting days twice in 7 days.

Nutrition is adjusted depending on the medications prescribed by the doctor. This is because some foods reduce the effectiveness of drugs. For example, while taking Warfarin, it is forbidden to eat garlic. For this reason, the doctor makes the decision to change the menu.

Allowed Products

Patients with thrombosis are advised to saturate the body with omega-3-unsaturated fatty acids, which are found in sea fish and shellfish. Tocopherol has a beneficial effect on blood vessels, has an antioxidant effect, prevents the formation of blood clots. You can find this vitamin in following products: cashews, sea buckthorn, dried apricots, sprouted grains, oatmeal and barley grits. Saltwater fish also contains vitamin E.

It is very important to enrich your diet with fresh fruits and vegetables.

Diet for deep vein thrombosis of the lower extremities should include the following foods:

Onions are necessary to inhibit congestion, stimulate the dissolution of blood clots. In addition, the vegetable reduces the clotting effect of fatty foods. To block fat, doctors say, you only need to eat half a medium onion.
Red grapes contain resveratrol. This substance prevents the accumulation of platelets.
Berries can be eaten fresh or frozen.
Ginger contains gingerol, which is a blood thinner.
Gingko biloba stimulates blood circulation, dilates blood vessels, makes them more durable.
Fish oil with omega-3, 6 fatty acids breaks down fibrin, which causes blood clots. In addition, the substance reduces the viscosity of the blood.

The patient's diet should include vegetables (tomatoes, paprika, beets, because they dissolve blood clots. Doctors say that the lowest concentration of fibrinogen (a protein that converts fibrin into blood clots) is in vegetarians.

A patient with thrombosis can eat lean meat three times in 7 days. In this case, the product can be boiled or steamed.

List of prohibited foods

During treatment, you should avoid foods that slow blood flow, contribute to platelet accumulation and the formation of blood clots.
For the period of the diet, foods that contain vitamin K are excluded from the daily menu. This is due to the fact that this element provokes an increase in blood viscosity and increases the risk of blood clots.

Patients prone to thrombosis should completely exclude fast food from the menu.

Nutrition for thrombosis should be beneficial, for this reason, the patient should refuse the following foods:

All types of nuts (except cashews).
Smoked, canned products.
Sweets.
Salty foods that retain fluid in the body.
Alcoholic drinks.
Berries are blue or purple in color (for example, black currants).
White grapes, pomegranate.
Rosehip, mountain ash.
Bananas.
Fatty meat broth.
Pork, beef liver, kidneys, heart, lungs.
Fermented milk products with a high percentage of fat.
Convenience food, fast food that contains trans fats and low-density cholesterol.
Sausage, sausages, wieners.
All kinds of cabbage, spinach.
Legumes.
Toning drinks (coffee, tea).

The above products increase the viscosity of the blood, as a result, platelets become sticky and form a blood clot.

Sample menu

The dietitian will help the patient to compose the most suitable menu, depending on the prescribed drugs. Approximate diet for a patient for 3 days.

Proper nutrition will help prevent leg vascular problems

1 day:

Breakfast - fruit or berry oatmeal in water with the addition of honey and unsweetened green tea.
Lunch - soup with vegetables, boiled potatoes, 200 g of baked fish, compote.
Afternoon snack - any fruit (not bananas).
Dinner - vegetable stew, tomato and cucumber salad, tea.

2nd day:

Buckwheat porridge on the water, tea.
Fish soup, boiled meat (chicken), vegetable salad, compote.
Fruit and 100 g cashews.
Boiled rice, vegetable salad, jelly.

Day 3:

Oatmeal, freshly squeezed juice.
Soup with vegetables, boiled meat, vegetable salad, jelly.
Pumpkin or sunflower seeds, any fruit.
Buckwheat porridge, vegetable salad, tea.

After treatment, the patient can eat different foods, but junk food should be discarded.

To improve the effectiveness of the diet, the patient must follow these rules:

Observe physical activity to prevent congestion. Dancing, swimming, walking will improve blood circulation. Serious load on the legs is contraindicated (squats with weights).
It is forbidden to take a hot bath.
You should give up tight clothes, corsets, socks, shoes. The permissible heel height for thrombosis is about 4 cm.
The patient must give up cigarettes and alcohol, otherwise the likelihood of developing inflammatory processes increases.
During the flight on the plane, it is worth wearing compression underwear.
It is recommended to consume at least 1.5 liters of liquid (filtered water, natural juices, compote).

Thus, deep vein thrombosis of the legs is a serious disease that threatens dangerous complications... Diet is an important component of comprehensive therapy. The patient must follow the recommendations of the nutritionist and lead healthy image life. Only in this case it will be possible to speed up recovery.

Pulmonary embolism, or PE, is one of the most common cardiovascular diseases. Pathology is expressed in the clogging of one of the pulmonary arteries or their branches with blood clots (thrombi), which often form in the large veins of the legs or pelvis. Rarely enough, but still there is the appearance of blood clots in the right heart chambers and veins of the hands.

