Department of cardiac muscle pathology and transplantation of organs and tissues

Acute embolism

Acute thromboembolism of the pulmonary artery

TEPA is an acute severe complication of cardiovascular, somatic, surgical (including traumatological), gynecological, oncological and hematological diseases. It develops due to the thrombus entry in the lumen of the pulmonary artery, causing acute lung ischemia with a reflectory starting-up of the cascade of pathological reactions, leading to a fatal outcome in the absence of timely therapy.

Etiology

The pathogenetic cause of TEPA is the tendency to thrombosis. This is facilitated by damage of the vascular wall, hypercoagulation and slowing of blood flow in the vasculature. Floating thrombus, which can reach 15-18 cm in size, is especially dangerous. Varicose vein disease of the lower, more rarely upper limbs, traumas, large-scale surgical interventions, prolonged immobilization, diseases that contribute to the increase of blood coagulability (hematological and oncopathology, congenital and autoimmune diseases), dehydration, blood clots in the heart and heart rhythm disturbances (in combination with severe physical exertion or without it) more often provoke acute TEPA.

Clinic

Less than 70% of TEPA is diagnosed in life-time. This is associated with nonspecific symptoms and the absence of the possibility of reliable diagnosis of this pathological condition in the most medical institutions.
For acute TEPA, there are two main variants of the clinical course:

  • Infarct-pneumonia (with thrombosis of small LA branches);
  • Acute pulmonary heart (with thrombosis of large LA trunks).

It’s characterized by sudden sharp pain in the chest, shortness of breath, cyanosis of the skin, swelling of the cervical veins, spitting of blood. Decrease in blood pressure, tachycardia, collapse, the development of cardiogenic shock in the shortest time, come over with massive thrombosis.

Diagnostics

  • X-ray study of thoracic organs, multislice spiral CT, pulmonography;
  • ECG, echocardiography;
  • Lung scintigraphy;
  • Laboratory studies (D-dimer, transaminases, LDH, coagulation profile, INR).

Treatment

In conditions of ICU first vital signs should be stabilized through infusion therapy.
The key to success is early thrombolytic therapy. Additionally, anticoagulants are used.
Surgical treatment is indicated when the conservative therapy is ineffective and involves open thromboembollectomy. An alternative is bougienage, fractionation of the embolus by Fogertie catheter with simultaneous thrombolysis. With recurrence of TEPA, a cava filter is implanted.

Contacts

 

02660, Kiev city,

Bratyslavka street, 5a

Phone.: +380975444655