Pulmonary infarction

At a Pulmonary infarction there is a blockage of blood vessels in the lungs. Pulmonary infarction is a common consequence of pulmonary embolism and can, under certain circumstances, be life-threatening. In the vernacular, pulmonary infarction and pulmonary embolism are often equated, which is medical but incorrect.

What is a pulmonary infarction?

Pulmonary infarction is a disease of the cardiovascular system and is very common as a result of pulmonary embolism. Blood clots block blood vessels that lead from the lungs to the heart.

These blood clots have also been washed into the lungs of another part of the body, creating a blockage. The cause of this is a thrombosis (blood clot) in another part of the body. The blood clot that is washed in is called an embolism in medical terminology.

If blood vessels are blocked by a blood clot that has washed into the lungs, there is a risk of a pulmonary infarction. The affected parts of the lungs are no longer supplied with blood and, in the worst case, can die. The death of parts of the lungs is known as a pulmonary infarction.

causes

A pulmonary infarction or pulmonary embolism is triggered by a thrombosis in the body. In the vast majority of all cases, this is a thrombosis in the large veins of the legs. In addition, thrombosis in the pelvic vein is a common cause of pulmonary infarction.

Thromboses are blood clots that have formed for various reasons. If these blood clots detach from their original location, they are driven around the body via the bloodstream until they can ultimately block a blood vessel at a bottleneck. As a result, the body part behind is no longer supplied with blood.

If you have a pulmonary embolism, there are already blood clots in the lungs. If these now lead to a blockage of blood vessels, the affected parts of the lungs are no longer supplied with oxygen. If the pulmonary embolism is not recognized and eliminated, there is a risk of pulmonary infarction. The affected lung tissue dies irretrievably. This can be life threatening.

Symptoms, ailments & signs

The first signs of a pulmonary infarction are sudden shortness of breath and impaired consciousness such as dizziness, disorientation or neurological failures of the arms and legs. Pain in the chest area, feelings of oppression and a racing heart or an increased pulse are also typical. The pain is localized in the pleura and can under certain circumstances radiate to the shoulders, stomach and arms.

In addition, various general symptoms can occur: sweating, dizziness, hot flashes and acute fatigue. The respiratory rate usually increases and hyperventilation occurs. Difficulty breathing is often described by those affected as a feeling of drowning. A foreign body sensation in the throat is often reported, which usually causes pain and disappears after a few minutes.

In addition, there may be coughing with blood. The symptoms usually appear suddenly and only a few minutes before the pulmonary infarction. Subsequently, the person concerned loses consciousness. If not treated, the pulmonary infarction is fatal. Before that, it can lead to circulatory disorders and a number of other serious complications. In the worst case, pneumonia sets in and the lung tissue dies. This is usually followed by circulatory shock, from which the patient eventually dies.

Diagnosis & course

In order to make the diagnosis of a pulmonary infarction, a detailed medical history by the doctor is first necessary. The subsequent physical examination includes listening to the lungs, measuring blood pressure and heart rate, and checking the body for thrombosis. Another criteria for diagnosing a pulmonary infarction is the so-called Wells score or the Geneva score. This allows the risk of a pulmonary embolism to be assessed.

If a pulmonary infarction is suspected after these examinations, further diagnostic procedures must be initiated to confirm the suspicion.

A pulmonary infarction can be visualized by means of computed tomography, in which the patient is given a contrast medium. An ultrasound on the leg can reveal the cause of the embolism. The effects of the pulmonary infarction on the body will be determined by means of an EKG, a pulmonary blood flow controller and a heart ultrasound.

Complications

In the worst case, a pulmonary infarction can lead to death. Because of this, the pulmonary infarction urgently needs to be treated by a doctor. Without treatment, irreversible consequential damage to the patient can occur. Those affected primarily suffer from thrombosis.

Pain in the chest and ribs also occurs, which significantly reduces the quality of life. In most cases, this also significantly restricts the patient's movement, so that the everyday life and work of the person affected are also restricted. Difficulty breathing also occurs due to the pulmonary infarction and the internal organs are no longer supplied with sufficient oxygen.

In the further course there is also a coughing up blood. The internal organs can be damaged due to the insufficient supply of oxygen, whereby this damage is in most cases irreversible. The treatment of pulmonary infarction is acute and usually does not lead to any particular complications. However, the further course depends strongly on the cause of the infarction, so that a general prediction of the course of the disease is usually not possible. It is not uncommon for the patient's life expectancy to be significantly reduced.

When should you go to the doctor?

In the event of a pulmonary infarction, the emergency doctor must be called immediately. If the first signs such as sudden chest pain or shortness of breath are noticed, it is best to take the person to the nearest hospital. If the symptoms persist for a few hours and worsen as the disease progresses, the suspicion is that it is a pulmonary infarction, which must always be examined and treated by a doctor to rule out complications.