The disease develops, as a rule, rapidly, often ends sadly - leading to the death of the patient. TELA ranks third ( after pathologies such as ischemic disease heart and stroke) among the causes of death associated with cardiovascular disease. Most often, pathology occurs among the elderly. According to statistics, mortality from the consequences of PE among men is almost one third higher than among women.

The likelihood of death of the patient is possible after pulmonary embolism, which has developed due to surgery, trauma, generic activity... In case of pulmonary embolism, treatment started on time can achieve a significant (up to 8%) reduction in the death rate.

The reasons for the development of PE

The essence of thromboembolism is the formation of blood clots and their subsequent obstruction of the arterial lumens.

In turn, blood clots develop against the background of certain conditions, among which the main causes of PE are distinguished:

Impaired blood flow. Disruptions in blood supply arise as consequences:

varicose veins,
squeezing blood vessels external factors(cyst, tumor, bone fragments),
transferred phlebothrombosis, the consequence of which is the destruction of the valves of the veins,
forced immobility, disrupting the correct functioning of the muscular and venous systems of the legs.

In addition, the movement of blood in the body slows down, as its (blood) viscosity increases.... Polycythemia, dehydration, or an abnormal increase in red blood cells in the blood are factors that affect the increase in blood viscosity.

Damage to the inner wall of the vessel, accompanied by the launch of a number of blood coagulation reactions. The endothelium can be damaged due to vein prosthetics, catheter placement, surgery, and trauma. Viral and bacterial diseases sometimes provoke endothelial damage. This is preceded by the active work of leukocytes, which attach to inner wall vessels, injure her.
Also, with pulmonary embolism, the reason for the development of the disease is inhibition of the natural process of dissolution of blood clots (fibrinolysis) and hypercoagulation.

The main risk factors for PE include:

Prolonged immobilization (long-distance travel, prolonged and forced bed rest), respiratory and cardiovascular insufficiency, as a result of which the movement of blood through the body slows down, venous stasis is observed.

It is believed that immobility for even relatively short periods of time increases the risk of so-called "venous thromboembolic disease".
The use of a considerable amount of diuretics. Against the background of taking such drugs, dehydration develops, the blood becomes more viscous. It also increases the intensity of blood clotting by taking certain hormonal drugs.
Cancers.
Varicose veins of the legs. The development of this pathology of the lower extremities contributes to the occurrence of blood clots.
Diseases accompanied by incorrect metabolic processes in the body ( diabetes, obesity).
Surgical intervention, installation of a catheter into a large vein.
Injuries, bone fractures.
Carrying a baby, childbirth.
Age after 55 years, smoking, etc.

PE classification and pathology development mechanism

There are three main types of pulmonary embolism:

Massive. This type of PE is characterized by the fact that it affects more than half of the vessels in the lungs. Consequences - shock, systemic hypotension (decrease in blood pressure).
Submassive. It is accompanied by a lesion of more than 1/3, but less than half of the volume of the vessels of the lungs. The main symptom is right ventricular failure.
Non-massive. Less than 1/3 of the pulmonary vessels are affected. With this type of pulmonary embolism, symptoms are usually absent.

Let's pay more attention to the pathogenesis of PE. Embolization is provoked by blood clots that are in the vein and are not securely held by its wall. Having separated from the wall of the vein, a significant size thrombus or a small embolizing particle, along with the movement of blood, pass through the right side of the heart, then ending up in the pulmonary artery and closing its passage. Depending on the size of the detached particles, how many of them and the response of the body, the consequences of blockage of the lumen of the pulmonary artery are varied.

Stuck in the lumen of the pulmonary artery, small particles do not provoke almost any symptoms. Larger particles impede the passage of blood, which entails improper gas exchange and the occurrence of oxygen starvation (hypoxia). As a result, pressure rises in the arteries of the lungs, the degree of congestion of the right ventricle increases significantly, which can result in acute failure of the ventricle.

The clinical picture of the disease

With pulmonary embolism, the symptoms, treatment of pathology depend on the initial state of the patient's body, the number and size of blocked pulmonary arteries, the rate of development of the pathological process, the degree of pulmonary blood supply disturbances. TELA is characterized by various clinical conditions... The disease can proceed without showing almost any noticeable symptoms, but it can also lead to sudden death.

In addition, the symptoms of PE are similar to those accompanying other diseases of the heart and lungs. In this case, the main difference in symptoms in pulmonary embolism is their sharp occurrence.

With standard PE variation, the symptoms are often as follows:

On the part of the cardiovascular system:

Vascular insufficiency. It is accompanied by a decrease in blood pressure, tachycardia.
Sharp coronary insufficiency... She is accompanied by strongly palpable and with varying duration of pain behind the sternum.
Acute cor pulmonale (pathology that occurs in the right heart region). As a rule, it is typical for a massive PE version. It is accompanied by a rapid heartbeat (tachycardia), while the veins of the cervical region swell strongly.
Acute cerebrovascular insufficiency. It is characterized by malfunctioning of the brain, insufficient blood supply to the brain tissues. The main symptoms are vomiting, ear noise, loss of consciousness (often accompanied by convulsions), sometimes falling into a coma.

