Chronic thromboembolism of the pulmonary artery, ICB code 10. Thromboembolism of the pulmonary artery (tela). Epidemiology in adults

02.10.2020 Traditional treatment

ICD-10 code
I26 Pulmonary embolism.

ETIOLOGY AND PATHOGENESIS

PE in 80–90% can occur as a result of initial deep vein thrombosis of the leg and ilio-femoral thrombosis or after the initial penetration of the floating part of the thrombus into the deep vein of the thigh and external iliac vein in superficial thrombophlebitis of the great saphenous vein.

CLINICAL PICTURE (SYMPTOMS) OF PULMONARY THROMBOEMBOLIS

The clinical picture depends on the degree and prevalence of pulmonary artery branch occlusion.

Massive PE, covering the pulmonary trunk and the main pulmonary arteries, occurs suddenly and is fatal. With embolism of segmental pulmonary arteries, it usually manifests itself as pulmonary-pleural syndrome, which is characterized by chest pain, aggravated by breathing, shortness of breath, dry cough, and fever.

More extensive thromboembolism is accompanied by acute pulmonary heart failure, chest pain, sudden loss of consciousness. In patients, cyanosis, swelling and pulsation of the jugular veins, rapid and shallow breathing, a decrease in blood pressure, and tachycardia are noted.

DIAGNOSTICS

Diagnosis is based on the assessment of the complaints of the pregnant woman and the corresponding clinical picture.

ANAMNESIS

A history of pregnant women with pulmonary embolism has indications:
for violations fat metabolism;
on superficial thrombophlebitis of the great saphenous vein;
on deep vein thrombosis of the leg;
for ileofemoral thrombosis;
for rheumatic heart defects;
on the AG;
for infectious diseases;
for violations of the blood coagulation system with symptoms of hypercoagulation;
for long-term use of combined oral contraceptives;
to take glucocorticoids;
for kidney disease;
for severe gestosis.

PHYSICAL RESEARCH

Physical examination evaluates:
the color of the skin and mucous membranes (cyanosis);
the nature and frequency of breathing (shortness of breath, rapid breathing);
pulse rate (tachycardia).

Auscultation of the lungs is performed (wheezing in the lungs).

LABORATORY RESEARCH

The state of the coagulation system is determined, the following parameters are assessed:
APTT;
coagulogram
prothrombin index;
fibrinogen;
platelet aggregation;
soluble complexes of fibrin monomers;
D-dimer.

INSTRUMENTAL STUDIES

As additional instrumental methods studies perform an ECG and a plain chest x-ray.

With massive PE on the chest x-ray, enlargement of the right heart and superior vena cava is noted. It is also possible to determine the depletion of the pulmonary pattern and the high standing of the domes of the diaphragm. If the peripheral pulmonary arteries are damaged, the picture reveals the symptoms of infarction pneumonia, which usually develops 2-3 days after the embolic episode. Further clarification of the diagnosis should be carried out in the conditions of the department of vascular surgery.

DIFFERENTIAL DIAGNOSTICS

Differential diagnosis of PE is carried out:
with pneumonia;
with myocardial infarction;
with an attack of angina pectoris;
with acute cerebral lesions due to hemorrhage or ischemia.

INDICATIONS FOR CONSULTING OTHER SPECIALISTS

Pulmonary embolism is treated by vascular surgeons.

EXAMPLE FORMULATING A DIAGNOSIS

Pregnancy 35 weeks TELA.

TREATMENT OF PULMONARY THROMBOEMBOLIA DURING PREGNANCY

OBJECTIVES OF TREATMENT

Prevention of the spread of thromboembolism.
Respiratory function restoration.
Normalization of pulmonary hemodynamics.
Optimization of the hemostasis system.

MEDICAL TREATMENT

Thrombolytic and complex antithrombotic therapy is performed.

SURGERY

Pulmonary embolism is treated by vascular surgeons. In this case, it is possible to perform embolectomy from the pulmonary arteries.

INDICATIONS FOR HOSPITALIZATION

PE treatment is carried out in a hospital setting.

EVALUATION OF TREATMENT EFFICIENCY

Normalization of the general condition of the patient, restoration of the function of the respiratory and cardiovascular systems, confirmed by indicators of repeated ECG, plain chest X-ray and the results of an assessment of the hemostasis system.

CHOICE OF TIME AND METHOD OF DELIVERY

Obstetric tactics in pregnant women with PE depends on the severity of their condition and the duration of pregnancy.

If pulmonary embolism occurs in the first trimester, it is advisable to terminate the pregnancy due to the severe condition of the patient and the need for prolonged anticoagulant therapy.

In the II-III trimesters, the issue of prolongation of pregnancy is decided individually, depending on the condition of the pregnant woman and the fetus. Indications for termination of pregnancy are the grave condition of the pregnant woman and a pronounced deterioration in the condition of the fetus.

At serious condition of the patient, delivery should be performed by CS. Abdominal delivery is also carried out in the absence of a cava filter in the patient. In this case, the vascular surgeon also performs plication of the inferior vena cava with a mechanical suture.

If patients are in a satisfactory condition, when more than 1 month has elapsed since the onset of pulmonary embolism until delivery and the hemodynamic parameters have stabilized, in the presence of an installed cava filter, childbirth can be carried out through the vaginal birth canal.

In the postpartum period, treatment with sodium heparin is continued with a gradual transition to indirect anticoagulants, which are taken for a long time (up to 6 months) even after discharge from the hospital under the supervision of a surgeon and a cardiologist.

PREVENTION OF PULMONARY THROMBOEMBOLIA

Timely identification of risk factors from early pregnancy. Study of the hemostasis system in pregnant women. If necessary, in case of a violation of the hemostasis system, anticoagulants are prescribed. Prevention and adequate treatment of preeclampsia. Timely diagnosis and elimination of coagulopathic, metabolic and immune disorders. Exercises for the legs should be done with prolonged bed rest. With a high risk of thrombosis, it is necessary to limit physical and prolonged static loads, wear elastic stockings or perform intermittent pneumatic compression of the legs.

I26 Pulmonary embolism

Includes: pulmonary (arteries) (veins):

Thromboembolism

Excludes: complicating:

Abortion (O03-O07), ectopic or molar pregnancy (O00-O07, O08.2)

Pregnancy, childbirth and the puerperium (O88.-)

I26.0 Pulmonary embolism with mention of acute cor pulmonale

I26.9 Pulmonary embolism without mention of acute cor pulmonale

Definition: Pulmonary embolism (PE) is an acute occlusion by a thrombus or embolus of the trunk of one or more branches of the pulmonary artery. PE is an integral part of the syndrome of thrombosis of the upper and lower vena cava system (more often thrombosis of the veins of the small pelvis and deep veins of the lower extremities), therefore, in foreign practice, these two diseases are combined under the general name - "Venous thromboembolism".

Diagnostic criteria:

M. Rodger and P.S. Welis (2001) proposed a preliminary score for the likelihood of PE:

The presence of clinical symptoms of deep vein thrombosis of the leg - 3 points

When conducting differential diagnosis PE is most likely - 3 points

Forced bed rest for 3 - 5 days - 1.5 points

Hemoptysis - 1 point

Oncological process - 1 point

Patients with a total of  2 points are classified as low probability of having PE, moderate - from 2 to 6 points, high -  6 points

On the ECG in 60 - 70% of cases - "triad" SI, QIII, TIII (negative). With massive PE, a decrease in the ST segment (systolic overload of the right ventricle), diastolic overload (dilatation) is manifested by blockade right leg bundle of His, the appearance of a pulmonary P wave is possible

Radiographic signs of PE:

High sedentary position of the dome of the diaphragm - 40%

Depletion of pulmonary pattern (Westermark symptom)

Disciform atelectasis

Lung tissue infiltrates - infarction-pneumonia

Expansion of the shadow of the superior vena cava

Bulging of three arcs along the left contour of the heart shadow

American researchers have proposed a formula for confirming or excluding PE:

YES = 0,22  A + 0.20 B + 0.29 B +0.25 G + 0.13 D - 0.17 =  0,5

NO  0.35

Where: A - swelling of the neck veins - yes -1, no - 0

B - shortness of breath - yes - 1, no - 0

B - deep vein thrombosis of the lower extremities - yes - 1, no - 0

G - ECG signs overload of the right heart - yes - 1, no - 0

D - radiographic signs - yes - 1, no - 0

Laboratory signs: an increase in the level of fibrinogen degradation (N  10 μg / ml) and, in particular, the concentration of fibrin D-dimer more than 0.5 mg / l;

Leukocytosis up to 10,000 without a shift to the left, with pneumonia - more than 10,000 with a shift to the left, with MI - less than 10,000 with eosinophilia.

Increased level of glutamine oxalate transaminase, lactate dehydrogenase, bilirubin level

Scintigraphy and angiopulmonography to assess the volume, localization and severity of PE.

Body classification (European Society of Cardiology, 1978):

By the volume of the lesion:

Massive

Non-massive

By the severity of development:

Subacute
Chronic relapsing

By clinical symptoms:

"Infarction pneumonia" - thromboembolism of small branches

"Spicy cor pulmonale"- thromboembolism of large branches

"Unmotivated dyspnea" - recurrent pulmonary embolism of small branches

Examples of wording a diagnosis:

Ileofemoral thrombosis of the left extremity, acute pulmonary embolism, non-massive, right-sided infarction pneumonia, moderate severity, ARF stage 1.

Chronic thrombosis of the popliteal vein on the left, post-thrombotic syndrome, chronic venous insufficiency, chronic recurrent pulmonary embolism of small branches, chronic compensated pulmonary hypertension of vascular genesis, II degree CDI of the restrictive type.

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) has been adopted as a single normative document to take into account the incidence, reasons for medical institutions all departments, causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170

A new revision (ICD-11) is planned by WHO in 2017 2018.

As amended and supplemented by WHO

Processing and translation of changes © mkb-10.com

Pulmonary embolism - description, causes, symptoms (signs), diagnosis, treatment.

Short description

Pulmonary embolism (PE) is the closure of the lumen of the main trunk or branches of the pulmonary artery with an embolus (thrombus), leading to a sharp decrease in blood flow in the lungs.

Code by international classification diseases ICD-10:

I26 Pulmonary embolism

Statistical data. PE occurs with a frequency of 1 case per year. It ranks third among the causes of death after ischemic heart disease and acute cerebrovascular accidents.

Causes

Etiology. In 90% of cases, the source of PE is located in the basin of the inferior vena cava. Iliac - femoral venous segment of the vein prostate and other veins of the small pelvis Deep veins of the legs.

