Thrombosis and embolism symptoms
May 02, 2018
Thromboses of are more common in the veins. The causes of thrombosis can be diseases leading to a change in the reactivity of the body and to physicochemical shifts in the blood. Contribute to thrombosis damage to the vascular wall, slowing blood flow and changes in the blood coagulation system. The clots of the thrombus are called emboli. They can clog the vessel, then they talk about embolism. More often the venous thrombus obstructs the pulmonary arteries. In addition, embolism can cause air and droplets of fat, trapped in a vessel.
Currently, more than 30 genes are identified, mutations in which predispose to thrombosis. The most important value is attached to the protein gene C( * 176860, 2q13-q14, the PROC gene).Heterozygosity according to its mutant forms in patients with thrombosis is revealed 10-25 times more often than on average in the population( with homozygous lightning purple neonates, usually with fatal outcome develops).At the heterozygous carriers of defective genes, at the age of 60 years, thromboses develop in 100% of cases, whereas in the absence of mutations in the protein C gene, thrombosis is detected only in 30% of cases.
At present, an important role in the development of thromboses of hyper-homocysteinemia has been proven. The latter is considered an independent and significant risk factor for the development of arterial and venous thrombosis, as well as atherosclerotic lesions of coronary, cerebral and peripheral vessels. Hyperhomocysteinemia is based on genetic defects that lead to a violation of the synthesis of protein-enzymes involved in the metabolism of homocysteine
. With hyperhomocysteinemia, all components of the hemostasis - the vascular wall, platelet and plasma links are activated. Homocysteine has a cytotoxic effect on the endothelium, by increasing the formation of free radicals, and also inhibits cyclooxygenase activity in endothelial cells and thereby reduces prostacyclin formation. In platelets, homo-cysteine disrupts the metabolism of arachidonic acid, increasing the release of thromboxane A2, which in turn leads to an increase in the adhesive and aggregation properties of platelets. Homocysteine is also capable of activating factor V. All of these effects eventually change the balance between the coagulating and anticoagulant systems of blood in favor of the predominance of the former and thereby increase the risk of thrombosis.
The course of embolism of peripheral arteries depends on the location and size of the embolus. There is a sharp pain, cold extremity, pallor of the skin. With embolism of the pulmonary arteries - a sharp pain in the chest, pronounced dyspnea, cyanosis, rapidly develop circulatory disorders, the pulse disappears, the patient loses consciousness and death occurs.
A radical surgery is embolectomy, which is performed in the vascular compartment. With embolism of the pulmonary arteries, as well as embolism of the peripheral arteries of the limb, heparin, streptase, oxygen therapy, cardiovascular drugs are treated.
Renal vein thrombosis
Renal vein thrombosis is an unusual disease that consists in the formation of a blood clot in one or both veins that supply blood from the kidneys back to the heart. In children, the disease can appear suddenly and result in kidney failure and a serious illness. In adults, the disease can not cause any symptoms. In many cases, blood clots can also form in the pulmonary artery, where a clot, known as an embolus, can cause chest pain and shortness of breath.
• In adults, renal vein thrombosis is almost always the result of nephrotic syndrome, although there are other causes.
• Diarrhea with severe dehydration is the most common cause of illness in children.
• Damage to the abdomen or lower back can lead to thrombosis of the renal vein.
• Malignant tumors in the kidneys that spread to the renal vein can lead to renal vein thrombosis.
• Pregnancy or the use of oral contraceptives increases the risk of the disease.
• Adults often have no symptoms, as the clot grows slowly.
• Pain, usually mild, in the lower back and in the side. Blood in the urine may be noticeable.
• In children: fever and chills;blood in the urine.
• Chest pain, shortness of breath, cough, possibly with bloody phlegm, profuse sweating, anxiety and uneven heartbeat due to embolus in the pulmonary artery.
• Case history and physical examination.
• Renal venography( administration of a contrast agent to the renal vein before the x-ray), ultrasound examination or magnetic resonance examination can be performed to determine the location of the blood clot.
• Streptokinase or urokinase( enzymes) may be prescribed to dissolve blood clots in severe cases of thrombosis of both renal veins associated with acute renal failure.
• Anticoagulants can be prescribed for long-term use to reduce the risk of blood clots in the pulmonary and renal veins.
• Children whose lives are at risk may need surgical removal of the affected kidney.