Pulmonary:

... She is accompanied by pronounced shortness of breath, cyanotic skin or a change in their color to ashy gray, pale.
Bronchospastic syndrome. The main distinguishing feature is the presence of dry wheezing with whistling.
Lung infarction. He is accompanied by shortness of breath, cough, chest pain during breathing, fever, hemoptysis. When auscultation of the heart using a stethoscope, characteristic rales of a moist character, weakening of respiration are heard.

Fever. Increased body temperature (from subfebrile to febrile). It develops as a response to inflammatory processes in the lungs. Lasts up to 2 weeks.
Abdominal Syndrome. Appears due to acute swelling of the liver. She is accompanied by vomiting, belching, pain in the right hypochondrium.

Diagnosis of the disease

It is quite difficult to diagnose PE, since the pathology has nonspecific symptoms, and diagnostic methods are far from perfect. However, in order to exclude other diseases, first of all, it is customary to carry out a number of standard diagnostic methods: x-ray of the sternum, ECG, laboratory research including measurement of the d-dimer level.

At the same time, the doctor is faced with a difficult task, the purpose of which is not only to find out the presence of pulmonary embolism as such, but also to determine the place of blockage, the extent of damage and the patient's condition in terms of hemodynamics. Only in the presence of the obtained data is it possible to create a competent and functional patient therapy program.

Patients with possible pulmonary embolism often undergo the following diagnostic methods:

Clinical and biochemical blood tests.
Measurement of the level of d-dimer (a protein in the blood after the destruction of a blood clot). With an adequate d-dimer value, the patient has a low risk of pulmonary embolism. At the same time, it should be noted that the establishment of the d-dimer level is still not entirely accurate. diagnostic method, since an increase in d-dimer, in addition to the likely development of pulmonary embolism, can also indicate many other diseases.

ECG, or electrocardiography in dynamics. The purpose of the examination is to exclude other heart diseases.
X-ray of the sternum organs in order to remove suspicions of rib fracture, tumor, pleurisy, primary pneumonia, etc.
Echocardiography, which detects the malfunctioning of the right ventricle of the heart, pulmonary hypertension, blood clots in the heart.
Computed tomography, thanks to which it is possible to detect the presence of blood clots in the pulmonary artery.
Deep vein ultrasound. Allows you to detect blood clots in the legs.
Scintigraphy - detects areas of the lung that are ventilated but not supplied with blood. This method is indicated if there are contraindications to CT.
Angiography (contrast X-ray examination). One of the most accurate diagnostic methods.

Treatment of the disease

The main tasks of physicians in the treatment of patients with pulmonary embolism are resuscitation actions aimed at saving a person's life, as well as the maximum possible restoration of the vascular bed.

Elimination of the consequences of the acute stage of pulmonary embolism consists in the elimination of the pulmonary embolus or lysis (destruction) of a thrombus, expansion of collateral (lateral, non-main) pulmonary arteries. In addition, it is supposed to carry out symptomatic therapeutic interventions, aimed at preventing the occurrence of consequences formed as a response to impaired blood circulation and respiration.

Conservative treatment

Successful conservative treatment pathology consists of the appointment of drugs fibronolytics or thrombolytics ( thrombolytic therapy - TLT) by introducing them through a catheter into the pulmonary artery. These drugs are able to dissolve blood clots inside the vessels thanks to streptase, which penetrates into the blood clot and destroys it. That is why, a few hours after the start of taking the drugs, an improvement in the general condition of a person is observed, and after a day - almost complete dissolution of blood clots.

Fibronolytic drugs are indicated for fast-flowing pulmonary embolism, massive pulmonary embolism with an active blood circulation at a minimum level.

At the end of therapy with fibronolytic drugs, the patient is shown taking heparin... Initially, the drug enters the body in smaller doses, and after 12 hours, the amount of heparin is increased 3-5 times compared to the initial one.

As a prophylactic agent, heparin (direct anticoagulant), together with phenylin, neodecoumarin or warfarin (indirect anticoagulants), prevents the occurrence of blood clots in the affected area of the lung, minimizes the risk of the appearance and growth of other venous blood clots.

For submassive pulmonary embolism, doctors prefer heparin because it can block blood clotting almost instantly (as opposed to indirect anticoagulants, which do not act as quickly).

Nevertheless, despite the "slowness" of indirect anticoagulants, it is recommended to connect Warfarin at the beginning of treatment. Typically, warfarin is given with a supportive, small dose, which is subsequently revised, taking into account the results of a special analysis. Warfarin should be consumed for at least 3 months. Indirect anticoagulants can penetrate the placenta and negatively affect the development of the fetus, therefore, taking Warfarin is contraindicated during pregnancy.

All patients with pulmonary embolism are shown to carry out a massive combined,

Treatment aimed at restoring the whole body and pulmonary arteries:

cardiac therapy (Panangin, Obzidan);
the appointment of antispasmodics (No-shpa, Andipal, Papaverin);
correction of metabolism (vitamin B);
anti-shock treatment (hydrocortisone);
anti-inflammatory therapy (antibacterial drugs);
the appointment of expectorant, antiallergic drugs and analgesics (Andipal, Diphenhydramine).

