what causes blood clots in lungs

what causes blood clots in lungs


 What is a pulmonary embolism? (Regarding the case of Plácido Domingo)

lungsIn these days, we speak in all the media of the pulmonary embolism, happily resolved, of the greatest tenor that Spanish lyric has given: Plácido Domingo. Many now wonder what this disease consists of, how it is perceived, why it is produced and how it is solved. Here we explain it.

To begin with, it would be more correct to speak of pulmonary embolism since the process can be of multiple localization. Its most relevant pathophysiological aspect is the occlusive impact of a blood clot in a pulmonary artery that stops the passage of blood circulation through it and leaves, therefore, no flow to the pulmonary territory dependent on that artery. The blood clot is the most common cause, which does not exclude others such as a fat thrombus, a sudden entry of air (air embolism) or even an agglomeration of cancer cells.

The origin of the problem
The production mechanism, with certain differences and nuances, is similar to that produced in the course of a myocardial infarction, a stroke or a peripheral arterial occlusion. What differentiates this process from others is that, as a rule, in the walls of the pulmonary arteries, due to the low pressure they support, occlusive arteriosclerotic phenomena do not usually occur as in the coronary, cerebral or limb arteries. inferior, so that pulmonary arterial occlusive phenomena are always a consequence of the arrival of a clot (from a thrombus) born in other vascular beds and transported by the blood flow, in this case venous.

The majority of pulmonary embolisms are accidents secondary to the detachment of a clot generated in the deep venous system of the legs. In this sense, deep vein thrombosis, acute thrombophlebitis, and other pathologies such as cancer, cardiac surgery, pelvic surgery, hip and urinary-genitic system, bone fractures, prolonged immobilization, burns and even post-partum or consumption of contraceptive pills, are conditions that facilitate the formation of blood clots in the deep veins of the legs that, with a certain frequency, can detach and be carried by the bloodstream to the pulmonary arterial system where they impact, producing pulmonary embolism. In some series of patients it has been possible to observe an inherited-family tendency, although this is an authentic rarity.

The size of the obstructed artery and the amount of lung tissue affected will determine the acute symptomatology, the severity of the process and the subsequent evolution. There are massive embolisms whose immediate and unappealable result is sudden death. On the contrary, smaller ones evolve more favorably, never forgetting that the process is always serious and requires urgent medical intervention.

Alarm signs
The most common symptoms begin with the feeling that something very serious is happening inside the chest:

There is usually great shortness of breath with a feeling of shortness of breath
Wistful breathing
Sometimes cough with bloody sputum
Intense chest pain
Palpitations
Tachycardia
Profuse and cold sweating
Stunning or loss of consciousness
Paleness and bluish color of lips, fingers and nails
The acute picture has medically dramatic characteristics.

The immediately correct thing is to notify the emergency medical services or to transfer the patient quickly to the hospital. Once there, the doctors will try to make a diagnosis of certainty and immediately start the respiratory and circulatory stabilization using oxygen or even endotracheal intubation and certain specific medications for these situations.Diagnosis and treatment
The confirmation diagnosis is made by means of an arterial blood gas analysis (oxygen and carbon blood level and pH values), chest radiography, electrocardiogram, Doppler echocardiography, contrast lung angiography and computerized tomography. Once the situation is stabilized, a study of the veins of the legs will be carried out, using ultrasounds, trying to investigate the origin of the clot and the possibility that there are other menaces of new pulmonary embolisms.

The treatment of pulmonary embolism is always a vital emergency. Current treatments seek the destruction of the clot (lysis) by intravenous injection of powerful anticoagulant agents such as streptokinase, urokinase, plasminogen activating agents, heparins, as well as new ones already approved for clinical use or in the approval process. In some cases, it will be necessary to resort to emergency surgery by opening the thorax to release the occluded artery by directly extracting the thrombus.

After the acute phase, patients are usually anticoagulated with dicumarol, warfarin, dabigatran, or other emerging oral anticoagulants to prevent the formation of new potentially embolic venous clots. In some cases in which remaining clots are detected in the veins of the legs, a filter will be placed in the inferior vena cava, at the level of the abdomen, which will allow the normal flow of venous blood but will block the arrival of venous blood. any thrombus to the lung.

                                                                         Placido Domingo

                                                                                  Courtesy: www.placidodomingo.com

In the case of Plácido Domingo, pulmonary arterial occlusion was fortunately modest and thanks to the rapid interventionmedical the great tenor is currently in an evolutionary process of excellent recovery. The lovers of the lyric,apart from wishing him a quick restoration, we wish to see him again uploaded to bel canto stages,what according to the doctors who treat it will take place after six or eight weeks of inactivity.