Risk factors Malignant neoplasms Heart failure MI Sepsis Stroke Erythremia Inflammatory bowel disease Obesity Nephrotic syndrome Estrogen intake Hypodynamia APS Syndromes primary hypercoagulability Antithrombin III deficiency Protein C and S deficiency Dysfibrinogenemia Pregnancy and the postpartum period Injury Epilepsy Postoperative period.

The pathogenesis of PE causes the following changes: Increased vascular pulmonary resistance (due to vascular obstruction) Deterioration of gas exchange (due to a decrease in the respiratory surface area) Alveolar hyperventilation (due to receptor stimulation) Increased airway resistance (due to bronchoconstriction) Decreased elasticity of the lung tissue (due to hemorrhage in pulmonary tissue and a decrease in surfactant content) Hemodynamic changes in pulmonary embolism depend on the number and size of clogged vessels With massive thromboembolism of the main trunk, acute right ventricular failure (acute pulmonary heart) occurs, usually leading to death. tension of the wall of the right ventricle, leading to its dysfunction and dilatation. At the same time, the ejection from the right ventricle decreases, and the end diastolic pressure in it increases (acute right ventricular failure). This leads to a decrease in blood flow to the left ventricle. Due to the high end diastolic pressure in the right ventricle, the interventricular septum bends towards the left ventricle, further reducing its volume. Arterial hypotension occurs. As a result of arterial hypotension, ischemia of the left ventricular myocardium may develop. Myocardial ischemia of the right ventricle may be a consequence of compression of the branches of the right coronary artery. With minor thromboembolism, the function of the right ventricle is slightly impaired and blood pressure may be normal. In the presence of initial right ventricular hypertrophy, stroke volume of the heart usually does not decrease, and only severe pulmonary hypertension occurs. Thromboembolism of small branches of the pulmonary artery can lead to pulmonary infarction.

Symptoms (signs)

The symptomatology of PE depends on the volume of pulmonary vessels turned off from the bloodstream. Its manifestations are many and varied, in connection with which PE is called the "great masker" Massive thromboembolism Dyspnea, severe arterial hypotension, loss of consciousness, cyanosis, sometimes chest pain (due to pleural damage) Expansion of the cervical veins, enlargement of the liver In most cases in the absence of emergency assistance, massive thromboembolism leads to death.In other cases, signs of PE may be shortness of breath, chest pain, aggravated by breathing, cough, hemoptysis (with pulmonary infarction), arterial hypotension, tachycardia, sweating. Patients can hear wet rales, crepitus, pleural friction noise. Subfebrile fever may appear after a few days.

PE symptoms are nonspecific. Often there is a discrepancy between the size of the embolus (and, accordingly, the diameter of the occluded vessel) and clinical manifestations- slight shortness of breath with a significant size of the embolus and severe pain in the chest with small blood clots.

In some cases, thromboembolism of the branches of the pulmonary artery remains unrecognized or pneumonia or MI is misdiagnosed. In these cases, the preservation of blood clots in the lumen of the vessels leads to an increase in pulmonary vascular resistance and an increase in pressure in the pulmonary artery (the so-called chronic thromboembolic pulmonary hypertension develops). In such cases, shortness of breath comes to the fore in physical activity, as well as fatigue and weakness. Then right ventricular failure develops with its main symptoms - leg edema, enlarged liver. When examining in such cases, sometimes a systolic murmur is heard over the pulmonary fields (a consequence of stenosis of one of the branches of the pulmonary artery). In some cases, blood clots lyse on their own, which leads to the disappearance of clinical manifestations.

Diagnostics

Laboratory data In most cases, the blood picture without pathological changes The most modern and specific biochemical manifestations of PE include an increase in the concentration of plasma d-dimer more than 500 ng / ml.The gas composition of the blood in PE is characterized by hypoxemia and hypocapnia.In the event of a heart attack - pneumonia, inflammatory changes in the blood appear.

Classic ECG changes in PE Deep S waves in lead I and pathological Q waves in lead III (SIQ III syndrome) P - pulmonale Incomplete or complete blockade of the right bundle branch (right ventricular conduction disturbance) Inversion of T waves in the right chest leads (result ischemia of the right ventricle) Atrial fibrillation EOS deviation of more than 90 ° ECG changes in PE are nonspecific and are used only to exclude MI.

X-ray examination It is used mainly for differential diagnosis - exclusion of primary pneumonia, pneumothorax, rib fractures, tumors.When pulmonary embolism, it is possible to detect radiographically: high standing of the dome of the diaphragm on the side of the lesion of atelectasis pleural effusion infiltrate (usually it is located subpleurally or has a conical shape with the apex facing to the gate of the lungs) a break in the course of the vessel (a symptom of "amputation") a local decrease in pulmonary vascularization (a symptom of Westermark) plethora of the roots of the lungs possible bulging of the trunk of the pulmonary artery.

EchoCG: with PE, dilation of the right ventricle, hypokinesis of the wall of the right ventricle, bulging can be detected interventricular septum towards the left ventricle, signs of pulmonary hypertension.

Ultrasound of peripheral veins: in some cases it helps to identify the source of thromboembolism - characteristic feature consider the non-collapse of the vein when pressing on it with an ultrasonic sensor (there is a thrombus in the lumen of the vein).

Lung scintigraphy. The method is highly informative. A perfusion defect indicates the absence or decrease in blood flow due to the occlusion of the vessel by a thrombus. Normal lung scintigram allows excluding PE with an accuracy of 90%.

Angiopulmonography is the "gold standard" in the diagnosis of PE, since it allows you to accurately determine the localization and size of the thrombus. The criteria for a reliable diagnosis are a sudden break of the branch of the pulmonary artery and the contours of a thrombus, the criteria for a probable diagnosis are a sharp narrowing of the branch of the pulmonary artery and slow washout of the contrast.

Treatment

With massive PE, it is necessary to restore hemodynamics, oxygenation.

Anticoagulation therapy The goal is to stabilize the thrombus, prevent its increase. Heparin is administered at a dose of 5000 IU IV bolus, then its administration is continued IV drip at a rate of 1000-1500 IU / h. Activated PTT during anticoagulation therapy should be increased 1.5-2 times compared to the norm Low-molecular heparins can also be used (calcium nadroparin, sodium enoxaparin and others at a dose of 0.5-0.8 ml sc 2 r / day ). The introduction of heparin is usually carried out within 5-10 days with the simultaneous appointment from the 2nd day of an oral indirect anticoagulant (warfarin, etc.). Treatment with an indirect anticoagulant is usually continued from 3 to 6 months.

Thrombolytic therapy - streptokinase is injected at a dose of 1.5 million IU for 2 hours into a peripheral vein. During the administration of streptokinase, it is recommended to suspend the administration of heparin. Its introduction can be continued with a decrease in the activated PTT to 80 s.

Surgery Effective method treatment for massive PE - timely embolectomy, especially with contraindications to the use of thrombolytics.With a proven source of thromboembolism from the inferior vena cava system, installation of caval filters (special devices in the inferior vena cava system to prevent the migration of detached blood clots) is effective, as in the case of already developed acute PE, so and for the prevention of further thromboembolism.

Prevention of pulmonary embolism. Considered to be effective is the use of heparin at a dose of 5000 IU every 8-12 hours for the period of limited physical activity, warfarin, intermittent pneumatic compression (periodic clamping of the lower extremities with special cuffs under pressure).

Complications Pulmonary infarction Acute cor pulmonale Recurrent deep vein thrombosis of the lower extremities or PE.

Forecast. In unrecognized and untreated cases of PE, the mortality rate of patients within 1 month is 30% (with massive thromboembolism it reaches 100%). The general mortality rate within 1 year is 24%, with repeated pulmonary embolism - 45%. The main causes of death in the first 2 weeks are cardiovascular complications and pneumonia.

Thromboembolism code according to ICD-10

A large number of diseases detected in humans, the need for a general approach to diagnosis and accurate recording of diseases became the reason for the creation of a special international classification (ICD). The lists were compiled by WHO medical experts, who are collected every 10 years to revise and correct the previous version. Now all doctors work with ICD-10, which presents all possible diseases and diagnoses found in humans.

Arterial thrombosis in the classification of diseases

Cardiac and vascular pathology, which occurs in adults and children, is in the section entitled "Diseases of the circulatory system." Arterial thromboembolism has several variants with the code I, and includes the following main vascular problems encountered in children and adults:

pulmonary thromboembolism(I26);
various types of thrombosis and embolism of cerebral vessels (I65 - I66);
blockage of the carotid artery (I63.0 - I63.2);
embolism and thrombosis of the abdominal aorta (I74);
cessation of blood flow due to thrombosis in other parts of the aorta (I74.1);
embolism and thrombosis of the arteries of the upper extremities (I74.2);
embolism and thrombosis of the arteries of the lower extremities (I74.3);
thromboembolism of the iliac arteries (I74.5).

The doctor, if necessary, can always find any, even a rare cipher of arterial thromboembolic conditions that occur in the vascular system, both in children and in adult patients.

Venous thrombosis in ICD 10 revision

Vein thromboembolism can cause serious complications and conditions that are common in medical practice. In the statistical list of diseases of the venous system, acute vascular occlusion has the code I80 - I82, and is represented by the following diseases:

various types of venous inflammation with thrombosis in the lower extremities (I80.0 - I80.9);
portal vein thrombosis (I81);
embolism and thrombosis of the veins of the liver (I82.0);
thromboembolism of the vena cava (I82.2);
blockage of the renal vein (I82.3);
thrombosis of other veins (I82.8).

Venous thromboembolism often complicates postoperative period for any surgical intervention, which can lengthen the number of days a person is in the hospital. That is why correct preparation to surgery and careful implementation of preventive measures for varicose veins of the lower extremities.

Aneurysms in ICD-10

A large place in the statistical list is allocated for a variety of options for vasodilatation and enlargement. ICD-10 codes (I71 - I72) include the following types of severe and dangerous conditions:

Each of these options is dangerous to human health and life, therefore, if this vascular pathology is detected, surgical treatment is required. When detecting any type of aneurysm, the doctor should, in the near future, together with the patient, decide on the necessity and possibility of surgery. If problems and contraindications arise for the surgical correction of the aneurysm, the doctor will give recommendations and prescribe conservative treatment.

How a doctor uses ICD-10

At the end of the treatment process, regardless of the days the sick person is in the hospital or the course of therapy in the clinic, the doctor must make a final diagnosis. For statistics, a cipher is needed, not a medical report, so the specialist enters the diagnosis code found in the International Classification 10 revision into the statistical coupon. Subsequently, after processing the information coming from different medical institutions, it can be concluded about the frequency of occurrence of various diseases. If the cardiovascular pathology begins to grow, then you can notice it in time and try to correct the situation by influencing the causal factors and improving medical care.