Many of the drugs presented, for example, Andipal, have a number of contraindications. Therefore, Andipal and therapeutic drugs are prescribed carefully to pregnant women and other categories of patients at risk.

Therapy is carried out mainly by drip intravenous infusion of drugs (with the exception of drugs such as Andipal, which is taken orally). Fibrinolytic treatment involves injections into the system to intravenous administration, insofar as intramuscular injections are able to provoke the appearance of large bruises.

Surgical intervention

In situations where, despite the ongoing thrombolytic therapy for PE, the expected result from treatment is not observed for an hour, embolectomy is indicated (elimination of emboli surgically). The operation is performed in a specially equipped clinic.

The prognosis of treatment depends, first of all, on the severity of the patient's condition and the massiveness of the pathology.

Usually, at 1 and 2 degrees of severity of PE, the prognosis is favorable, with a minimum number of deaths and a high probability of almost complete recovery.

It should be noted that thromboembolism of small branches of the pulmonary artery has the likelihood of recurrent pulmonary infarctions and, as a result, the development of the so-called chronic cor pulmonale.

However, grade 3 or 4 pathology is capable, when timely therapeutic or surgical assistance is not provided, to lead to instant death.

Video

Video - pulmonary embolism

Prevention of pathology

PE prophylaxis is necessary for all patients with a high likelihood of complications from this pathology. In this case, the degree of risk of thromboembolism is assessed individually for each patient and surgical intervention. Accordingly, the primary and secondary prevention TELA are also selected individually.

Bedridden patients are shown regular holding prevention of phlebitis and phlebothrombosis of the legs and pelvis by walking, getting up as early as possible, the use of special devices that improve blood flow in such patients.

Among medications allocate:

Subcutaneous injection of heparin in small doses. A similar method of preventing pathology is prescribed a week before surgery and continues until the patient is fully physically active.
Reopoliglyukin. It is introduced during surgery. Not recommended due to possible anaphylactic reactions for patients with allergies and patients with bronchial asthma.

TO preventive methods surgical orientation include the installation of special clips, filters, special sutures on the vena cava instead of ligation. People who may have a relapse of the disease can use such methods in order to minimize the likelihood of recurrence of the pathology.

Today, the consequences of thromboembolism cannot be completely eliminated. However, competent rehabilitation, including sanatorium and resort treatment, subsequent medical examination (it is necessary to be registered at the clinic) and prevention can minimize the clinical manifestations of pathology.

Patients prone to blood clots in the lower extremities are strongly advised not to neglect the wearing of compression stockings. These items of clothing promote better blood circulation in the legs and prevent blood clots.

And, of course, an excellent prevention of not only thromboembolism, but also many other diseases will be proper nutrition, and, if necessary, adherence to a certain diet. Competently selected balanced diet with PE, it contributes not only to the formation of a normal consistency of blood, but also to the fact that in the presence of excess weight, a person loses weight and feels much better.

A healthy lifestyle, constant control of body weight (if necessary, weight loss), as well as timely treatment of various infectious diseases are equally important.

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Treatment of pulmonary embolism (PE), its diagnosis is an important task of medicine. High mortality in PE is caused by the rapid development of the disease, many patients die within the first 1-2 hours, the reason is that adequate treatment has not been received. The pathology has become widespread due to the fact that the etiology includes many factors. The pathogenesis of PE (thromboembolism) includes 3 stages. In the first period goes thrombus formation in the veins of the systemic circulation. In the second period, there is a blockage of the vessels of the small circle. In the third period, they develop clinical symptoms.

How blood clots form

There are three main reasons:

Signs of damage to the vascular wall. Thrombus formation due to this reason can be called a natural process. This cause leads to thromboembolism due to the fact that there was a long-term treatment in the form of surgical interventions.
Slowing blood flow. Blood circulation slows down in the systemic circulation during pregnancy, varicose veins are the main reasons. Red blood clots are formed, consisting of filaments of fibrin and erythrocytes - thromboembolism develops.
Thrombophilia - This cause makes the body prone to the formation of blood clots. Thrombus formation is associated with factors that activate this process and interfere with it. An excess of the former or a lack of the latter is a provoking syndrome, which causes thromboembolism.

Blockage of blood vessels by thrombus

The torn off blood clot reaches the heart through the veins, passes through the atrium and the right ventricle, and enters the pulmonary circulation. There is a complete or partial blockage of the branches of the pulmonary artery, which causes the main symptoms of an ailment such as thromboembolism. The lungs are no longer supplied with food, and this cause leads to respiratory and hemodynamic disturbances in pulmonary embolism. As a result of blockage and increased pressure, blood clotting increases. Due to the occurrence of conditions for thrombus formation, complication symptoms develop, additional thrombosis of small vessels and capillaries occurs. And the release of vasoactive substances (histamine, serotonin) increases the narrowing of the bronchi. As a result respiratory distress when PE is aggravated, and treatment should be started as soon as possible.

