pulmonary embolism causes

pulmonary embolism causes


 Pulmonary embolism: Causes, symptoms and therapeutic treatment

- Actions
Share Via EmailShare Via della Via Via della Via LinkedinShare Via Google + Share Via PinterestComment
Pulmonary embolism refers to an acute, partial or complete obstruction of one or more branches of the pulmonary artery, generally caused by embolic material of extra-pulmonary origin. Therapeutic treatment is usually a supportive treatment aimed at correcting haemodynamic alterations.

Pulmonary embolism: What it is, how it manifests itself and why
Rx lungs
Pulmonary embolism consists of the obstruction of one or more branches of the pulmonary artery
Pulmonary embolism is a relatively frequent cardio-pulmonary disease and one of the most important causes of death in Western countries. The incidence of the disease, in Italy, is about 55 cases per 100,000 inhabitants for women and 40 cases per 100,000 for men with a mortality rate of about 21% in patients over 65 years of age.

In addition, pulmonary embolism is the main cause of death in pregnancy, since especially in the last quarter the blood tends to coagulate faster as the body activates a physiological process to prevent massive hemorrhages during delivery. Also for this reason the nursing assistance to the patient with pulmonary embolism involves more aspects, from those purely anatomo-pathophysiological to those that revolve around the state of anxiety.

Pulmonary embolism refers to an acute, partial or complete obstruction of one or more branches of the pulmonary artery, generally caused by embolic material of extra-pulmonary origin.

In the vast majority of cases the thrombosis is of thrombotic nature given by peripheral venous thrombosis (95% of cases) and only in 5% of cases the embolus is not thrombotic, but can be gaseous (air, nitrogen bubbles), liquid (amniotic fluid), fatty (emboli of adipose tissue), solid (foreign bodies).

Risk factors for pulmonary embolism

Venous stasis: may be given by varicose veins or a prolonged period of immobility
Diseases related to the venous system: vasculopathies, thrombophlebitis, etc.
Previous pulmonary embolism or Peripheral Venous Thrombosis (DVT)
Surgical interventions
Disorders that alter the coagulation: tumor, increased platelet count
Other diseases: diabetes mellitus, Bpco, heart disease.
Other predisposing conditions: advanced age, obesity, pregnancy, use of oral contraceptives
Pulmonary embolism, the diagnosis
Pulmonary embolism is one of the most difficult pathologies to diagnose because it is characterized by non-specific signs and symptoms; analyzing the pathophysiology we can define the symptoms that can occur:

Heart: Reduction of cardiac output associated with decreased systolic pressure due to right ventricular failure may occur. The cause of this inadequacy is pulmonary hypertension due to the reduction of the vascular bed. At the ultrasound level we will therefore have a right ventricle of increased size compared to normal. The patient may have tachycardia, hypotension and chest pain.
Breath: there is a reduction in pulmonary perfusion with consequent hypoxia; in addition, the clot tends to release quantities of vasoactive and bronchoconstrictive substances, which can worsen the symptoms. The patient will present dyspnea and tachypnea, sometimes even cough. Hypoglycemia and hypocapnia with a tendency to respiratory alkalosis will occur at the blood gas analysis.
The Wells Score

To facilitate the diagnosis there is also available the "Wells Score" which gives an estimate of the probability of contracting the Pulmonary Embolism:

TVP signs (3 points)
Tachycardia with FC> 100 (1.5 points)
Immobility for more than 3 days or surgery in the last 4 weeks (1.5 points)
History of DVT or Pulmonary Embolism (1.5 points)
Presence of hemoptysis (1.5 points)
Presence of carcinoma (1,5 points)
No alternative diagnosis able to explain the problem (3 points)
Score> 6: high probability
Score between 2 and 6: moderate probability
Score <2: low probability
The types of pulmonary embolism

Pulmonary embolism can essentially be of 2 types:

Massive: characterized by haemodynamic instability and signs of shock.
Non Massive: characterized by a decidedly more stable hemodynamics.
Iter diagnostic in the case of pulmonary embolism

The diagnostic procedure begins with a series of investigations:

Electrocardiogram: other cardiac pathologies are excluded and attention is paid to signs of overload of the right ventricle and tachycardia
Arterial blood gas analysis: it is known if hypoxemia, hypocapnia and any alkaline pH are present
D-dimer: it goes to assess if it is present in the bloodstream product of degradation of fibrin by the plasmin
Chest x-ray: to exclude other pathologists...Pulmonary embolism, the diagnosis
Pulmonary embolism is one of the most difficult pathologies to diagnose because it is characterized by non-specific signs and symptoms; analyzing the pathophysiology we can define the symptoms that can occur:

Heart: Reduction of cardiac output associated with decreased systolic pressure due to right ventricular failure may occur. The cause of this inadequacy is pulmonary hypertension due to the reduction of the vascular bed. At the ultrasound level we will therefore have a right ventricle of increased size compared to normal. The patient may have tachycardia, hypotension and chest pain.
Breath: there is a reduction in pulmonary perfusion with consequent hypoxia; in addition, the clot tends to release quantities of vasoactive and bronchoconstrictive substances, which can worsen the symptoms. The patient will present dyspnea and tachypnea, sometimes even cough. Hypoglycemia and hypocapnia with a tendency to respiratory alkalosis will occur at the blood gas analysis.
The Wells Score

To facilitate the diagnosis there is also available the "Wells Score" which gives an estimate of the probability of contracting the Pulmonary Embolism:

TVP signs (3 points)
Tachycardia with FC> 100 (1.5 points)
Immobility for more than 3 days or surgery in the last 4 weeks (1.5 points)
History of DVT or Pulmonary Embolism (1.5 points)
Presence of hemoptysis (1.5 points)
Presence of carcinoma (1,5 points)
No alternative diagnosis able to explain the problem (3 points)
Score> 6: high probability
Score between 2 and 6: moderate probability
Score <2: low probability
The types of pulmonary embolism

Pulmonary embolism can essentially be of 2 types:

Massive: characterized by haemodynamic instability and signs of shock.
Non Massive: characterized by a decidedly more stable hemodynamics.
Iter diagnostic in the case of pulmonary embolism

The diagnostic procedure begins with a series of investigations:

Electrocardiogram: other cardiac pathologies are excluded and attention is paid to signs of overload of the right ventricle and tachycardia
Arterial blood gas analysis: it is known if hypoxemia, hypocapnia and any alkaline pH are present
D-dimer: it goes to assess if it is present in the bloodstream product of degradation of fibrin by the plasmin
Chest x-ray: to exclude other lung diseases
Echocardiography: evaluates dysfunction and overload of the right ventricle
Thorax CT with MdC: the diagnosis is very reliable
Pulmonary Scintigraphy: evaluates the capacity for perfusion and pulmonary ventilation
Pulmonary angiography: proceed only if the suspicion is very strong and with other non-invasive means it has not been possible to reach a certain diagnosis.
Pulmonary embolism and therapeutic treatments
Usually the therapeutic treatment for pulmonary embolism is supportive for the purpose of correcting haemodynamic alterations:Oxygen therapy: if hypoxia is present
Analgesics: if pain is present
Drugs to increase systolic pressure: dobutamine, dopamine
Water balance: to avoid overloading the heart
Low molecular weight heparin / Oral anticoagulants