The International Statistical Classification of Diseases and Health Problems 10 revision is a simple, understandable and convenient list of diseases used by doctors around the world. As a rule, each narrow specialist applies only that part of the ICD, which lists diseases according to his profile.

In particular, the codes from the section "Diseases of the circulatory system" are most actively used by doctors of the following specialties:

Thromboembolic conditions occur against the background of various diseases, which are not always associated with diseases of the heart and blood vessels, therefore, although rarely, the codes of thrombosis and embolism can be used by doctors of almost all specialties.

The information on the site is provided for informational purposes only and cannot replace the advice of your doctor.

Pulmonary embolism

RCHRH (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Archive - Clinical protocols MH RK (Order No. 764)

general information

Short description

Protocol code: E-026 "Pulmonary embolism"

Profile: ambulance

Classification

1. Acute form - a sudden onset with chest pain, shortness of breath, a drop in blood pressure, signs of acute pulmonary heart disease.

2. Under acute form- progressive respiratory and right ventricular failure and signs of pulmonary infarction, hemoptysis.

3. Recurrent form - repeated episodes of shortness of breath, fainting, signs of pulmonary infarction.

By the degree of pulmonary artery occlusion:

1. Small - less than 30% of the total cross-sectional area of the vascular bed (shortness of breath, tachypnea, dizziness, fear).

2. Moderate% (chest pain, tachycardia, decreased blood pressure, severe weakness, signs of pulmonary infarction, cough, hemoptysis).

3. Massive - more than 50% (acute right ventricular failure, obstructive shock, swelling of the cervical veins).

4. Supermassive - more than 70% (sudden loss of consciousness, diffuse cyanosis of the upper half of the body, circulatory arrest, convulsions, respiratory arrest).

Most frequent sources:

MCB 10 thromboembolism

Vein thrombosis is a pathological condition characterized by partial or complete blockage of the lumen of the vessel by the formed blood clots. Blood clots can be located in any part of the body, but most often they diagnose thrombosis of the veins of the lower extremities, heart and abdominal cavity... Blocking the blood flow leads to stagnant processes inside the vein, full blood circulation, nutrition of an organ or part of the body is disrupted. As a result, complications of the disease that are dangerous to health and life develop. Thrombosis of the lower extremities or arms causes death of soft tissues (gangrene), damage to the vessels of the head (stroke), cardiac arteries (infarction), etc. The most life-threatening mesenteric thrombosis (occlusion of the mesenteric arteries), which often causes the development of peritonitis. An equally life-threatening complication is pulmonary embolism. It develops against the background of separation of a blood clot from a permanent location and entering the veins of the lung. In this case, it is very difficult to save a person; sudden death often occurs.

Deep vein thrombosis ICD 10

In most cases, vein occlusion is asymptomatic or mild. This course of the disease complicates timely diagnosis and early treatment, increasing the risk of developing fatal dangerous consequences... That is why experts insist on regular examination by a doctor, and in the presence of characteristic symptoms of the disease - immediate diagnosis and treatment.

The reasons for the development of the disease

Acute thrombosis develops against the background of existing pathologies. Affects mainly middle-aged and elderly women suffering from various vascular diseases (varicose veins, atherosclerosis). The risk group also includes overweight men and women with diabetes mellitus, survivors of vein surgery, with a history of fractures with damage to blood vessels, as well as blood clotting disorders. Atherosclerosis is the main source of acute thrombosis. Cholesterol plaques that cover the inner surface of blood vessels disrupt blood flow, provoke stagnant processes, and contribute to the formation of blood clots. According to research, more than half of people with this condition have clogged blood vessels.

Reasons for the development of venous thrombosis

Other factors affecting the development of the disease include:

consistently increased blood pressure(hypertension);
infectious diseases (typhoid fever, sepsis, pneumonia, purulent abscesses);
mechanical closure of the vascular duct by tumors of various etiologies;
oncology;
congenital anomalies blood vessels;
disruptions of the hormonal background;
transferred leg paralysis (characteristic of ileofemoral thrombosis of the lower extremities);
nicotine smoking, addiction to alcoholic beverages, drugs;
frequent flights, the duration of which exceeds 4-5 hours;
insufficient fluid intake, uncontrolled intake of diuretics.

The formation of blood clots is also typical for people who are forced to stay in bed, sit or stand for a long time in one position. Due to slow blood circulation, blood clots appear, eventually blocking the lumen of the veins. Any medications that increase blood viscosity should be taken strictly under medical supervision. An increase in blood clotting is fraught with the formation of blood clots.

At the initial stages of development, vascular and deep vein disease of the lower extremities can pass without showing any symptoms

Varieties of thrombosis according to the International classification

ICD 10 (International Classification of Diseases of the Tenth Revision) is an official document that is the statistical and classification basis in the field of health protection. ICD is used to systematize, as well as study information on the level of morbidity and mortality of people from all over the world. This is a normative document that allows you to convert the verbal names of diseases into special codes. Such code ciphers contribute to convenient and systematic storage, study and registration of the received data.

The ICD is regularly reviewed by WHO (World Health Organization) every 10 years. Each disease has a special three-digit code that includes mortality information from different countries the world. The document includes the following groups of diseases:

Thrombophlebitis has several forms: acute and chronic

The ICD of the tenth revision consists of three parts (books), among which only the first carries a detailed classification and information about diseases. The classification is divided into classes, headings, subheadings that provide ease of use of the document.

The list of thrombosis described in the International Classification is in class IX "Diseases of the circulatory system", has a subclass "Diseases of the arteries, arterioles and capillaries". You can find out more specifically about the types of occlusions in the section "Vein embolism and thrombosis".

According to ICD-10, the following types of embolism are distinguished:

abdominal aorta (ICD code 10 - 174.0);
obstruction and stenosis of the vertebral artery (165.0);
basilar (165.1);
sleepy (165.2);
precerebral arteries (165.3);
coronary artery);
pulmonary (126);

The cause of mesenteric thrombosis is heart disease, for example, myocardial infarction, cardiosclerosis, arrhythmias

renal (N 28.0);
retinal (N 34/0);
other and unspecified areas of the aorta (according to ICD 10 - 174.1);
hand arteries (174.2);
veins of the lower extremities (ICD code 10 - 174.3);
peripheral blood vessels (174.4);
ileofemoral thrombosis of the iliac artery (174.5);
phlebitis and deep vein thrombosis of the lower extremities (μb 10 - 180.2).

As for the thrombosis of mesenteric vessels, it belongs to the class "Vascular bowel disease". Subclass according to ICD 10 - K 55.0 "Acute vascular intestinal diseases".

Diagnosis and treatment of the disease

Treatment of the disease is mandatory, aimed at eliminating the formed blood clot, resuming normal blood flow, and reducing symptoms. Of no small importance is the control and treatment of concomitant pathologies that provoke the progression of venous occlusion. These include: atherosclerosis, hypertension, diabetes, dysfunction endocrine system, some infectious diseases. Therapy consists in taking certain medications, undergoing courses of physiotherapy, and in advanced cases - in surgery. If there is a threat of thrombus separation, immediate surgical treatment is indicated, the main task of which is to remove the formed blood clot.

A deep vein examination is performed using ultrasound to determine the nature of the formed blood clot

Self-medication in this case is strictly contraindicated. Before starting the treatment of the disease, it is necessary to visit a phlebologist (sometimes additional consultation of an endocrinologist, infectious disease specialist, therapist, cardiologist is required), who will conduct a comprehensive examination of the vessels of the body. Mandatory appoint clinical research blood, urine, blood coagulation rate analysis, biochemical study. If thrombosis is suspected, functional tests are performed to help determine the features of the valves. The Brody – Troyanov – Trendelenburg and Hackenbruch – Sicar tests are the most common methods for diagnosing the disease. Instrumental research methods are very informative:

Doppler ultrasound is the safest and most painless method for diagnosing deep vein thrombosis of the lower extremities µB 10 - 180.2 and other types of occlusions. Ultrasound helps to study the condition of the walls of blood vessels, the peculiarities of blood movement, the operation of valves, as well as the presence of blood clots.
Angiography is an X-ray examination method using a contrast agent that is injected into the lumen of the affected vein. After that, a series of X-rays are taken to assess the state of the vessels (inner surface, degree of narrowing, features of blood flow). Unlike Doppler ultrasound, angiography has a number of contraindications. This is severe heart and hepatic failure, mental disorders, the presence of acute inflammatory or infectious diseases... Angiography is often replaced by computed tomography, which allows a detailed study of the vessels.

After confirming the diagnosis, individual treatment is prescribed, taking into account the patient's state of health, his age and sex, the presence of additional pathologies, the degree of vascular lesions.

Thrombosis of mesenteric vessels, lower and upper extremities, brain, heart and other types of occlusions are treated in three directions:

taking medications (heparins, indirect anticoagulants, thrombolytics, hemorheologically active drugs, anti-inflammatory drugs);
undergoing physiotherapy (amplipulse, magnetotherapy, electrophoresis, barotherapy, ozone therapy, diadynamic therapy, etc.);
establishment of a healthy lifestyle and nutrition.

If necessary, emergency surgical treatment is indicated, the purpose of which is to remove the blood clot from the lumen of the vein and restore normal blood circulation in the affected organ or limb. Most often, thrombectomy, the Troyanov – Trendellenburg operation, and a cava filter are installed. The success of treatment depends on the degree of vascular damage, the patient's health status, as well as the timeliness of the therapeutic measures.

Vein thrombosis ICD-10 code

According to ICD 10 (International Code of Diseases), venous thrombosis occurs due to blood clotting disorders. In this case, vasoconstriction occurs, due to which the thickened blood cannot freely pass through them. Thus, it begins to accumulate in certain areas, which leads to the development of serious complications.

ICD-10 table

Thrombosis belongs to the section Diseases of the circulatory system, subsections I81-I82, which includes the following venous diseases:

Excludes: phlebitis of portal vein (K75.1)

embolism and venous thrombosis:

Intracranial and spinal, septic or NOS (G08)

Intracranial, non-pyogenic (I67.6)

Brain (I63.6, I67.6)

Lower limbs (I80.-)

Abortion, ectopic or molar pregnancy (O00-O07,

Pregnancy, childbirth and the puerperium (O22.-, O87.-)

Cerebrospinal, non-pyogenic (G95.1)

How does thrombosis manifest?