As you can see, even a reason such as a slight blockage of the lungs leads to a chain, cascade reaction, due to which the patient's condition may worsen within 1-2 days. Also, PE can be complicated by other diseases (pneumonia, pleurisy, pneumothorax, chronic emphysema, and others). If there is a thromboembolism of the small branches of the pulmonary artery, then the body can compensate for the pathology at the expense of other vessels.

Thromboembolism classification

PE classification takes into account the severity of the disease, the localization of the embolus, and the rate of flow.

By localization

The classification takes into account the level of vascular occlusion, which determines how severe the symptoms will be:

Grade 1 (mild) - embolism occurs at the level of small branches.

Grade 2 (medium) - thromboembolism affects the level of segmental branches.

Grade 3 (severe) - thrombopulmonary pathology of the lobar branches.

Grade 4 (extremely severe) - a thrombus clogs the trunk of the pulmonary artery or its branches.

By severity

Depending on the proportion, the number of affected vessels of pulmonary thromboembolism, the severity of the course of pulmonary embolism changes:

Small PE - up to 25%. Symptoms are limited to shortness of breath and coughing.

Submassive PE - from 25 to 50%. Symptoms are supplemented by severe right ventricular failure, but arterial pressure normal.

Massive - from 50% to 75%. An extremely serious condition is observed, the main symptoms are low blood pressure with tachycardia, increased pressure in the arteries of the small circle. Is developing cardiogenic shock(extreme degree of left ventricular failure), acute right ventricular failure. Treatment must be urgent.

Fatal PE - more than 75%. Death ensues.

By the speed of the current

PE is divided into acute, recurrent and chronic forms.

Lightning fast. Thromboembolism of this form occurs with instant and complete blockage of the pulmonary artery trunk. Symptoms develop rapidly: breathing stops, collapse instantly develops (loss of consciousness, pallor, low pressure) and signs of ventricular fibrillation. Death with PE of this type occurs within 1-2 minutes, other symptoms do not have time to develop. Timely treatment is of great importance in this case

Sharp. Occurs when large lobar or segmental pulmonary vessels are blocked - this is the main cause. Pulmonary embolism of this form arises and develops quickly; following symptoms- shortness of breath, heart rate increases, hemoptysis appears. If there is no treatment, then after 3-5 days an infarction reaction will develop.

Subacute. Symptoms are the same, but increase within 2-3 weeks, occurs with blockage of the middle pulmonary arteries. If treatment is not prescribed on time, symptoms escalate and lead to death from PE.

Recurrent PE. It develops against the background of cardiovascular, cancer pathologies, at the postoperative stage - this is a common cause. Often, the syndrome gradually increases, becoming stronger, complications occur (symptoms of bilateral pleurisy, pneumonia, pulmonary infarction appear). Treatment should take into account all the causes of the development of the disease.

Etiology of the disease

The immediate etiology of pulmonary embolism is the formation of a blood clot or getting into big circle blood circulation of other emboli (neoplasms, gas, foreign bodies). A common etiology is deep vein thrombosis (DVT). As a result, 40-50% of patients sooner or later develop symptoms of such a pathology as pulmonary embolism.

A common etiology is deep vein thrombosis (DVT).

The etiology of PE includes factors that can be divided into congenital (genetic abnormalities) and acquired (diseases, various physiological conditions).

Acquired

Most factors increase the risk of developing pathologies such as DVT and PE (pulmonary embolism) by less than 1%. But a combination of 3-4 points should alert, especially people over 40 need to take care of their health, treatment will help to avoid complications.

Acquired factors:

Treatment using surgery.
Taking oral contraceptives and HRT, estrogens.
Pregnancy and childbirth.
Sedentary lifestyle, overweight.
Malignant tumors, infection, burns.
Nephrotic syndrome and stroke.
Heart failure.
Varicose veins veins.
Treatment with artificial tissue.
Regular long distance air travel.
Inflammatory diseases intestines.
Systemic lupus erythematosus.
DIC syndrome.
Lung disease and smoking.
Treatment with contrast agents.
The presence of a venous catheter.

Often, blood clots in pulmonary embolism form after surgery. The reason is simple - surgeons cut the skin, along with the capillaries, and sometimes the vessels. As a result, blood clotting factors are released. Due to the high degree of danger after surgery, vascular studies are carried out for the risk of thrombosis and, if necessary, appropriate treatment.

Often, blood clots in pulmonary embolism form after surgery.

A low risk of blood clots is possible if treatment involves minimal surgery in people under 40 years of age without congenital thrombophilia. Average level risk - in people from 40 to 60 years old or in patients with congenital thrombus formation factors. High risk of thrombosis - if surgical treatment was performed in people over 60 years old or during large-scale interventions in patients with congenital thrombophilia factors.

Congenital

People with congenital factors should also pay attention to the condition of the veins. Conditions with a predisposition to thrombosis and the formation of pulmonary embolism are divided into:

Vascular thrombophilia. Conditions with damage to the walls of arteries and veins (atherosclerosis, vasculitis, aneurysms, angiopathy, etc.).
Hemodynamic thrombophilia. Various intensity of circulatory disorders due to myocardial damage (the main reason), anomalies in the structure of the heart, local mechanical obstacles.
Blood thrombophilia. Disorders of blood clotting factors.
Violation of the mechanisms that form blood clots, regulate their formation and dissolve the excessive formation of hemocoagulant.