The risk factors include long-term bed rest and previous cancers. Patients who suffer from deep pelvic and leg thrombosis or who regularly take hormone preparations are also at risk and should seek medical help if the symptoms mentioned occur. If the complaints arise in connection with a flight, the flight attendant must be called in. If they occur during pregnancy or childbirth, the responsible doctor must be informed. A pulmonary infarction requires emergency medical attention. Further diagnosis and treatment are carried out by a pulmonologist, supported by internists and physiotherapists.

Treatment & Therapy

It is very important that a pulmonary infarction is treated very quickly after it is diagnosed. This is the only way to avoid consequential damage, such as the death of the affected part of the lung. That is why the top priority in the event of a pulmonary infarction is to remove the blood clot and the resulting blockage. In most cases, starting drug therapy with anti-coagulants is enough to dissolve the blood clot.

However, there are also acute cases that require tougher measures. In these cases, anesthesia and subsequent placement of a venous catheter and administration of oxygen may be necessary. In rare cases, surgery to remove the blood clot may also be necessary. However, this operation is the last resort and is only performed in extremely life-threatening conditions in which other measures are unsuccessful.

The success of treatment for a pulmonary infarction depends on many different factors. The size of the blood clot and how long it has been in place is particularly important. The number of embolisms in the lungs also play a major role. In addition, the general health of the patient is of course also responsible for the success of the treatment.

Pre-existing illnesses and advanced age can make treatment difficult. In general, however, it can be said that the faster treatment is initiated in the event of a pulmonary infarction, the better the chances of success. If a patient has a pulmonary infarction, this is pre-stressed for the rest of his life. For this reason, further blood clots must be prevented. For this purpose, anticoagulant drugs are used that must be taken permanently.

Outlook & forecast

A pulmonary infarction is an emergency medical situation. Without the fastest possible medical care, in most cases the person concerned dies suddenly. The prognosis improves with immediate treatment. However, it must be taken into account that consequential damage can occur even if action is taken immediately.

Irreparable damage to the lungs is possible, which can lead to a restriction or permanent impairment of the functionality of breathing. In these cases, only one donor organ can help alleviate existing symptoms in the long term. There are numerous risks and complications associated with transplantation. In addition, it cannot be assessed in advance whether the donated organ will be successfully accepted by the organism. With an advanced age of the person concerned and the presence of other diseases, the prognosis is usually unfavorable. In addition, the prospect of a successful treatment depends on the size of the existing blood clot that triggered the pulmonary infarction.

It cannot be ruled out that there are further clots in the organism and that further damage is threatened. If the patient is generally in a very good state of health and medical care is taken immediately, the survival of the person concerned can be ensured. If there are no complications, no symptoms are possible. Nevertheless, the risk of complications and secondary diseases is high.

prevention

Pulmonary infarction prevention is possible in many cases. Risk factors include being overweight and consuming nicotine. But even after operations or in bedridden people, there is an increased risk of thrombosis and thus also of a pulmonary infarction. In these cases, thrombosis stockings prevent blood clots from forming.

Aftercare

The lack of blood supply to the tissue of the lungs causes irreversible damage to the tissue. For this reason, in the event of a pulmonary infarction, ongoing follow-up care is necessary, which aims to contain the various symptoms or keep them under control.

Because many vessels are subject to closure, the right ventricle has to perform better than usual. If this is overwhelmed, it can lead to total failure of the right half of the heart. Heart malfunctions can also occur. Those affected can suffer life-threatening cardiac arrhythmias.

Those affected should make sure that no harmful germs can spread in the lung region, because this can lead to harmful inflammation. There may also be inflammation of the lungs. Follow-up care should also focus on recognizing complications such as pulmonary hypertension in good time and averting them at an early stage. In this case, in order to be able to withstand the closure, the heart must continuously increase its pumping capacity. This can lead to high blood pressure in the lungs, which is harmful to the heart. Regular monitoring of cardiac activities and the lungs themselves by a doctor is therefore essential.

You can do that yourself

A pulmonary infarction is a medical emergency that requires immediate notification of the emergency doctor. As a rule, the affected person cannot take any self-help measures during an acute pulmonary infarction. First aiders should try to calm the patient down after they call 911. The cause of a pulmonary infarction is often a pulmonary embolism, which puts a heavy strain on the cardiovascular system. If the patient panics, this increases the stress on the circulatory system even further. First aider should therefore ensure that the patient calms down and moves as little as possible. It is best if the person concerned sits down in a comfortable armchair or lies down, with the upper body slightly elevated.

The pulse and breathing must be monitored continuously in unconscious patients. If a cardiac arrest occurs, immediate resuscitation measures are required. First aiders will need to give chest compressions and mouth-to-mouth or mouth-to-nose ventilation. Resuscitation should not be interrupted until the patient regains consciousness or the emergency doctor arrives.

Those affected should not let it come to a crisis in the first place, but rather consult a doctor at the first signs of an impending pulmonary infarction. A pulmonary infarction rarely comes suddenly, but is usually indicated by characteristic symptoms. These include in particular chest pain or pain in the area of ​​the ribs, shortness of breath and coughing up blood.