According to the ICD, acute thrombophlebitis primarily manifests itself as pain and swelling. Here it is important to pay attention to whether the painful sensations spread along the course of the blood flow (especially when the load on the injured leg is applied) or whether it remains in a specific area. If you try to feel such a vein, you can feel some seals along the vessel, which will give off a sharp pain. Literally in 2-3 days, on lower limbs a vascular network of a red or cyanotic hue appears. The faster the patient reacts to the situation, the better for him.

If the ailment is not treated or not completely cured, then it can take on a chronic form. In this case, the symptoms according to ICD 10 in chronic thrombophlebitis will be as follows:

recurring pain;
slight swelling, which mainly manifests itself after prolonged stress on the leg;
vascular "asterisks".

How is acute thrombosis detected?

As diagnostic methods of research, we use:

Phlebography is one of the most accurate methods for diagnosing deep vein thrombosis.
Vascular ultrasound.
Radionuclide scanning and other advanced methods of detecting thrombosis.

After an accurate diagnosis and a comprehensive study of the parameters of thrombosis, the attending phlebologist prescribes a course of treatment, taking into account the individual characteristics of the patient.

How is it treated

Patients with such a diagnosis need treatment in a hospital setting. The patient can be transported to the hospital only in a horizontal position on a stretcher. The patient is prescribed bed rest until the formation of blood clots stabilizes and laboratory confirmation of a decrease in blood clotting. After that, active movements are gradually restored, but a squeezing bandage must be applied using an elastic bandage. Prolonged bed rest is contraindicated.

Conservative therapy is carried out using drugs that can reduce blood clotting - for this purpose, anticoagulants are prescribed. It is also necessary to use drugs to prevent platelet adhesion - antiplatelet agents. The implementation of thrombolytic therapy is possible only in the first 6 hours after the onset of the disease. It should not be performed without inserting a cava filter into the inferior vena cava. The fact is that there is a risk of embolus formation, which will lead to the development of complications. Surgical therapy is indicated when there is a high likelihood of pulmonary embolism.

For this purpose, the following activities are carried out:

installation of a cava filter into the inferior vena cava just below the renal vein attachment;
dismemberment of the inferior vena cava with sutures, the formation of several canals - carried out if it is impossible to install the cavafilter;
the introduction of the enzyme streptase - carried out through the catheter directly to the thrombus;
thrombus removal - used for blue phlegmasia and the lack of effect from conservative treatment.

Prophylaxis

Prevention issues concern patients at risk. They should:

constantly wear compression stockings (superficial veins narrow, blood flow through deep vessels increases, which prevents their thrombosis);
take venotonic drugs;
check the analysis for the prothrombin index and maintain the indicator reduced with the help of drugs of the anticoagulant group;
do not allow prolonged bed rest, carry out exercises for the legs, even in a supine state.

The occurrence of pain and swelling of the leg should alert any person. Timely examination will help to recognize the cause and prescribe treatment.

International code

ICD 10 is an international classification of diseases, a short adapted version of the 10th revision, adopted at the 43rd World Health Assembly. Varicose veins according to the MKB 10 code consists of three volumes with encodings, transcripts and an alphabetical index of diseases. Deep vein thrombosis has a specific code in the ICD-10 classification - I80. It is characterized as a disease with inflammation of the walls of the veins, a failure in normal circulation and the formation of blood clots in the venous lumen. Such an acute inflammatory process of the lower extremities is dangerous to human life, and ignoring it can be fatal.

Causes

The main factors that can provoke deep vein thrombophlebitis are:

Infectious pathogens;
Injury and damage to tissues and bones;
Disruption of tissue nutrition and the development of aseptic inflammation;
Introduction of a chemical irritant into the vessels of the lower extremities;
Long-term intake hormonal drugs or the period of pregnancy;
Increased blood clotting.

In diseases such as vasculitis, periarthritis or Brueger's disease, the risk of developing venous thrombosis of the lower extremities increases by about 40%. Addiction to smoking and alcoholic beverages, problems with the cardiovascular system, as well as excess weight, which leads to obesity, can provoke vascular disease.

Signs

At the initial stages of development, vascular and deep vein disease of the lower extremities can pass without any symptoms. But soon the following signs appear:

edema of the lower extremities occurs. Moreover, the higher the area of inflammation is, the more pronounced is the edematous process;
painful sensations of a pulling and bursting character;
the skin becomes very sensitive and reacts to any pressure. In the place where vascular thrombosis has formed, it becomes warmer and acquires a reddish tint. Often, the surface of the lower extremities acquires cyanosis characteristic of the disease;
itching and burning;
the venous system becomes more expressive, changes its structure.

Sometimes an infection joins the inflammatory process, which can lead to an abscess and purulent discharge.

Thrombophlebitis has several forms: acute and chronic. At acute manifestation inflammation of the deep veins and blood vessels of the lower extremities, for no reason, severe edema and unbearable pain appear. It is quite difficult to get rid of the disease completely, and most often this is the cause of the appearance of chronic venous insufficiency. Chronic inflammation is very often accompanied by the formation of abscesses and abscesses.

Separately, mesenteric and ileofemoral thrombophlebitis are distinguished:

mesenteric thrombosis is characterized by an acute disturbance of the blood flow of the mesenteric vessels, which is formed against the background of embolism. The cause of mesenteric thrombosis is heart disease, for example, myocardial infarction, cardiosclerosis, arrhythmias;
Ileofemoral thrombophlebitis is a rather complex disease that appears against the background of thrombotic clots overlapping the femoral and iliac vessels. The acute inflammatory process passes rather quickly as a result of compression of the arteries of the lower extremities and can lead to the formation of gangrene. The most dangerous complication can be the separation of the embolus and its transfer to the vessels of the lung and heart, arterial thrombophlebitis.

Diagnostics

In order to diagnose deep vein thrombosis, which is listed in the ICD-10 classifier, the doctor must conduct an external examination, as well as conduct a number of laboratory tests. The color of the skin, the presence of puffiness and vascular nodes are taken into account. The following research methods are usually used:

Blood test;
Coagulogram;
Thromboelastogram;
Determination of the prothrombin index, as well as C-reactive protein.

A deep vein examination is performed using ultrasound to determine the nature of the blood clot formed.

Treatment

Thrombophlebitis of the lower extremities, indicated in the ICD-10 under the code I80, is recommended to be treated taking into account the complexity of the disease. For example, acute deep vein thrombosis, which can result in the separation of a blood clot, requires bed rest for 10 days. During this period of time, the thrombus is able to fix on the walls of the vessels. At the same time, specialists take measures to improve blood circulation, reduce swelling and pain. After which it is recommended to proceed with physical exercise in the form of flexion and extension of the fingers, as well as special gymnastics performed in the supine position.

It is important to wear special compression garments to help support the dilated vessels during all procedures.

A good effect is given by special thrombotic agents that improve blood flow and resorption of the formed clots. At inflammatory processes such ointments and gels are not as effective, but as an additional way to care for the affected legs is possible. For solutions complex processes recommended use medicines in the form of tablets and injections.

There are the most effective and efficient physiotherapy procedures recommended for leg problems:

Electrophoresis (promote the penetration of drugs through the skin by exposure to an electric current);
UHF (the action of high-frequency electric fields promotes the outflow of lymph, regeneration);
Magnetotherapy (thanks to the magnetic field, the composition of the blood improves);
Paraffin applications (done as a prophylaxis for trophic ulcers).

If it is impossible to cure the problem in such ways, surgical intervention may be recommended. During the operation, a small incision is made through which the surgeon can insert a special cava filter that traps large blood clots. When using another technique - thromboectomy - veins are cleared of clots using a special flexible catheter. No less popular is the method of stitching the affected vessel.

And a little about secrets ...

Have you ever tried to get rid of varicose veins on your own? Judging by the fact that you are reading this article, the victory was not on your side. And of course you know firsthand what it is:

over and over again to observe the next portion spider veins on foot
wake up in the morning with the thought of what to wear to cover the swollen veins
suffer every night from heaviness, schedule, swelling or buzzing in the legs
a constantly bubbling cocktail of hope for success, anxious expectation and disappointment from a new unsuccessful treatment

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) has been adopted as a single normative document to take into account the incidence, the reasons for the population's visits to medical institutions of all departments, and the causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170

A new revision (ICD-11) is planned by WHO in 2017 2018.

As amended and supplemented by WHO

Processing and translation of changes © mkb-10.com

Thromboembolism code according to ICD-10

Arterial thrombosis in the classification of diseases

pulmonary thromboembolism (I26);
various types of thrombosis and embolism of cerebral vessels (I65 - I66);
blockage of the carotid artery (I63.0 - I63.2);
embolism and thrombosis of the abdominal aorta (I74);
cessation of blood flow due to thrombosis in other parts of the aorta (I74.1);
embolism and thrombosis of the arteries of the upper extremities (I74.2);
embolism and thrombosis of the arteries of the lower extremities (I74.3);
thromboembolism of the iliac arteries (I74.5).

The doctor, if necessary, can always find any, even a rare cipher of arterial thromboembolic conditions that occur in the vascular system, both in children and in adult patients.

Venous thrombosis in ICD 10 revision

various types of venous inflammation with thrombosis in the lower extremities (I80.0 - I80.9);
portal vein thrombosis (I81);
embolism and thrombosis of the veins of the liver (I82.0);
thromboembolism of the vena cava (I82.2);
blockage of the renal vein (I82.3);
thrombosis of other veins (I82.8).

Venous thromboembolism often complicates the postoperative period with any surgical intervention, which can lengthen the number of days a person is in the hospital. That is why proper preparation for the operation and careful implementation of preventive measures for varicose veins of the lower extremities are of great importance.

Aneurysms in ICD-10

How a doctor uses ICD-10

In particular, the codes from the section "Diseases of the circulatory system" are most actively used by doctors of the following specialties:

Thromboembolic conditions occur against the background of various diseases, which are not always associated with diseases of the heart and blood vessels, therefore, although rarely, the codes of thrombosis and embolism can be used by doctors of almost all specialties.

The information on the site is provided for informational purposes only and cannot replace the advice of your doctor.

Pulmonary embolism - description, causes, symptoms (signs), diagnosis, treatment.

Short description

Pulmonary embolism (PE) is the closure of the lumen of the main trunk or branches of the pulmonary artery with an embolus (thrombus), leading to a sharp decrease in blood flow in the lungs.

Code for the international classification of diseases ICD-10:

I26 Pulmonary embolism

Statistical data. PE occurs with a frequency of 1 case per year. It ranks third among the causes of death after ischemic heart disease and acute cerebrovascular accidents.