The first reason, just like the second, often develops due to other ailments, but it can also be of a genetic nature. The third group is an immediate congenital factor for thrombus formation. Thrombophilia can be suspected and appropriate treatment can be prescribed in the presence of heart attacks (lung, heart), thrombosis in the past.

Clinical manifestations

Symptoms of a pathology such as PE depend on the nature and severity of the course of the disease, hemodynamic disturbances, and the rate of development. There are no characteristic clinical symptoms that would be present in all types of pulmonary embolism. Also, thromboembolism is often complicated pulmonary diseases(there are symptoms of pleurisy, pneumonia, pneumothorax and others), effective treatment which is also important.

The most common symptoms are associated with pain (58-88%), which develops in half of cases. Most patients complain of a sharp, intense pain that occurs with acute thromboembolism... At chronic course symptoms are subtle, characterized as "discomfort behind the breastbone", are not always present. Severe tearing chest pain occurs with embolism of the main trunk of the pulmonary artery.

A symptom such as pain that intensifies when breathing or coughing indicates a pulmonary infarction. It is created due to the appearance of reactive pleurisy. These symptoms occur 2-3 days after the onset of the development of the disease. Stitching and cutting pains in the chest during breathing, swallowing, coughing or shortness of breath accompany thromboembolism in most situations.

Increasing pain when breathing or coughing, indicates a pulmonary infarction.

Syndrome with pain in the right hypochondrium rarely occurs with pulmonary embolism. This painful sensation occurs due to swelling of the liver (the etiology of an enlarged liver is right ventricular failure).

Dyspnea

Pulmonary embolism in most situations (70-85%) develops with shortness of breath. She is inspirational, appears suddenly. Its causes are blockage of large pulmonary arteries and the resulting oxygen deficiency. A gradual, within 2-3 weeks, increase in shortness of breath indicates subacute or chronic thromboembolism.

Tachycardia

The third most common syndrome is tachycardia, which occurs in about half of patients with PE (30-58%). The syndrome is characterized by a heart rate of 100 beats per minute. Heart palpitations occur suddenly, intensify over time, and can cause death if treatment is delayed.

Cyanosis

With blockage of small branches, cyanosis is noticeable on the wings of the nose, lips, mucous membrane oral cavity... With blockage of the lobar and segmental vessels, pallor of the skin of the face and neck is noted, which takes on an ashy color. Massive pulmonary embolism comes with severe cyanosis that extends only to the upper half of the body.

Fainting

Symptoms such as cerebral hypoxia and fainting develop with massive thromboembolism. Cerebral disorders are varied. Dizziness, drowsiness, vomiting, fear of death, and anxiety because of this are common. There are disturbances of consciousness of various depths, confusion of thoughts, psychomotor agitation can be expressed by convulsions.

Cerebral hypoxia can cause fainting.

Cough and hemoptysis

At first, the cough with PE is dry, without discharge. After 2-3 days, it turns into wet, often appears characteristic syndrome- hemoptysis. Pulmonary embolism often occurs with hemoptysis, so the symptom is quite reliable, but it does not appear immediately and develops in only 30% of cases. Usually hemoptysis is not massive, in the form of small veins, blood clots in the sputum.

Temperature increase

A common syndrome, but it does not appear immediately, develops in 2-3 days. In addition, the symptom is nonspecific and indicates a variety of diseases. The body temperature rises due to inflammation in the lungs or pleura. With pleurisy, the temperature rises by 0.5-1.5 degrees, with a lung infarction - by 1.5-2.5 degrees. The temperature lasts from 2 days to 2 weeks.

Research options

Since there are no reliable symptoms that accurately indicate the disease, the diagnosis is made solely on the basis of instrumental research methods. There are recommendations to do when the slightest symptom examination for DVT and the likelihood of developing pulmonary embolism, since PE is deadly if treatment is delayed.

A detailed history can only give a suspicion of the disease. The main criteria are cough, hemoptysis, sudden onset of pain. A clearer picture can be given by the presence of thrombosis or complex operations in the patient in the past, taking hormonal drugs.
If pulmonary embolism is suspected, the patient should be sent for x-ray chest... In most situations radiological signs will not allow the diagnosis of thrombopulmonary pathology, but they will help to exclude other diseases from the list (pericarditis, croupous pneumonia, aortic aneurysm, pleurisy, pneumothorax).
A more reliable research method is ECG. But it will help only if the thrombopulmonary pathology is massive, with blockage of large branches of the artery, changes in the ECG occur in 65-81% of cases (depending on the extent of the lesion).
An ultrasound of the heart (echocardiography) makes it possible to detect signs of an overload of the right sections (cor pulmonale). The absence of pathologies on the echocardiogram is not a reason for thrombopulmonary pathology to be excluded.
Laboratory methods include the study of the amount of dissolved oxygen in the blood and d-dimer in plasma. The natural content of dissolved oxygen will help clear up the diagnosis. A d-dimer in an amount of 500 ng / ml will confirm it.
Angiopulmonography - X-ray examination with the introduction of contrast agents. Angiopulmonography is the most reliable way studies, since pulmonary embolism is detected in 98% of cases. Angiopulmonography is not harmless, but today the danger has decreased (0.1% - deaths, 1.5% - non-fatal complications).

