Ms. Huang has just retired and is taking care of her daughter at home!
Usually my body is okay, but I have a little high blood pressure. I am taking antihypertensive drugs, and my blood pressure is well controlled. It is maintained between 120-130/70-80mmHg for a long time.
In the morning, after feeding her little grandson, Ms. Huang suddenly felt short of breath, chest tightness and suffocation, and she was very flustered. She thought it was a blood pressure problem, so she quickly measured her blood pressure and found that it was 90/60mmHg. After the first measurement, she suspected it was a mistake because her blood pressure had never been this low. After measuring again, her blood pressure was still around 90/60mmHg, and her heartbeat was very fast, 110 beats/min, while her usual heart rate was only 70 beats/min per minute, with a maximum of 80 beats/min.
This made Ms. Huang terrified. She quickly called her daughter, saying that she had low blood pressure and chest tightness and suffocation. The daughter said that she should lie down and don’t move around. It might be a heart attack. Heart attack.
Daughter called 120 immediately and rushed home at the same time.
After 120 arrived at home, he did an electrocardiogram and found no evidence of myocardial ischemia, let alone a myocardial infarction-like electrocardiogram. Subsequently, the blood pressure was measured at 87/56 mmHg, and a small dose of dopamine was given infusion; the heart rate was measured at 120 beats/min, and the patient was quickly lifted into a 120-car and sent to the hospital.
On arrival at the hospital, we were already in the ER waiting for a consultation, I took a look at the EKG and told the ER nurse to review the EKG.
ECG showed: S wave in lead I, Q wave + T wave in lead III, heart rate 122 beats/min.
This type of ECG is a typical S1Q3T3 ECG. After our professional doctors read it, it is highly suspected that there is a thrombus in the pulmonary blood vessels, which is called pulmonary embolism, also called pulmonary infarction.
Myocardial infarction and cerebral infarction are the ones we hear the most. Myocardial infarction is when the arteries of the heart are blocked by blood clots, while cerebral infarction is when the blood vessels of the brain are blocked by blood clots.
According to the performance of the electrocardiogram, combined with the patient’s sudden rapid heart rate, low blood pressure, and blood oxygen saturation of 86% (the blood oxygen saturation of healthy people is generally 95%-100%.). Then it is possible to diagnose acute pulmonary embolism, immediately and accurately thrombolyse, inform the family of the condition, sign the critical illness notice and thrombolysis consent.
Two hours after thrombolysis, the patient’s heart rate gradually slowed from 120 to 100 beats, the patient’s blood pressure gradually increased from 90/60mmHg to 105/70mmHg, and the patient’s blood oxygen saturation increased from 86% rose to 93%. The patient’s feeling of chest tightness, shortness of breath, shortness of breath, palpitation, etc. was significantly improved.
Ms. Huang’s daughter was very grateful and said she would send a pennant to express her gratitude.
1. What is pulmonary embolism?
As we mentioned above, pulmonary embolism, also known as pulmonary infarction, is when a blood vessel in the lung is blocked by a blood clot.
When the blood vessels in the lungs are blocked, the function of the lungs will be reduced. The main function of the lungs is to breathe and provide oxygen to the human body. When a pulmonary embolism occurs, lung function decreases, and we feel deprived of oxygen.
The thrombus in the lung is generally not produced by the lung itself, but from other parts of the body, such as the common venous thrombosis of the lower extremities, the shedding of cancer thrombi caused by tumors, and the amniotic fluid embolism during childbirth. Falling off is the main cause of pulmonary embolism. Of course, there are some unexplained thrombus shedding, which can also cause pulmonary embolism.
Second, what are the typical manifestations of pulmonary embolism?
Since pulmonary embolism is a blockage of blood vessels in the lungs and pulmonary function decline, the most typical manifestation is hypoxia: chest tightness and suffocation, difficulty breathing, fatigue, and profuse sweating.
Vital signs will be: drop in blood pressure, increase in heart rate, decrease in oxygen saturation.
This Ms. Huang is theTypical symptoms of pulmonary embolism: beginning to feel chest tightness, suffocation, shortness of breath, low blood pressure measured, high heart rate, and low blood oxygen saturation when checked at the hospital.
Some patients also have chest pain, cough, or collapse, pale face, cold sweats, etc., and even extreme anxiety, fatigue, nausea, convulsions and even coma, syncope or even sudden death . An analysis of the China Pulmonary Thromboembolism Registry showed that 10% of patients with pulmonary embolism had syncope as the first symptom.
How to diagnose pulmonary embolism?
Pulmonary embolism is suspected when a person presents with these symptoms.
At this time, an electrocardiogram is needed, which can diagnose not only myocardial infarction, but also pulmonary embolism. Typical ECG manifestations of pulmonary embolism are: S wave in lead I, Q wave + T wave in lead III.
At the same time, it is possible to test whether the D2-mer is high through blood testing. Most of the pulmonary embolisms have high D2-mer. It is also necessary to draw arterial blood gas analysis to see if the arteries are hypoxic.
The most accurate test is called contrast-enhanced CT of the pulmonary vessels or pulmonary angiography.
4. How to rescue pulmonary embolism?
Once pulmonary embolism is diagnosed, risk stratification is completely eliminated, and thrombolysis is determined. Low-risk groups can be hospitalized for observation and anticoagulant therapy; high-risk groups, like Ms. Huang, need immediate Thrombolytic rescue.
At the same time, find the source of the blood clot as much as possible to prepare for the next step in preventing pulmonary embolism.
5. How to prevent pulmonary embolism?
Pulmonary embolism blood clots originate from different sites, so prevention cannot be said in the same way.
For example, amniotic fluid embolism cannot be effectively prevented at present, early detection and early rescue; long-term bedridden patients mainly turn over and pat their backs to assist activities; those of us who can move should insist on activities to avoid slow blood flow , to avoid thrombus; people with definite thrombus need regular treatment to prevent thrombus from falling off.
In short, pulmonary embolism is one of the critical diseases, and it is called the triad of chest pain together with acute myocardial infarction and aortic dissection. When we have low blood pressure, fast heart rate, hypoxia, etc. When performing, you must first think about whether it is a pulmonary embolism!