Causes

Etiology. In 90% of cases, the source of PE is located in the basin of the inferior vena cava. Iliac - femoral venous segment Prostate veins and other veins of the small pelvis. Deep veins of the legs.

Risk factors Malignant neoplasms Heart failure MI Sepsis Stroke Erythremia Inflammatory bowel diseases Obesity Nephrotic syndrome Reception of estrogens APS hypodynamia Primary hypercoagulable syndromes Antithrombin III deficiency Protein C and S deficiency Dysfibrinogenemia Epidemic period Pregnancy and postoperative period.

Symptoms (signs)

PE symptoms are nonspecific. Often there is a discrepancy between the size of the embolus (and, accordingly, the diameter of the blocked vessel) and clinical manifestations - slight shortness of breath with significant embolus and severe chest pain with small blood clots.

In some cases, thromboembolism of the branches of the pulmonary artery remains unrecognized or pneumonia or MI is misdiagnosed. In these cases, the preservation of blood clots in the lumen of the vessels leads to an increase in pulmonary vascular resistance and an increase in pressure in the pulmonary artery (the so-called chronic thromboembolic pulmonary hypertension develops). In such cases, shortness of breath during exercise comes to the fore, as well as fatigue and weakness. Then right ventricular failure develops with its main symptoms - leg edema, enlarged liver. When examining in such cases, sometimes a systolic murmur is heard over the pulmonary fields (a consequence of stenosis of one of the branches of the pulmonary artery). In some cases, blood clots lyse on their own, which leads to the disappearance of clinical manifestations.

Diagnostics

EchoCG: with PE, dilatation of the right ventricle, hypokinesis of the wall of the right ventricle, swelling of the interventricular septum towards the left ventricle, signs of pulmonary hypertension can be detected.

Ultrasound of peripheral veins: in some cases, it helps to identify the source of thromboembolism - a characteristic sign is considered to be non-collapse of the vein when pressed on it with an ultrasound sensor (there is a thrombus in the lumen of the vein).

Treatment

With massive PE, it is necessary to restore hemodynamics, oxygenation.

Surgical treatment An effective method of treatment for massive PE is timely embolectomy, especially with contraindications to the use of thrombolytics. acute pulmonary embolism, and for the prevention of further thromboembolism.

Complications Pulmonary infarction Acute cor pulmonale Recurrent deep vein thrombosis of the lower extremities or PE.

Pulmonary embolism

RCHRH (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan (Order No. 764)

general information

Short description

Protocol code: E-026 "Pulmonary embolism"

Profile: ambulance

Classification

1. Acute form - a sudden onset with chest pain, shortness of breath, a drop in blood pressure, signs of acute pulmonary heart disease.

2. Subacute form - progressive respiratory and right ventricular failure and signs of pulmonary infarction, hemoptysis.

3. Recurrent form - repeated episodes of shortness of breath, fainting, signs of pulmonary infarction.

By the degree of pulmonary artery occlusion:

1. Small - less than 30% of the total cross-sectional area of the vascular bed (shortness of breath, tachypnea, dizziness, fear).

2. Moderate% (chest pain, tachycardia, decreased blood pressure, severe weakness, signs of pulmonary infarction, cough, hemoptysis).

3. Massive - more than 50% (acute right ventricular failure, obstructive shock, swelling of the cervical veins).

4. Supermassive - more than 70% (sudden loss of consciousness, diffuse cyanosis of the upper half of the body, circulatory arrest, convulsions, respiratory arrest).

Most frequent sources:

Pulmonary embolism Classification (ICB, x revision, WHO, 1992):

I26 Pulmonary embolism

Abortion (O03-O07), ectopic or molar pregnancy (O00-O07, O08.2)

Pregnancy, childbirth and the puerperium (O88.-)

I26.0 Pulmonary embolism with mention of acute cor pulmonale

I26.9 Pulmonary embolism without mention of acute cor pulmonale

Definition: Pulmonary embolism (PE) - acute occlusion by a thrombus or embolus of the trunk of one or more branches of the pulmonary artery. PE is an integral part of the syndrome of thrombosis of the upper and lower vena cava system (more often thrombosis of the veins of the small pelvis and deep veins of the lower extremities), therefore, in foreign practice, these two diseases are combined under the general name - "Venous thromboembolism".

Diagnostic criteria:

M. Rodger and P.S. Welis (2001) proposed a preliminary score for the likelihood of PE:

The presence of clinical symptoms of deep vein thrombosis of the leg - 3 points

When carrying out differential diagnosis of PE, the most likely - 3 points

Forced bed rest for 3 - 5 days - 1.5 points

Hemoptysis - 1 point

Oncological process - 1 point

Patients with a total of  2 points are classified as low probability of having PE, moderate - from 2 to 6 points, high -  6 points

On the ECG in 60 - 70% of cases - "triad" SI, QIII, TIII (negative). With massive PE - a decrease in the ST segment (systolic overload of the right ventricle), diastolic overload (dilatation) is manifested by a blockade of the right bundle branch, possibly the appearance of a pulmonary P wave

Radiographic signs of PE:

High sedentary position of the dome of the diaphragm - 40%

Depletion of pulmonary pattern (Westermark symptom)

Lung tissue infiltrates - infarction-pneumonia

Expansion of the shadow of the superior vena cava

Bulging of three arcs along the left contour of the heart shadow

American researchers have proposed a formula for confirming or excluding PE:

Where: A - swelling of the neck veins - yes -1, no - 0

B - shortness of breath - yes - 1, no - 0

B - deep vein thrombosis of the lower extremities - yes - 1, no - 0

D - ECG - signs of overload of the right heart - yes - 1, no - 0

D - radiographic signs - yes - 1, no - 0

Laboratory signs: an increase in the level of fibrinogen degradation (N  10 μg / ml) and, in particular, the concentration of fibrin D-dimer more than 0.5 mg / l;

Leukocytosis does not shift to the left, with pneumonia - more with a shift to the left, with MI - less with eosinophilia.

Increased level of glutamine oxalate transaminase, lactate dehydrogenase, bilirubin level

Scintigraphy and angiopulmonography to assess the volume, localization and severity of PE.

Body classification (European Society of Cardiology, 1978):

By the volume of the lesion:

By the severity of development:

By clinical symptoms:

"Infarction pneumonia" - thromboembolism of small branches

"Acute cor pulmonale" - thromboembolism of large branches

"Unmotivated dyspnea" - recurrent pulmonary embolism of small branches

Examples of wording a diagnosis:

Ileofemoral thrombosis of the left extremity, acute pulmonary embolism, non-massive, right-sided infarction pneumonia, moderate severity, ARF stage 1.

Medical reference books

Information

handbook

Cardiologist

Diagnostics and treatment of diseases of the cardiovascular system

Pulmonary embolism

Pulmonary embolism (PE) is an occlusion of the arterial bed of the lungs by a thrombus that initially formed in the veins of the systemic circulation, or in the cavities of the right heart and migrated into the vessels of the lungs with blood flow, leading to the development of hypertension of the pulmonary circulation and pulmonary heart.

Pulmonary embolism is the third most common type of pathology of the cardiovascular system after coronary artery disease and stroke. In a multidisciplinary clinical hospital, pulmonary embolism is observed annually.

1000 treated patients, including 3-5 patients with a fatal outcome. According to the data of clinical and pathological studies, the frequency of PE among all deaths was 7.2% for the period from 1970 to 1989. In the structure of diseases complicated by the development of PE, malignant neoplasms (29.9%), cardiovascular (28.8%) and cerebrovascular (26.6%) diseases prevailed. Over the past 10 years, the mortality rate of PE has not changed and without treatment it is 30%, with early anticoagulant therapy - less than 10%.

Risk factors and etiology

Risk factors and causes of PE are: old age, chronic cardiovascular failure, any surgical interventions, trauma, prolonged immobilization, the postpartum period, thrombophlebitis, phlebothrombosis, atrial fibrillation and the presence of diseases leading to the formation of thrombotic masses in the cavities of the right heart, treatment with diuretics, the use of oral contraceptives, pregnancy, childbirth, trauma, heparin-induced thrombocytopenia, malignant neoplasms, sepsis, stroke, obesity, nephrotic syndrome. In 30% of patients, the development of PE occurs against the background of complete well-being. In most cases, deep vein thrombosis (DVT) is the cause. PE can occur as an embolism from separate parts of the vascular system and as a local thrombosis, but in clinical practice, it is impossible to distinguish between these processes. The most dangerous in terms of the development of PE is the so-called "floating" thrombus, which has a single fixation point in the distal section. The rest of it is located freely and along its entire length is not connected with the walls of the vein. The emergence of floating thrombi is often due to the spread of the process from veins of a relatively small caliber to larger ones.

PE is often multiple, in 2/3 of cases - bilateral. The right lung is affected more often than the left, and the lower lobes more often than the upper ones. 70% of patients with PE have deep vein thrombosis of the legs. PE is complicated in 50% of cases of deep vein thrombosis of the ilio-femoral segment, while in deep vein thrombosis of the legs, the risk of PE is only 1-5%. Deep vein thrombosis of the arms and superficial thrombophlebitis are relatively rare causes of PE.

Pathogenesis

The pathogenesis of PE includes two main links - "mechanical" obstruction of the pulmonary vascular bed and humoral disorders. Widespread thromboembolic occlusion of the arterial bed of the lungs leads to an increase in pulmonary vascular resistance, which prevents the ejection of blood from the right ventricle and insufficient filling of the left ventricle, pulmonary hypertension, acute right ventricular failure and tachycardia develop, and cardiac output and blood pressure decrease.

With massive PE, an acute cor pulmonale develops within a few minutes, less often - hours. With blockage of large and medium vessels of the lungs - subacute cor pulmonale, which develops within several days, and with repeated small episodes - chronic cor pulmonale with a duration of occurrence in months, years. In parallel with the development of cor pulmonale, hypertension of the pulmonary circulation occurs, which is based on a narrowing of the pulmonary vascular bed with a simultaneous increase in the minute blood volume.

Thromboembolism of large branches of the pulmonary artery can cause a sharp increase in pulmonary artery pressure (PAP). If, at the same time, the right ventricle is not hypertrophied, then its functional reserves may be insufficient to ensure normal ejection against a sharply increased resistance to ejection. In such cases, there is an acute cor pulmonale and right ventricular failure, requiring immediate intervention. With initial RV hypertrophy, the stroke volume does not fall, despite a sharp increase in PAP.

