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Thromboembolic disease

Thromboembolic disease is a thrombosis of the blood vessels or cavities of the heart with skidding off parts of a thrombus (thromboembolus) in other parts of the cardiovascular system . This name - thromboembolic disease - is especially justified with repeated, multiple thromboembolism in the arteries of various organs and parts of the body. Thrombosis (see) for thromboembolic disease should be distinguished from thrombosis, which is a physiological reaction, for example, for injuries, wounds of blood vessels, when a thrombus contributes to the cessation of bleeding.

The primary localization of the thrombotic process may be different: the heart cavity, the aorta and its large branches, veins, mostly peripheral. Thromboembolic disease can accompany heart defects , thromboendocarditis, myocardial infarction, cardiac aneurysm , aortic atherosclerosis and other diseases of blood vessels, as well as cancer of various localization.

From the cavities of the left heart or the aorta, thromboembolus is introduced into the arteries of the lower extremities, mesenteric vessels, arteries of the kidneys, spleen, brain. From the cavities of the right heart, veins of the lower extremities and the small pelvis - into the pulmonary artery and its branching. A significant role in the occurrence of thromboembolic disease is played by changes in the blood coagulation system resulting from infection and a number of other diseases, injury to blood vessels during surgery, prolonged bed rest, emotional overstrain, etc.

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The clinical picture and treatment of thrombosis and thromboembolism . The clinical picture depends on which vessel and at what level it underwent obturation; mainly dominated by symptoms associated with impaired circulation.

Differential diagnosis between thrombosis and thromboembolism presents great difficulties. It should be borne in mind that the development of a thrombosis is gradual and circulatory disturbance occurs more slowly with it; clinical symptoms develop less acutely than with thromboembolism due to developing collateral blood flow. There are thromboembolism of the vessels of the large circle of blood circulation and thromboembolism of the vessels of the small circle of blood circulation (pulmonary artery). In acute blockage (thromboembolism) of the abdominal aorta, clinical manifestations develop rapidly: ischemic pains in the legs appear, the skin on which becomes pale, pulsation on the peripheral arteries is absent; active leg movements are not possible; no sensitivity. If urgent medical measures are not provided, the general condition of the patient quickly deteriorates, the pulse speeds up and blood pressure drops sharply; consciousness inhibited. General intoxication is growing rapidly; the skin of the lower extremities becomes marble with cyanosis ; moist gangrene of the extremities develops.

The occurrence of a thromboembolism in the iliac or femoral artery is accompanied by the sudden appearance of severe pain in the corresponding limb, a state of collapse, the disappearance of the pulsation below the site of occlusion, and an increased pulsation above this site. Without urgent remedial measures, gangrene of the limb develops quickly, at a different level, depending on the localization of the thrombus.

Comparatively often thrombosis and thromboembolism of the mesenteric vessels. Usually, the superior mesenteric artery is obstructed. The clinical picture is characterized by signs of acute abdomen (see). If urgent surgical treatment is not undertaken, intestinal necrosis develops. Surgical treatment in this stage of the disease is rarely accompanied by success.

Thrombosis of the intestinal veins is accompanied by a gradual increase in circulatory disorders of the intestine and can also lead to intestinal necrosis.

When thromboembolism of the renal arteries suddenly appears pain in the lumbar region, blood in the urine, a persistent increase in blood pressure. Thromboembolism of the splenic artery is manifested by a sudden pain in the left hypochondrium, an enlarged spleen .

When zmbola is brought into the cerebral arteries, clinical phenomena can be in many ways similar to the thrombosis of these arteries and are not always distinguishable from cerebral hemorrhage.

Differential diagnosis is very important in relation to special treatment: anticoagulants and fibrinolytic drugs, shown in thromboembolism, are absolutely contraindicated in hemorrhages in the brain. To clarify the diagnosis, conduct additional research methods - capillaroscopy (see), oscillography (see), arteriography of cerebral vessels (see Angiography ).

The prognosis is often difficult.

Pulmonary embolism is manifested by sudden pain in the region of the heart, severe pallor, then cyanosis of the face, swelling of the neck veins, agitation of the patient and loss of consciousness. When closing the pulmonary trunk, right or left pulmonary artery, death can occur within a few minutes. Thromboembolism of smaller branches of the pulmonary artery is manifested by the appearance of pain in the side, hemoptysis, symptoms characteristic of pulmonary infarction.

thromboembolism
Fig. 1. Occlusive red thrombus in a varicose vein. Fig. 2. Globular thrombus of the left atrium with rheumatic mitral valve disease. Fig. 3. Pulmonary embolism: 1 - blood clots; 2 - pulmonary artery; 3 - easy.

Treatment . A patient with suspected thromboembolism of any vessels must be urgently hospitalized. Hot water bottles are contraindicated. In thromboembolic disease and deep vein thrombosis of the extremities, especially the lower ones, the patient should be placed so that the affected limb is in an elevated position (you can use the standard Beler splint); getting up and moving limbs is prohibited. When an embolism of a large blood vessel that caused sudden circulatory disorders in a limb or in a vital organ, an emergency operation is necessary to remove the embolus and restore blood circulation.

With the conservative treatment of thromboembolism, the doctor prescribes a means of lowering blood clotting (see Anticoagulants) and fibrinolysin under the control of the prothrombin index in the blood plasma (normal 90-100%) and blood clotting time, since overdose of anticoagulants may cause bleeding ( nasal , uterine, intestinal, etc.).

Painkillers are also prescribed.

Thrombosis prophylaxis : in patients with atherosclerosis, cardiovascular diseases, disorders of water and fat metabolism, it is necessary in the case of injuries or surgical interventions to systematically check the blood coagulogram, reduce bed rest, combat dehydration, and carry out therapeutic exercises . Assign small doses of weakly acting anticoagulants (as prescribed by a doctor).

To prevent thromboembolism - the possible separation of an already formed blood clot - in recent cases, a strict dormancy for at least one week is indicated.