Ultrasound of the heart (echocardiography) makes it possible to detect signs of an overload of the right sections.

As you can see, no study can give a 100% diagnosis, therefore, all diagnostic methods are used in turn to make a diagnosis, starting from simple methods and ending with complex ones. Pulmonary angiography is performed only as a last resort. Recommendations for its implementation are unsatisfactory results of previous research methods. Treatment cannot be postponed, it is often prescribed already at the examination stage.

How to eliminate pathology effectively

Often the patient needs treatment in intensive care. To save lives, Heparin, Dopamine are injected, and a catheter is inserted to facilitate breathing. Conventional treatment involves the use of anticoagulants and the like. hormonal agents. Surgery rarely used. To eliminate the risk of complications and subsequent death, all patients with PE are hospitalized.

Blood clot removal

Surgical operation is used only for massive lung damage, blockage of the trunk of the pulmonary artery, its large branches. During the operation, a thrombus is removed, which prevents blood flow, and, if necessary, a filter of the inferior vena cava is placed. The operation is risky, therefore, it is used only in severe cases, if the specialist has the appropriate experience.

Surgical operation is used only for massive lung damage, blockage of the trunk of the pulmonary artery, its large branches.

Any of the methods has a high mortality rate, on average 25-60%. A good indicator is 11-12%. When carrying out operations in a cardiology center, if there is an experienced specialist in the hospital, as well as if patients with severe shock are excluded from the statistics, mortality can be achieved no more than 6-8%.

Anticoagulant therapy

After providing first aid and when a serious condition is eliminated in the patient, treatment should be continued until the clot dissolves in the pulmonary artery and the likelihood of subsequent relapses is excluded.

Heparin. Introduced within 7-10 days intravenously. At the same time, the indicators of blood clotting are monitored.
3-4 days before stopping the use of heparin, warfarin tablets are prescribed. Warfarin is taken throughout the year, also controlling blood clotting.
Streptokinase and Urokinase are injected intravenously once a month.
Also, a tissue plasminogen activator is injected intravenously.

Anticoagulant therapy should not be used if the patient has internal bleeding, in the postoperative period, in the presence of stomach or intestinal ulcers.

What to expect in the end

With timely assistance in full, the prognosis is favorable. The problem is that it happens 10% of the time. With the manifestation of a vivid clinical picture with acute form the mortality rate is 30%. When rendering necessary assistance the probability of death remains at the level of 10%. Often heart attack lung tissue becomes complicated, pleurisy, pneumonia, and other diseases appear. However, careful prevention and monitoring of the health condition provides a positive prognosis. After completing the entire course of treatment, the patient may be diagnosed with grade 3 disability (rarely - the second). Rehabilitation will come faster, and the prognosis is more favorable if you follow the doctor's instructions.

With timely assistance in full, the prognosis is favorable.

Disease prevention

Pulmonary embolism often flows into a chronic form, therefore, after an attack, it is necessary to monitor your condition and carry out prevention. Certain preventive procedures are needed after long and complex operations, difficult labor (especially with caesarean section) Is a reason for special attention.

Also, PE prevention is needed for people at risk:

Over 40 years old;
Those who had thrombosis in the past - heart attack (lung, heart) or stroke;
Overweight;
Patients with cancer.

People entering the risk zone need to constantly check their veins for blood clots using an ultrasound scan. If necessary, you need to use tight bandaging of the legs, avoid static loads, a diet with vitamin K is indicated. After a case of thromboembolism, patients are advised to take direct anticoagulants (Ksarelto, Inokhen, Fragmin and others).

Prevention of PE is necessary after complex operations on the legs, joints, abdominal or chest cavity. For this, it is recommended to use Heparin and Reopolyglucin:

Heparin. Begin to use a week before surgery, continue to use until the patient is fully mobilized. One dose - 5 thousand units. Injections are given 3 times a day with an eight hour interval. The second option is also 5 thousand units, but 2 times a day with an interval of 12 hours.
Reopolyglucin is used before, during and after surgery to reduce the likelihood of a blood clot and the development of complications. Use 1000 milliliters from the onset of anesthesia and continue for 5-6 hours after surgery. Introduced intravenously.

The specialist can also refer the patient to an operation to implant venous cava filters, which reduce the risk of thrombus formation and complications.

As a result, we can conclude that pulmonary embolism is an extremely dangerous syndrome. Thrombopulmonary pathology creates a problem not so much with mortality as with the difficulty of diagnosis and a high probability of exacerbation. To eliminate the risk, examinations are performed if there is the slightest sign of thromboembolism.

