pulmonary thromboembolism

pulmonary thromboembolism


 Pulmonary Thromboembolism: when to worry?
Pulmonary Thromboembolism (TEP) refers to the recurrent or chronic acute occlusion of one or more arterial vessels of the pulmonary circulation, determined - in 90% of cases - by a thrombus coming from a vein in the lower limbs (Deep Vein Thrombosis) or abdomen as a consequence of other pathologies while, less frequently, by a fat embolus resulting from major traumas of the lower limbs. The incidence of this disease in Italy is 70-100 per 100,000 inhabitants.
"The TEP - explains Dr. Giorgio Serino, director of the Emergency Room and Department of Emergency and Acceptance at the IRCCS Policlinico San Donato - can be classified in: Massive Pulmonary Embolism, more serious, when the thrombus is large and, occluding a large pulmonary artery generates an acute and even fatal episode; Submassive Pulmonary Embolism, when the thrombus is of intermediate size and goes to occlude a more peripheral branch; Asymptomatic pulmonary embolism, when the thrombus is small and only obstructs tiny peripheral branches of the pulmonary artery tree where it usually does not create symptoms but can lead to pulmonary hypertension.
If a thrombus takes a few days to be able to form, pulmonary thromboembolism is a matter of moments: when the thrombus comes off, the attainment of the pulmonary arteries is immediate, the time of a few heartbeats. Thromboembolism development is generally associated with three factors: venous stasis, caused for example by staying in bed, castings or guardians, pronounced lack of fluids, varicose veins, pregnancy, long-term air travel; endothelial damage, during surgery, or from injury or inflammation; increased tendency to coagulation. In general, the risk of thrombosis increases with age, overweight, in pregnancy, in puerperium and in smokers ".
"It is necessary to make a distinction between the different types of continuous embolism - in the case of massive pulmonary embolism, the heart pumps against a thrombus, doing much more effort and thus risking to undergo acute decompensation. The subject involved will therefore experience significant symptoms such as chest pain, shortness of breath, coughing with blood and loss of consciousness and, in the worst cases, if the intervention was not timely, shock and death. This is why it is essential to quickly reach the emergency room.In case of submassive pulmonary embolism, the symptomatology is the same but much more attenuated so much that it can develop in some days, manifesting itself little by little without preventing the subject to carry out their daily activities even for a few days.
In case, instead of asymptomatic pulmonary embolism, the subject does not feel any kind of disorder and no particular symptom. However, the situation worsens over time with the onset of pulmonary hypertension, with a consequent chronic and non-reversible increase in the pressure of the pulmonary circulation. Being this third case of asymptomatic embolism, very often the subject detects the disorder by pure chance, during routine exams. There are some subjects who, for years, develop this asymptomatic thromboembolism without realizing it until there is a diagnosis of chronic pulmonary hypertension, not only of particular gravity, but also burdened by poorly accessible and expensive therapies. The subject, once in the hospital, may lose consciousness: first the acute chest pain, then the shortness of breath, the cough and finally the loss of the senses due to a clear reduction of oxygen in the brain.
The diagnostic procedure to be followed in these cases includes, in addition to the clinical examination, also instrumental examinations such as electrocardiogram, blood tests, chest CT scan but, above all, the Echocardiogram which allows to observe in more depth and non-invasive dilatation and consequent suffering of the right side of the heart.
A definitive diagnosis of pulmonary thromboembolism can only be obtained by means of angiography with pulmonary contrast media. Since the angioTAC is not without risks for the administration of high doses of X rays, in some cases, such as in very young subjects or pregnant women, it is resorted to the Pulmonary Scintigraphy, with times of diagnosis but much more dilated. Once the diagnosis has been made, the treatment involves anticoagulant therapy with the intent to dissolve the thrombus and, therefore, restore the blood circulation to the lung through the intake of specific anticoagulant drugs, first intravenously, then - for a certain number of days varying according to the condition of the subject - subcutaneously and finally, ending with oral maintenance therapy for at least 6 months.
For example, if the subject had previously suffered from pulmonary embolism, the treatment could also last a lifetime to avoid the risk of recurrence. In some cases, however, genetic factors intervene for which some subjects are born with the predisposition to form thrombi in the blood without having previous knowledge or symptoms. This is why in the case of trauma, the specialist prescribes a subcutaneous heparin treatment for a few weeks to prevent episodes of venous thrombosis. In rare cases, pregnancy also represents another condition that could lead to the onset of a TEP, especially in the initial phases when the woman is in a situation of physiological hypercoagulability of the blood ".
"In the event that the drug therapy with anticoagulants was not very effective and the thrombus was still in the same original position of blood flow occlusion - concludes the dott. Serino - the subject will be referred to a specialized structure to evaluate a possible cardiac surgery intervention through which, in the extracorporeal circulation, we will proceed to the final removal of the thrombus ".
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