In this case, PE leads to severe pulmonary hypertension without right ventricular failure. The manifestations of PE depend on cardiac output (which, in turn, is determined by the degree of obstruction of the pulmonary artery and functional reserves of the right ventricle) and on concomitant factors (lung disease, left ventricular dysfunction). In parallel with the development of cor pulmonale, hypertension develops in the pulmonary circulation, which is based on the narrowing of the pulmonary vascular bed, with a simultaneous increase in the minute blood volume. There are:

Intrapulmonary vaso-vasal reflex, leading to diffuse narrowing of precapillaries and bronchopulmonary arteriovenous anastomoses;

Pulmonary heart reflex, leading to gross disturbances in rhythm and conduction, up to asystole;

Parin reflex or pulmonary vascular reflex, manifested by a decrease in blood pressure in big circle blood circulation.

The effect of humoral factors does not depend on the volume of embolic occlusion of the pulmonary vessels, therefore, obstruction of less than 50% of the vascular bed can lead to severe hemodynamic disturbances due to the development of pulmonary vasoconstriction. It is caused by hypoxemia, the release of biologically active substances - serotonin, histamine, thromboxanes from platelet aggregates in a thrombus.

Clinical picture

The clinical picture can develop in the following forms:

· Fulminant or syncopal form, in this case the clinical picture does not have time to develop;

· Acute form (30-40% of patients). Against the background of complete well-being - dagger pain behind the sternum, combined with severe shortness of breath, cyanosis of the upper half of the body, swelling of the cervical veins. Many patients develop pain in the right hypochondrium due to swelling of the liver. Auscultation - an accent of 2 tones over the pulmonary artery, in the same place - systolic and diastolic murmur, at the xiphoid process, a "gallop" rhythm. The acute course, most often, occurs in the postoperative period and in patients with MI.

· The subacute form occurs against the background of increasing pulmonary thrombosis, layering on the initial small or large emboli. Often late or inadequate treatment is the underlying cause. The clinic is dominated by symptoms of progressive respiratory and right ventricular failure, often - hemoptysis, pleuropneumonia. More often observed in severe cardiovascular decompensation, malignant neoplasms, cerebrovascular pathology, diuretic treatment;

The recurrent form proceeds under the mask of short-term fainting, attacks of shortness of breath, febrile syndrome unclear etiology, pneumonia, dry pleurisy, atypical angina pectoris. It is observed with frequent exacerbations of chronic thrombophlebitis of the lower extremities.

There are so-called precursors, or minor symptoms, manifested by sudden shortness of breath, tachycardia, the occurrence of short-term pain during breathing, a slight short-term drop in blood pressure, which often serve as harbingers of massive thromboembolism.

The most common symptoms of PE are shortness of breath (85%), respiratory rate from 5-8 per minute to tachypneopathy per minute (92%). Chest pain (88%), varied in pathogenesis, localization and severity. It can be a constant pain in the region of the heart, localized in the upper half of the sternum, ischemic in nature; chest pain associated with pleural involvement, aggravated by breathing, pain in the right hypochondrium associated with swelling of the liver; pain due to increased pressure in the pulmonary circulation. Cough - unproductive (50%), a feeling of fear (59%), hemoptysis (usually streaks of blood in sputum - 30%), appears several hours after the disaster, but is not an obligatory symptom of the disaster. Tachycardia (more than 100 per minute) - 44%, often accompanied by gross disturbances in rhythm and conduction. Fever is characteristic (43% - more than 37.8 ° C), thrombophlebitis - 32%, pleural friction noise - 20%. Cyanosis of the skin develops. The nature of cyanosis varies from pale cyanotic to cast iron gray, which occurs with thrombosis of the trunk trunks. In 80% of cases, routine clinical blood tests are without pathology.

A decrease in blood pressure manifests itself in a wide range of symptoms - from fainting until severe collapse that does not respond to treatment, while the hypertension of the small circle remains, which is determined by swelling of the cervical veins.

PE is characterized by the development of a collaptoid state at first, and only then - the onset of pain syndrome. The longer the decrease in blood pressure and the greater the swelling of the cervical veins, the more massive the thromboembolism.

There are three main syndromes:

Lung infarction - pleural pain, shortness of breath, sometimes hemoptysis. It is observed almost exclusively in left ventricular failure (due to low collateral blood flow through the bronchial arteries).

Acute pulmonary heart: sudden shortness of breath, cyanosis, right ventricular failure, arterial hypotension, in severe cases - fainting, circulatory arrest. It occurs with thromboembolism of large branches of the pulmonary artery, often against the background of damage to the heart and lungs.

Sudden shortness of breath for no apparent reason.

Chronic pulmonary insufficiency: shortness of breath, swelling of the cervical veins, hepatomegaly, ascites, leg edema. Usually develops with multiple PE or an undissolved thrombus with its retrograde growth. Less commonly, it is the result of a single undissolved thrombus in the pulmonary artery.

Thromboembolism of the mesenteric arteries, or abdominal syndrome, is characterized by acute pain in the right hypochondrium, intestinal paresis, false-positive symptoms of peritoneal irritation, vomiting, hiccups, belching, frequent stools, dysphagia. In the future, peritonitis develops with severe intoxication. There is a leukocytosis with a stab shift and an increase in ESR. All this simulates cholecystitis, pancreatitis and can lead to the operating table.

Cerebral syndrome is characterized by psychomotor agitation, meningeal symptoms, symptoms of focal lesions of the brain and spinal cord, epileptic seizures, polyneuritis. With retinal thromboembolism, sudden loss of vision may develop.

Thromboembolism of the arteries of the lower extremities is accompanied by a cold snap and pallor of the lower extremities, the appearance of sharp pain. The pulse on the blocked arteries is not determined, trophic disorders develop.

Thromboembolism of the bifurcation of the abdominal aorta (Leriche syndrome) is very difficult, accompanied by the development of gangrene of the affected limb. Pulse on femoral artery not defined.

Renal artery thromboembolism may be asymptomatic. When a large artery is damaged, pain appears in lumbar region and the abdomen on the side of the lesion, often a positive Pasternatsky symptom. Characterized by microhematuria, proteinuria, short oliguria. Renal ischemia can lead to arterial hypertension.

Conditionally, certain forms of PE are characterized by following symptoms... For an acute onset of the disease - collapse, shortness of breath, anginal status with fear of death. Subacute course - signs of pleuropneumonia and hemoptysis. Repeated attacks of sudden shortness of breath and short-term collapse characterize the recurrent course.

There is often a discrepancy between PE size and clinical presentation. A small blood clot can cause pulmonary infarction and severe pleural pain, and vice versa, the only complaint with thromboembolism of large branches of the pulmonary artery may be mild shortness of breath. The great difficulty is created by the fact that the symptoms are nonspecific and can occur in other diseases.

Attention should be paid to the patient's discomfort in the lower or upper extremities, burning sensation, pulling pain along the veins, swelling of the extremities, soreness when feeling them, unilateral edema by the end of the day. Lowenberg's test - the occurrence of pain when applied and compressed with a cuff at a pressure of 60 to 150 mm Hg. Gorman's test - pain in the calf muscles during dorsal flexion (flexion) of the foot.

Diagnostics

ECG - the formation of the S / QIII syndrome (deepening of the QIII and S waves, an increase in the RIII wave, displacement of the transition zone to the left, with a cleavage of the QRS complex in the right chest leads, displacement of the ST segment upward from the isoline in III, aVF and right chest leads, the appearance of negative wide T waves in the same leads, pulmonary P waves in standard leads. In some cases, there is a blockade of the right bundle branch. Rapid dynamics of the ECG is characteristic, after 48 hours the ECG takes its original form. Changes in the ECG are observed only in 25% of cases.

Other possible violations: possible atrial and ventricular premature beats, atrial fibrillation and flutter.

Chest X-ray: high standing of the right or left dome of the diaphragm, pleural effusion, atelectasis, plethora of the roots of the lungs, or parapleural infiltration, sudden breakage of the vessel.

The reference method for the diagnosis of PE is pulmonary angiography.

In order to optimize the ways of diagnosis and treatment, European Society cardiologists recommends distinguishing two groups of patients: the "high risk" group and the "low risk" group. Belonging to a particular group is determined by the development of shock or a drop in systolic blood pressure of less than 90 mm Hg. Patients who have the symptoms described are classified as "high risk"; mortality in this group is up to 15%.

Principles of treatment: if a patient is suspected of having PE, then the choice of treatment tactics depends on the assessment of the likelihood of developing PE and the assessment of the risk group. Special tables are used - Geneva or Wales (Table 1, Table 2).

Treatment

Treatment in the "high risk" group: heparin –0 IU intravenously, then - continuous infusion IU / kg / min. Higher doses are often required to achieve the effect. It is carried out under the control of APTT, determined every 4 hours until an increase of 1.5-2 times higher than the initial level is found. After that, determine the APTT 1 time per day. If the APTT has increased 2-3 times, the infusion rate is reduced by 25%.

Correction of hypotension in order to prevent the progression of right ventricular failure, the introduction of vasopressor drugs - dobutamine and dopamine.

With the development of hypoxemia, oxygen inhalation.

Thrombolysis is mandatory.

Warfarin (an indirect anticoagulant) is started on the first day, in combination with heparin, for at least 5 days, at a dose of 10 mg / day. Even if the risk factors for thrombosis are eliminated, anticoagulants continue to be taken for

3-6 months, if risk factors persist, or PE develops after drug withdrawal, anticoagulants are prescribed for life.

Thrombolysis: streptokinase intravenous IU for 30 minutes, then IU / h during the day. Urokinase - 4400 IU / kg for 10 minutes, then 4400 IU / kg / h for hours. Alteplase - intravenous infusion of 100 mg over 2 hours. Thrombolytics are injected into a peripheral vein, the effectiveness is the same as when injected into the pulmonary artery.

Surgical embolectomy is indicated if there are absolute contraindications to thrombolysis. Pulmonary catheter embolectomy or proximal pulmonary thrombus fragmentation can be used as an alternative treatment if thrombolysis is absolutely contraindicated.

In contrast to myocardial infarction, in pulmonary embolism, heparin is not administered together with thrombolytics. If the APTT at the time of cessation of the thrombolytic infusion exceeds the initial value by less than 2 times, intravenous infusion of heparin is started, followed by a switch to warfarin.

Thrombolysis may not be performed if the patient is classified as a “low to moderate risk” patient with normal blood pressure, but anticoagulant therapy should be started immediately, even if the diagnosis has not yet been confirmed. Instead of unfractionated heparin, low molecular weight heparins or fondaparinux can be used for at least 5 days. Simultaneously appointed indirect anticoagulants(warfarin) followed by switching to monotherapy, the target INR values are 2.0-3.0. Warfarin continues for at least three months. In patients at high risk of bleeding, the target APTT lengthening values should be within the lengthening range.

