Pulmonary infarction is when blood vessels in the lungs become blocked. Pulmonary infarction is a common consequence of pulmonary embolism and can be life-threatening in some circumstances. In common parlance, pulmonary infarction and pulmonary embolism are often equated, but this is not medically correct.
What is pulmonary infarction?
A pulmonary infarction belongs to the diseases of the cardiovascular system and very often occurs as a result of a pulmonary embolism. In this case, blood clots cause blockage of blood vessels leading from the lungs to the heart. These blood clots have also been transported to the lungs from another part of the body, causing a blockage. This is caused by a thrombosis (blood clot) in another part of the body. The blood clot that is washed into the lungs is referred to in medical terminology as an embolism. If the blood vessels in the lungs are blocked by a blood clot that has been washed into the lungs, there is a risk of pulmonary infarction. In this case, the affected parts of the lung are no longer supplied with blood and, in the worst case, may die. The death of parts of the lung is called a pulmonary infarction.
Causes
A pulmonary infarction or pulmonary embolism, is caused 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 also a common cause of pulmonary infarction. Thromboses are blood clots that have formed due to various causes. If these blood clots detach from their original location, they are propelled around the body via the bloodstream until they can eventually cause a blockage of a blood vessel at a bottleneck. As a result, the part of the body behind them is no longer supplied with blood. In a pulmonary embolism, blood clots are already present in the lungs. If these now lead to a blockage of blood vessels, the affected parts of the lung are no longer supplied with oxygen. If the pulmonary embolism is not recognized and removed, there is a risk of pulmonary infarction. In this case, the affected lung tissue dies irreversibly. This can become life-threatening.
Symptoms, complaints, and signs
The first signs of a pulmonary infarction are sudden shortness of breath and impaired consciousness such as dizziness, disorientation or even neurological deficits of the arms and legs. Typical are also pains in the chest area, feelings of anxiety and palpitations or an increased pulse. The pain is localized in the pleura area and may radiate to the shoulders, stomach and arms. In addition, various general signs of illness may occur: Sweating, dizziness, flushing, and acute fatigue. The respiratory rate usually increases and hyperventilation occurs. The shortness of breath is often described by sufferers 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, coughing with expectoration of blood may occur. The symptoms usually occur quite suddenly and only a few minutes before the pulmonary infarction. Subsequently, the affected person loses consciousness. If no treatment is given, the pulmonary infarction is fatal. Before this happens, there may be circulatory problems 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 patients eventually die.
Diagnosis and course
To make the diagnosis of pulmonary infarction, the first step is for the physician to take a detailed medical history. The subsequent physical examination involves listening to the lungs, measuring blood pressure and heart rate, and checking the body for thrombosis. Other criteria in the diagnosis of a pulmonary infarction is the so-called Wells score or the Geneva score. This allows the risk of a present pulmonary embolism to be estimated. If a pulmonary infarction is suspected after these examinations, further diagnostic procedures must be initiated to ensure the suspicion. Computed tomography, in which the patient is administered a contrast medium, can be used to visualize a pulmonary infarction. To reveal the cause of the embolism, an ultrasound of the leg can provide information.What effects the pulmonary infarction has already had on the body will be determined by ECG, controller of pulmonary blood flow and a cardiac ultrasound.
Complications
In the worst case, a pulmonary infarction can lead to the death of the affected person. For this reason, pulmonary infarction must be treated urgently by a physician. Without treatment, this can also lead to irreversible consequential damage in the patient. The affected person primarily suffers from thrombosis. They also experience pain in the chest and rib area, which considerably reduces their quality of life. In most cases, this also significantly restricts the patient’s movement, so that the affected person’s everyday life and occupation are also restricted. Respiratory distress also occurs due to the pulmonary infarction and the internal organs are no longer supplied with sufficient oxygen. In the further course, hemoptysis also occurs. The internal organs can be damaged due to the lack of oxygen supply, and this damage is irreversible in most cases. Treatment of pulmonary infarction is acute and does not usually 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 physician must be called immediately. When the first signs are noticed, such as sudden chest pain or shortness of breath, the affected person is best taken to the nearest hospital. If the symptoms persist for a few hours and become more severe in the course of time, there is reason to suspect that the patient is suffering from a pulmonary infarction, which must be examined and treated by a doctor in any case in order to rule out complications. Risk factors include prolonged bedriddenness and past cancer. Patients suffering from deep pelvic and leg thrombosis or regularly taking hormone preparations are also at risk and should seek medical attention if the above symptoms occur. If the symptoms occur in connection with air travel, the flight attendant must be called in. If they occur in the context of pregnancy or childbirth, the physician in charge must be informed. A pulmonary infarction must be treated by an emergency physician. Further diagnosis and treatment is carried out by a pulmonary specialist, supported by internists and physiotherapists.
