Selected Causes of Hemoptysis

Respiratory tract infections

• Bronchitis

• Pneumonia

• Tuberculosis

• Fungal infection (for example, Aspergillus infection)

• Lung abscess,

•Bronchiectasis

Circulation problems

• Heart failure

• Mitral valve stenosis

• Arteriovenous malformations

Foreign objectin airways

Bleeding disorders

Trauma

Injury during a medical procedure

Pulmonary embolism

Tumor

Text B. Hemoptysis

Hemoptysis is the coughing up of blood from the respiratory tract.

Blood-streaked sputum is rather common and usually not serious. Infections such as acute or chronic bronchitis cause about half the cases. However, a large amount of blood in the sputum requires quick evaluation by a doctor.

Tumors, especially lung cancer, account for 20 percent of cases of hemoptysis. Doctors check for lung cancer in smokers over age 40 who develop hemoptysis, even if the sputum is only blood streaked. A pulmonary infarction (death of lung tissue from blockage of the artery supplying the tissue) may also cause hemoptysis. Blockage of a pulmonary artery, called pulmonary embolism, can result when a blood clot travels through the bloodstream and lodges in the artery.

Bleeding may be severe if a pulmonary vessel is accidentally damaged by a catheter. Such a catheter may be inserted into the pulmonary ar­tery or vein to measure pressures in the heart and the blood vessels to and from the lungs. High blood pressure in the pulmonary veins, as may occur in heart failure, may also cause hemoptysis.

Diagnosis

If hemoptysis causes significant blood loss or recurs often, it may be life threatening, so the source must be found and the bleeding stopped. Bronchoscopy (an examination using a viewing tube passed into the bronchi) may identify the bleeding point. A scan using a radioactive marker (perfusion scan) may reveal pulmonary embo­lism. Despite testing, the cause of hemoptysis isn't found in 30 to 40 percent of cases; however, the cause of severe hemoptysis usually is found.

Treatment

Mild hemoptysis may require no treatment or only antibiotics to clear an infection. Bleeding may produce clots that block the airways and lead to further breathing problems; therefore, coughing is important to keep the airways clear and shouldn't be suppressed with antitussive medications. Breathing steam or cold mist from a vaporizer or humidifier may help the person ex­pel a clot. Respiratory therapy may be needed. If a large clot blocks a major bronchus, the clot can be removed using a bronchoscope.

Bleeding from smaller vessels usually stops by itself. However, bleeding from a major vessel usu­ally requires treatment. A doctor may try to close off the bleeding vessel using a procedure called bronchial artery embolization. Using x-rays for guidance, the doctor passes a catheter into the vessel and then injects a chemical that causes the blood vessel to close. Bleeding caused by an in­fection or heart failure usually subsides if the un­derlying disorder is treated successfully. Some­times bronchoscopy or surgery may be needed to stop bleeding, or surgery may be needed to remove a diseased portion of the lung. These high-risk procedures are used only as last resorts. If clotting abnormalities are contributing to the bleeding, a transfusion of plasma, clotting factors, or platelets may be needed.

Notes:

blood-streaked с прожилками крови

clotting abnormalities нарушение свертывания

antitussive medication противокашлевые лекарства

humidifier увлажнитель

heart failure сердечная недостаточность

Text C. Respiratory Failure

Respiratory failure is a condition in which the level of oxygen in the blood becomes dangerously low or the level of carbon dioxide becomes dangerously high.

Respiratory failure results from an inadequate exchange of oxygen and carbon dioxide between the lungs and the blood or from an inadequate movement of air (ventilation) in and out of the lungs.

Almost any condition that affects breathing or the lungs can lead to respiratory failure. An over­dose of narcotics or alcohol can cause such pro­found sleepiness that a person stops breathing and suffers respiratory failure. Obstruction of the airways, injury to the lung tissues, damage to the bones and tissues around the lungs, and weak­ness of the muscles that normally inflate the lungs are also common causes. Respiratory failure can occur if blood flow through the lungs becomes abnormal, as occurs in pulmonary embolism. This disorder doesn't stop air from moving in and out of the lung, but without blood flow to a portionof the lung, the oxygen isn't properly extracted from the air, and carbon dioxide isn't transferred to it. Other causes of abnormal blood flow, such as congenital disorders that send blood directly to the rest of the body without its first going through the lungs, can also lead to respiratory failure.

Symptoms and Diagnosis

Some symptoms of respiratory failure vary with the cause. However, low oxygen levels cause cy­anosis (a blue tinge to the skin), and high carbon dioxide levels cause confusion and sleepiness. A person with an obstructed airway may gasp and struggle for breath; someone who is intoxicated or weak will quietly slip into a coma. No matter what the cause of respiratory failure, eventually low levels of oxygen make the brain and heart malfunction, resulting in deteriorating conscious­ness and abnormal heart rhythms (arrhythmias) that can lead to death. The buildup of carbon dioxide causes the blood to become acidic, fur­ther affecting all the organs, especially the heart and brain. The body tries to rid itself of carbon dioxide by deep, rapid breathing, but if the lungs can't function normally, this breathing pattern may not help.

If respiratory failure develops slowely, pressure in the blood vessles through the lungs increases, a condition called pulmonary hypertension. If left untreated, this condition damages the blood vessels, further impairs the transfer of oxygen to the blood, and streses the heart causing heart failure.