Deep vein thrombosis is considered a serious condition. If the disease is not diagnosed in time and urgent measures are not taken, in 3-15% of cases, a blood clot affects the pulmonary artery. This condition is dangerous lethal outcome... One of the methods of therapy is special nutrition for thrombosis.

There is no separate dietary table for the disease, but the diet is a little limited. Diet table must be prescribed for exacerbation. Diet for deep vein thrombosis of the lower extremities is aimed at achieving several goals:

For thrombosis, it is better to follow a vegetarian diet and eat foods that thin the blood.

Promote weight loss. Excess weight considered a provoking factor.
Thinning the blood.
Cleanse blood vessels and strengthen venous walls.
Normalize the work of the digestive tract.
To activate metabolic processes.

The diet is prescribed for 3-4 weeks. Twice every 7 days, it is advisable to arrange days for unloading the body and cleaning it. The dietary food should be adjusted depending on the prescribed medications. Some of them interact chemically and reduce the effectiveness of the drug. For example, "Warfarin" should not be used together with garlic. Therefore, nutrition should be coordinated with your doctor.

The diet should include foods high in omega-3 polyunsaturated fatty acids. These are non-fasting marine varieties of fish, mussels, squid, oysters. Vitamin E, contained in dried apricots, unpolished barley and oat kernels, cashew nuts, and marine varieties of fish, has a beneficial effect on blood vessels. Vitamin E protects against disruption of the heart and insufficient blood supply to organs and tissues, the further process of thrombus formation. For the vitamin to be well absorbed, bile and fats are a prerequisite. After heat treatment or freezing, the vitamin content in the product is reduced.

At venous thrombosis it is allowed to add vinegar (especially apple cider), pepper, horseradish, onion, garlic to food

Treatment will be more effective if the following foods are added to the diet:

Onions - activates the process of dissolving blood clots, platelets accumulate more slowly. It is considered a means of preventing thrombosis from fatty foods. Eating ½ cup of onions is enough to block the effects of fats.
Red grapes. Berries contain resvepatrol, which prevents platelets from accumulating.
Berries, fresh or frozen.
Ginger. The substance gingerol thins the blood.
Gingko biloba. It improves blood circulation, reduces the permeability of the walls of blood vessels, makes their lumen wider.
Fish fat. Thins the blood, prevents blood clots.

As a result of research, it has been proven that blood clots dissolve faster in people whose diet is dominated by vegetables. This effect is possible thanks to fiber and vitamin C. Vegetarians are least susceptible to blood clots. Meat, regardless of the method of its preparation, should be eaten no more than 3 times within 7 days.

Banned products

Foods that impair blood flow, promote stagnation, platelet growth and thrombus formation should be excluded from the diet. Reduce vitamin K intake until you feel better.

These products affect the viscosity of the blood and impair its blood flow, as well as contribute to the appearance of congestion, and then provoke the formation of blood clots.

It thickens the blood, increasing the likelihood of blood clots. There is a lot of vitamin K in greens, which include chlorophyll.

Excluded products also include:

all nuts except Indian;
smoked products, canned food, salted food or sweets - retain water in the body, constrict blood vessels;
alcohol;
White grape juice, pomegranate juice;
bananas, blackcurrant - promote thrombus formation;
liverworts;
rich meat broths;
dairy products with high fat content;
semi-finished products, fast food;
legumes;
green leaf tea and coffee with a high caffeine content;
fatty foods - platelets are easier to combine into blood clots due to thickening of the blood.

The diet for thrombosis must necessarily include food containing polyunsaturated fats

In order not to worsen the condition, these products should be discarded.

Sample menu

One-day diet for deep vein thrombosis of the lower extremities:

Eating food in the morning. Porridge made from any cereal that is recommended to be boiled in distilled water. You can add fruits of fruit trees and berries to it. Drink with a cup of non-concentrated black tea.
Lunch break. Vegetable soup, boiled potatoes, fish baked in the oven.
Evening meal. Vegetable salad without mayonnaise, fresh fruits of fruit trees. Wash down with compote.
Vegetables, fruit of fruit trees and berries are suitable for a snack. You can drink compote, juices.

American scientists in research have found that refusing the first breakfast can provoke a heart attack. Blood clots in such people are 3 times more common. This is due to the fact that in the morning the stickiness of blood clots increases, and breakfast reduces this indicator.

A balanced diet is not the only prevention method. To prevent stagnant processes in the veins, you need moderate physical activity... It can be dancing, fitness or pool activities. Walking at a brisk pace improves blood circulation. Heavy loads on the legs (squatting with a barbell) must be avoided. A hot bath is also contraindicated for such patients. Tight clothing and uncomfortable shoes have an adverse effect on blood vessels. The height of the heel should not exceed 4 cm. To avoid thrombophlebitis, you need to forget about addictions. With frequent flights, in order not to provoke the development of thrombosis, it is recommended to adhere to several rules:

Choose loose-fitting clothing. The best option will be using compression underwear.
Avoid drinking alcoholic beverages.
Drink plenty of fluids during the flight.
If after the end of the flight you feel severe pain in the legs, see a doctor.

To prevent blood clots, you must drink enough fluids.