Treatment and therapy
It is very important that a pulmonary infarction is treated very quickly after diagnosis. This is the only way to avoid secondary damage, such as death of the affected part of the lung. Therefore, the first priority in a pulmonary infarction is to remove the triggering blood clot and the resulting blockage. In most cases, it is sufficient to start drug therapy with anticoagulant preparations to dissolve the blood clot. However, there are acute cases that require harsher measures. In these cases, anesthesia followed by placement of a venous catheter and oxygen administration may be necessary. In rare cases, surgery may also be necessary to remove the blood clot. However, this operation is the last resort and is only performed in extremely life-threatening conditions where other measures are unsuccessful. The success of treatment for pulmonary infarction depends on many different factors. The size of the blood clot and how long it has existed are very decisive. The number of emboli in the lungs also plays a major role. In addition, the patient’s general state of health is of course also responsible for the success of treatment. Pre-existing conditions and advanced age can make treatment more difficult. In general, however, it can be said that the sooner therapy is initiated for a pulmonary infarction, the better the chances of success. If a patient has suffered a pulmonary infarction, he or she is predisposed for the rest of his or her life. For this reason, further blood clots must be prevented. Anticoagulant drugs are used for this purpose and must be taken permanently.
Outlook and prognosis
A pulmonary infarction represents an emergency medical situation. Without the fastest possible medical care, the affected person will die suddenly in most cases.The prognosis improves if immediate treatment takes place. However, it must be taken into account that even if immediate action is taken, consequential damage can occur. Irreparable damage to the lungs is possible, which can lead to a restriction or permanent impairment of respiratory function. In these cases, only a donor organ can help relieve existing symptoms in the long term. Transplantation is associated with numerous risks and complications. In addition, it is not possible to assess in advance whether the donated organ will be successfully accepted by the organism. If the patient is of advanced age and has other diseases, the prognosis is usually unfavorable. In addition, the prospect of successful treatment depends on the size of the blood clot that caused the pulmonary infarction. It cannot be ruled out that further clots are present in the organism and that further damage is imminent. If the patient’s health is basically very good and medical care is provided immediately, the patient’s survival can be ensured. If no complications occur, freedom from symptoms is possible. Nevertheless, the risk for complications and secondary diseases is high.
Prevention
Prevention of pulmonary infarction is possible in many cases. Risk factors include obesity and nicotine use. But also after surgery or in bedridden people, there is an increased risk of thrombosis and thus of pulmonary infarction. Thrombosis stockings prevent the formation of blood clots in these cases.
Follow-up
The lack of blood flow to the tissues of the lungs causes irreversible damage to the tissues. For this reason, lung infarction requires ongoing follow-up care aimed at containing or keeping the various symptoms under control. Because many vessels are subject to occlusion, the right ventricle has to work harder than usual. When this is overtaxed, total failure of the right side of the heart can occur. Malfunctions of the heart can also occur. Affected individuals can suffer life-threatening cardiac arrhythmias. Affected individuals should be careful not to allow harmful germs to spread to the lung region, as this can lead to harmful inflammation. Inflammation of the lung pleura may also occur. Follow-up care should also focus on detecting complications such as pulmonary hypertension in time and averting them early. In order to resist the occlusion, the heart must permanently increase its pumping capacity in this case. This can lead to high blood pressure in the lungs, which is harmful to the heart. Regular monitoring of heart activity as well as the lungs themselves by a physician is therefore essential.
This is what you can do yourself
A pulmonary infarction is a medical crisis that requires immediate notification of emergency medical services. The affected person generally cannot take self-help measures during an acute pulmonary infarction. First responders should attempt to sedate the patient after making the emergency call. The cause of a pulmonary infarction is often a pulmonary embolism, which places a great strain on the cardiovascular system. If the patient panics, this increases the stress on the circulatory system even further. First responders should therefore ensure that the patient calms down and moves as little as possible. The best thing is for the affected person to sit down in a comfortable chair or lie down, with the upper body slightly elevated. In unconscious patients, the pulse and breathing must be constantly monitored. If circulatory arrest occurs, immediate resuscitation measures are required. First responders must perform chest compressions and mouth-to-mouth or mouth-to-nose resuscitation in this case. Resuscitation measures must not be interrupted until the patient regains consciousness or the emergency physician arrives. However, affected persons should not allow a crisis to develop in the first place, but should consult a doctor at the first signs of an impending pulmonary infarction. A pulmonary infarction rarely comes on 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.