PE (or in decoding - pulmonary embolism) is accompanied by the formation of a blood clot in the vessels of the lungs. Depending on the affected artery, the blood supply to a specific area of the soft tissue stops. As a result, soft tissue ischemia develops.

A person begins to suffocate, a sufficient amount of oxygen ceases to enter the body. There is a risk of death, so it is important to know first aid techniques.

Pulmonary embolism is the closure of the lumen of the branches of the pulmonary artery with a piece of blood clot, which is formed by platelets glued to each other. In this case, the main thrombus can be located outside the respiratory system.

As a result of the formation of a clot, the blood supply to a small area of soft tissues is interrupted. Because of this part of the lungs stops transporting oxygen to the blood... Thromboembolism develops - a condition characterized by suffocation due to the spread of small blood clots in the vessels of the lungs.

The pathological process often occurs during the operation, which increases the risk of death by 30%. Without rendering medical care 20% of patients die within 2 hours after the onset of PE.

ICD-10 code

Pulmonary embolism - I26. Included are heart attack, thromboembolism, pulmonary artery and vein thrombosis. Complicated abortions (O03-O07), ectopic or molar pregnancy (O00-O07, O08.2), pregnancy, childbirth and the puerperium (O88.-) are excluded.

Pulmonary embolism with mention of acute cor pulmonale - I26.0, without mention - I26.9.

Does pulmonary thrombophlebitis happen?

Thrombophlebitis, in contrast to thrombosis, is characterized by inflammation of the venous vessel wall followed by the formation of a thrombus. In theory, the disease can affect any vein in the body. At the same time, in clinical practice, it was revealed that the disease often affects the superficial, saphenous veins, subject to temperature extremes.

In the pulmonary artery flows blood saturated with carbon dioxide. Therefore, with the development of a severe infection respiratory tract development of pulmonary thrombophlebitis is possible. The bacteria can cause inflammation of the vascular wall, which can lead to PE. This pathology develops in exceptional cases in less than 0.01% of patients..

Most often, pulmonary thromboembolism develops due to thrombophlebitis in the veins of the lower extremities. A blood clot forms in the legs, parts of which break off and enter the vessels of the lungs.

What happens in the body with PE?

For energy production, constant oxidative reactions take place inside cells, the main reagent of which is oxygen. In the process of breathing, air enters the lungs, where the alveoli are located.

Small bubbles of tissue are entangled in a network of capillaries, in which gas exchange takes place. The pulmonary artery delivers venous blood to the alveoli for release carbon dioxide and saturation with oxygen molecules.

With thromboembolism, the blood flow in the affected vessel stops, due to which gas exchange does not occur. The blood entering the lungs stops being saturated with oxygen. Cells throughout the body stop producing the energy needed for the organs to function. Under conditions of hypoxia, the death of brain and myocardial cells begins, blood pressure drops, and shock develops.

In the absence of treatment, a heart attack and atelectasis (a decrease in the lobe of the lung) occur.

Epidemiology in adults

TELA develops in 500-2000 people a year. Pathology occurs not only during the operation, but also during childbirth. The mortality rate of women in childbirth varies from 1.5% to 3% per 10,000 cases. 2.8-9.2% of women die from complications during the rehabilitation period.

Causes and pathogenesis

The following reasons can provoke the development of PE:

deep vein thrombosis of the lower extremities, complicated by thrombophlebitis in 90% of cases;
generalized sepsis;
cardiovascular pathologies with a high risk of thrombosis: ischemic disease, mitral stenosis, hypertension, cardiomyopathy, infective endocarditis;
thrombophilia;
thrombus in the inferior vena cava;
malignant neoplasms in the pancreas, lungs and stomach;
haemorrhoids;
artificial heart valve;
antiphospholipid syndrome.

PE begins with damage to the endothelium of the vascular wall... The latter normally produces nitric oxide and endothelin, which prevent vasospasm and platelet adhesion.

When endothelial cells are damaged, blood clotting increases and the blood flow subendothelium is exposed. The latter releases into the blood a substance that stimulates thrombus formation. Platelets activate the transformation of fibrinogen into fibrin, produce thrombin, which sticks platelets together.

Only part of the thrombus is fixed on the vessel wall. 75-80% of the blood clot remains free and can break off... Split platelets through the vessels enter the right ventricle of the heart. On the way of its advance, the split-off section of the thrombus can be destroyed into smaller parts.

From the heart, microthrombi enter the pulmonary circulation and begin to circulate through the vessels of the lungs, causing blockage of the branches of the pulmonary artery.

The consequences of PE depend on the size and number of blood clots... Large clots impair the blood supply to entire lobes and segments of the lung, which leads to hypoxia, respiratory and hemodynamic disorders:

hyperventilation of the lungs;
shock;
tachypnea;
pulmonary heart.

In some cases, metabolic disorders are possible. Smaller blood clots cause pulmonary infarction.

Risk factors

The following factors increase the risk of developing PE:

prolonged bed rest with post-infarction and post-stroke conditions;
cardiovascular pathologies: atrial fibrillation, heart failure, arterial hypertension, active phase of rheumatism;
paralysis of the limbs, fractures or immobility of the body for more than 12 weeks;
surgery on the organs of the abdominal cavity, lower extremities and small pelvis;
the use of an indwelling catheter in the central vein;
pregnancy, early delivery;
purulent-inflammatory diseases;
long-term use of drugs: hormonal, diuretics, laxatives, oral contraceptives;
diabetes;
systemic damage connective tissue: lupus erythematosus, vasculitis.

PE classification

There is no single classification for PE. To determine the type of pathology, the following criteria are used:

the degree of damage to the lung tissue;
the rate of development of the pathological process;
severity of thromboembolism;
clinical manifestations of PE;
the degree of blood flow disturbance.

Amount of damage: massive, submassive, non-massive

According to the level of lung damage, pulmonary embolism is divided into 3 types:

Massive... In such a situation, blood clots stop blood supply in 50% or more of the lungs. The main branch of the pulmonary artery is affected or a pulmonary embolism begins. As a result, shock and systemic hypotension develop.
Submassive... Affected from 30% to 50% of the vessels of the lungs: the pathological process captures segments and lobes of organs. In patients, there is a failure of the right ventricle.
Non-massive... Thromboembolism extends to 30% of the volume of the vascular bed of the lower respiratory system. PE is asymptomatic. There may be no consequences.

Clinic and severity

According to the severity, the following forms of PE are distinguished:

Heavy... Pathology is characterized by impaired respiratory function and hemodynamic disorder. Tachycardia, severe shortness of breath and shock develop rapidly. Due to hypoxia, the skin becomes blue. In some cases, loss of consciousness is observed. In 40-60% of cases, there is a feeling of anxiety and fear, chest pain appears.
Moderate... Heart rate reaches 100-120 beats / min, blood pressure decreases, tachypnea develops. The patient has pain syndrome in pleural cavity, cough, sputum with blood leaves. The person feels fear, periodically loses consciousness.
Easy... The pulse reaches 100 beats / min. There is no hyperventilation of the lungs, short-term dyspnea develops. In rare cases, a dry cough appears, patients cough up blood.

The degree of impaired blood supply to the lungs

3 forms of violations are classified:

Partial... It is asymptomatic. Small clots clog the capillaries without harming the main gas exchange. The function of the affected vessels is taken over by the adjacent branches of the artery.
Average... Multiple thromboembolism of the branches leading to one of the segments of the lung. Pathology extends to 30% of tissues.
Full... It is characterized by the formation of a blood clot in the central branch of the pulmonary artery with congestion or severe slowing of blood flow. The result is severe respiratory failure.

Clinical classification

By distinctive features clinical picture the following types of pulmonary embolism are distinguished:

Heart attack pneumonia: PE develops in small arteries. The progressive disease is characterized by acute shortness of breath, coughing up blood, and tachycardia. Respiratory failure develops when moving to an upright position. At the site of organ damage in the chest area, pain develops due to the spread of pathology through the pleural tissue.
Unmotivated shortness of breath: PE spreads through the small vessels of the lungs. The patient periodically suffers from sudden shortness of breath. Symptoms of cor pulmonale appear, despite the absence of cardiopulmonary pathologies.
Acute cor pulmonale: there is a thromboembolism of large arteries. The patient has sudden shortness of breath and blood pressure drops. The development of cardiogenic shock and angina pectoris pain is observed.

Dynamics

The classification of embolism along the pathological process is also important. There are the following types of pulmonary artery thrombosis:

lightning dynamics- death occurs within 5-30 minutes;
acute course diseases in which symptoms appear suddenly in succession: chest pain, shortness of breath, hypotension, acute cor pulmonale;
subacute- characterized by heart and respiratory failure, symptoms of infarction pneumonia and expectoration of blood clots;
recurrent pathology: repeated attacks of shortness of breath, symptoms of pneumonia, loss of consciousness.

Clinical picture

With the development of PE, shortness of breath immediately develops. When small arteries are damaged, the patient does not have enough air, he begins to panic. With blockage of the central branches of a large caliber, severe suffocation is observed, accompanied by cyanosis.

In 85% of cases, shortness of breath is quiet, not accompanied by noisy inhalation and exhalation... Patients are comfortable in a supine position. Respiratory failure leads to a number of other signs of impairment.

Symptoms of brain disorders

In a state of acute hypoxia, with damage to the branches of the pulmonary artery of a large caliber, a violation of cerebral circulation is observed. Neurons in the brain do not receive the required amount of oxygen, which provokes the development of the following symptoms:

violation of consciousness;
fainting;
violation of coordination of movements;
an increase in body temperature up to + 38 ° C;
darkening in the eyes;
decreased cognitive function;
dizziness and headache.

Signs in cardiology

The second most common symptom of PE is chest pain that is felt from a few moments to 12 hours depending on the degree of damage to the respiratory system.

In pulmonary embolism of small branches of the pulmonary artery, the pain syndrome is practically not felt, the symptoms are erased. Thrombosis of large vessels leads to prolonged aching-stitching pains. If the pathology extends to the pleura, there are stitching pains during coughing, walking and breathing deeply.

In rare cases, small-caliber artery involvement results in pain that is similar to a heart attack.

In most cases, abdominal syndrome develops arising from a malfunction of the right ventricle or due to irritation of the phrenic nerve. In such a situation, the pain is felt in the right hypochondrium. With right ventricular failure, the appearance of a gag reflex, abdominal distention is possible.

With PE, tachycardia and a decrease in blood pressure also appear.

Respiratory disorders

In addition to acute shortness of breath after 2-3 days after the onset of the disease a cough develops as a symptom of infarction pneumonia... At the same time, hemoptysis is observed in 30% of cases. Gas exchange disturbances lead to the development of oxygen starvation of cells, therefore, during a physical examination of the patient, cyanosis is noted - blue skin.

How to determine the likelihood before the survey?

On prehospital stage the onset of pulmonary embolism cannot be determined. It is almost impossible to prevent the development of the pathological process during surgery and delivery. To relieve an acute condition, resuscitation measures are carried out, the patient is transferred to the intensive care unit.

First aid emergency care: algorithm of actions

If pulmonary embolism is suspected it is necessary to call a team of paramedics. After that, you need to help the victim sit down or take a horizontal position with his head elevated. It will be necessary to remove dentures from the patient, free the chest from clothes, and provide fresh air to the room.

When a patient has panic, it is necessary to calm him down to prevent rapid breathing and heartbeat during stress. Food and drink should not be given to the sick person. With the development of pain syndrome, you need to give the victim narcotic painkillers. These medications can help to further reduce shortness of breath. Giving neuroleptanalgesia is prohibited when blood pressure is lowered.

Pain during breathing or movement indicates the development of heart attack pneumonia. Doctors should be informed about this upon arrival.

Until the ambulance arrives, you should count the pulse and measure the patient's pressure... The indicators need to be reported to the paramedics. In case of cardiac and respiratory arrest, it is necessary to start resuscitation measures: 2 breaths from mouth to mouth, pinching the patient's nose, alternate with 30 presses in the area of the heart.

To liquefy the thrombus, it is necessary to start anticoagulant therapy. In a critical situation, 15,000 units of heparin will need to be administered intravenously. It is forbidden to administer the drug with the development of bleeding and hemophilia. During hypotension, a rheopolyglucin drip should be given instead of heparin.

Diagnostics

If pulmonary embolism is suspected the main goal of diagnostics is to find out the exact localization of the thrombus... After that, the tasks are: to assess the degree of lung damage and the severity of the pathological process, to determine hemodynamic disturbances, to establish the source of pulmonary embolism. The latter is necessary to eliminate the main thrombus, from which a small clot has broken off, and to prevent relapses.

During the diagnosis, anamnesis is taken, the symptoms manifested are recorded, instrumental examinations are carried out, and laboratory tests are prescribed.

Laboratory Methods

To diagnose PE, the following laboratory tests are performed:

general and biochemical analysis blood;
lipid profile;
study gas composition blood;
urine analysis as part of differential diagnosis;
coagulogram;
determination of the level of D-dimers.

D-dimers are products of fibrinolysis. The norm should be 500 mcg of the compound. An increased concentration of a substance indicates a recent thrombus formation. In the diagnosis of PE in 90% of cases, the level of D-dimers is measured, as the most sensitive method.

Instrumental methods

Electrocardiography (ECG): with pulmonary embolism, right ventricular failure develops and sinus tachycardia, these changes can be recorded using a cardiogram. At the same time, in some patients, there are no signs of pulmonary embolism on the ECG. In 20% of patients, using a cardiogram, an acute cor pulmonale can be detected due to the load on the right ventricle.
Chest x-ray: in the picture, you can fix the high standing of the diaphragmatic dome from the side of the development of pathology. X-ray signs - expansion of the right ventricle and right descending pulmonary artery, enlargement of the roots of the lung.

Chest radiographs in patients with confirmed PE on the left - discoid atelectasis against the background of fluid in the chest cavity and expansion of the lung root, on the left - pulmonary infarction due to PE

Right lung infarction on x-rays in a patient with confirmed PE
Echocardiography: the procedure reveals a violation of the right ventricle, displacement of the interventricular septum to the left. During the diagnosis, hypertension is observed in the pulmonary circulation. In rare cases, blood clots are recorded in the region of the heart.
Spiral computed tomography: during the diagnosis, the localization of blood clots can be detected. The patient is injected with a contrast agent, which can be used to obtain a volumetric image of the lungs. During the procedure, the patient must hold his breath for a few seconds. The research method is safer for the patient compared to angiography.
Embolism of the upper lobe pulmonary artery on the left, revealed by CT of the chest organs with contrast, an embolus in the lumen of the artery is clearly visualized (marked with arrows and a circle)

Massive pulmonary embolism revealed in a patient with computed tomography in both pulmonary arteries, hypodense (against the background of contrasting blood) thrombi are visualized in their lobar branches

An example of polysegmental infarction pneumonia detected in a patient with PE of small branches of both pulmonary arteries by computed tomography
Ultrasound of deep veins of the lower extremity: the procedure allows you to determine the presence of blood clots in the veins of the legs, which may be the cause of pulmonary embolism.
Ventilation perfusion scintigraphy: During the procedure, it is possible to identify areas of the lung without blood supply, into which air enters. Scintigraphy makes it possible to diagnose PE with an accuracy of 90%.
Angiography- the most accurate method for diagnosing pulmonary embolism. Despite the accuracy, the procedure is invasive and not safe for the patient's health. With pulmonary embolism, the pulmonary artery is sharply narrowed with slow removal of the contrast agent.

Treatment: first aid standards

Treatment is focused on saving the patient's life and restoring the natural blood supply to the lungs. For treatment the patient is transferred to intensive care, where he will stay until the blood clot is removed... In the intensive care unit, the work of the respiratory and circulatory systems is supported with the help of mechanical ventilation.

In the presence of pain, the patient is injected with pain relievers. To eliminate thrombosis, treatment with anticoagulants is performed. In some cases, due to drug therapy, the thrombus is destroyed on its own, but if this does not happen, an operation is prescribed.

Treatment of patients with acute pulmonary embolism. Gilyarov M.Yu .:

Correction of hemodynamics and hypoxia

In case of cardiac arrest, resuscitation measures are performed. Oxygen therapy is used to prevent hypoxia.: Oxygen is supplied through masks or nasal catheters. Mechanical ventilation is used for the defeat of large branches of the artery.

To stabilize the pressure in the vessels and prevent venous congestion, saline, adrenaline, or dopamine are injected intravenously. To restore blood circulation in a small circle, anticoagulants are administered.

Anticoagulant therapy

Anticoagulant therapy helps prevent death. In the intensive care unit with a high risk of PE, sodium heparin is given intravenously. The dosage of the drug is influenced by the patient's body weight, indicators of thromboplastin time (APTT). After 6 hours of droppers, every 3 hours a blood test is taken from the patient to monitor the APTT indicator.

Heparin therapy PE is not prescribed for renal failure, hemophilia... In addition to heparin, on the first day of hospitalization, the patient is prescribed warfarin, which must be taken at least 3 months after discharge. The daily dosage is set by the attending physician, depending on the individual characteristics of the patient and the severity of the pathology.

Reperfusion therapy

To remove the thrombus and restore natural blood flow, reperfusion therapy is performed. Thrombolysis is used if there is a high risk of developing complications of PE. The following drugs are used to dissolve a blood clot:

streptokinase;
alteplase;
urokinase.

There is a high risk of bleeding during thrombolytic therapy.... In 2% of patients, cerebral hemorrhage occurs, in 13% of cases, severe internal bleeding.

Hospital surgery

Thrombus removal is performed by thrombectomy. In such a situation, the surgeon makes an incision at the site of the lesion of the vessel and removes the blood clot using instruments. After removing the thrombus, the incision is sutured. As a result, normal blood circulation is restored.

In spite of high efficiency,surgical intervention is associated with a high risk to the patient's life... A cava filter is used as a safer treatment for PE.

Installing a cava filter

A cava filter is installed in patients with a high likelihood of developing a recurrent pulmonary embolism. The indication for the procedure is also the presence of contraindications to the use of anticoagulants.

The product is a mesh filter that catches the splintered parts of the blood clot and prevents them from entering the vessels of the lungs... Kava-fil is installed through a small incision in the skin, passing the product through the thigh or jugular vein... The instrument is fixed below the veins of the kidneys.

Recurrent PE

In 10-30% of cases, patients who have undergone a pulmonary embolism may face a relapse of the disease. Pathology can be repeated many times. The high frequency of the transferred episodes is associated with blockage of the small branches of the pulmonary artery. The causes of relapse are:

malignant neoplasms;
cardiovascular pathology;
deep vein thrombosis, accompanied by the gradual destruction of a large blood clot;
cardiovascular and respiratory diseases;
carrying out the operation.

The repeated development of pathology does not have pronounced symptoms., therefore, it is practically impossible to diagnose. In most cases, the symptoms that appear are confused with other diseases.

An accurate diagnosis can be made only if you know about the previous PE and take into account the risk factors. Therefore, the main diagnostic method is a detailed history of the patient. After the survey, X-ray, ECG, ultrasound of the lower extremities are performed.

Recurrent pulmonary embolism can lead to the following consequences:

hypertension in the pulmonary circulation;
restructuring of blood vessels in the lower respiratory system with the formation of cor pulmonale;
blockage of the central branch of the pulmonary artery.

Lung thrombosis prognosis

Acute pathology can lead to cardiac and respiratory arrest. In the absence of resuscitation measures, a lethal outcome occurs. If the compensatory mechanisms of the body are triggered or small-caliber arteries are affected, the patient does not die. But in the absence of anticoagulant therapy, secondary violations hemodynamics.

With timely treatment, the prognosis is favorable- after the removal of the blood clot, the patient recovers quickly.

With prolonged hypoxia, there is a risk of brain damage, which leads to the irreversible loss of certain vital functions or human abilities.

Primary and secondary prevention

With the primary prevention of PE, it is necessary to treat varicose veins on time, undergo anticoagulant therapy and wear compression stockings with high blood clotting. After the birth of a child or in the postoperative period, it is necessary to strictly follow medical recommendations. Blood tests should be done twice a year for people at high risk of PE.

As a secondary preventive measure, you need to adhere to a healthy lifestyle:

treat infectious diseases;
avoid injury;
eat properly;
prevent obesity;
avoid stress;
exercise;
drink plenty of fluids;
to refuse from bad habits.

TELA is dangerous disease requiring immediate hospitalization. In most cases, it develops in women during childbirth or during surgery. To eliminate the thrombus, treatment with anticoagulants, thrombectomy, and installation of a cava filter are performed. With timely treatment, the patient recovers completely. Otherwise, hypoxia develops, disrupting the work of the brain, heart and respiratory failure. To reduce the risk of developing PE, cardiovascular pathologies should be diagnosed and treated in time.

Video "Living healthy"

Pulmonary embolism. Live healthy! Fragment of the release from 11/28/2016:

Now you know everything about PE: what is it in medicine, what are the causes, how to treat lung disease - modern principles and approaches to treatment, as well as the consequences of the disease.