• Prophylactic use of anti-clotting drugs( such as warfarin) may be recommended to patients at high risk of developing the disease who have a large amount of protein in the urine.
• Consult your doctor if you experience permanent pain in the lower back, or in the side or if you have a nephrotic syndrome and you experience chest pain and shortness of breath.
Embolism of the pulmonary artery
Embolism of the pulmonary artery occurs when a blood clot that passes through the veins blocks the pulmonary artery, one of the vessels that supply blood to the lungs, where it is enriched with oxygen. In most cases, a blood clot( thrombus) is formed in the vein of the leg due to thrombosis;other common sources are the right chambers of the heart. Some or all of the severed thrombi can be transferred to the pulmonary arteries. Accumulations of malignant cells, fat or air bubbles in the blood can also form emboli, although this rarely occurs. The embolus is located in the main pulmonary artery or in one of the smaller arteries, interrupting the flow of blood through a portion of the lungs.
Symptoms appear suddenly;their strength depends on the size and number of emboli. The disease can quickly become fatal if a large enough part of the lung is hit by one large embolus or many small ones. Approximately one case out of 10 leads to sudden death. Critical is the first hour of pulmonary embolism, so the patient should be given immediate help;those who survived for a sufficient time to be hospitalized and diagnosed are getting better. The development of the disease is most favorable in young patients. Embolism of the pulmonary artery is much more common in women than in men( in a ratio of approximately two to one).
• A blood clot that moves from the leg vein is the most common cause of pulmonary embolism.
• Sometimes an air bubble or accumulation of malignant cells, fat, bacteria or other material can block the pulmonary artery.
• Risk factors include: pregnancy;the recent operation;previous heart attack or stroke;prolonged stay in bed( for example, when recovering from a disease);obesity;smoking;fractures of the bone, especially the hip or leg bones;cancer, especially lungs, brain, chest, or liver;and the presence of vein thrombosis in the family, pulmonary embolism and diseases leading to blood clots.
• People with heart disease, emphysema or chronic bronchitis are at a higher risk of serious consequences from pulmonary embolism.
• Sudden shortness of breath.
• Sudden onset of chest pain;pain is usually acute and worsens with deep breathing.
• Cough, possibly with bloody phlegm.
• Abundant sweating.
• Heart palpitations.
• Sign of a state of emergency: loss of consciousness.
• Case history and physical examination.
• Chest X-ray.
• An electrocardiogram helps to exclude a heart attack and to detect signs of increased pressure in the pulmonary arteries or other serious cardiovascular diseases.
• Radioisotope scanning, in front of which it is necessary to inhale a small amount of radioactive gas and to introduce radioactive particles into the blood, can reveal blocked parts of the blood vessels in the lungs.
• Arteriography of the lungs( introduction of a contrasting dye into the pulmonary arteries before the x-ray) is the only completely reliable way to identify pulmonary embolism.
• Contrast computed tomography is used to detect extensive embolism easily:
• Anticoagulants such as heparin and warfarin are used to prevent the formation of further blood clots.
• Thrombolytic agents( dissolving thrombi), for example, the activator of tissue plasminogen streptokinase or urokinase, blood can be injected to eliminate blockage of the vessel.
• Analgesics are used to relieve pain.
• Oxygen can be supplied through a mask, and in serious cases, through a respirator.
• The patient needs immediate treatment if he is suspected of lung embolism. Immediately, surgery may be required if more thrombus blocks the main pulmonary artery.
• An elastic bandage prescribed by a doctor can help prevent deep vein thrombosis on the legs of those at risk. Try not to cross your legs when sitting, as this contributes to the development of thrombi.
• Regular intake of aspirin may be necessary to prevent the development of thrombi in patients at risk.
• Anticoagulant heparin can be prescribed in low doses for continuous intake to reduce the likelihood of blood clots in people at risk( eg, patients with chronic venous insufficiency, congestive heart failure or those who have recently had a heart attack) orpatients who are undergoing surgery. After surgery, such patients should get out of bed and start walking as quickly as possible so that blood circulation improves.
• Instead of heparin, another form of this drug, low molecular weight fractionated heparin, can be used. It can be taken periodically.
• Coomadin, another anticoagulant, can be prescribed for permanent use after acute symptoms of embolism are removed.
• Attention! Call an "ambulance" if you or someone in your presence has a sudden severe chest pain and shortness of breath, along with a premonition of trouble or a sense of fear. In addition to pulmonary embolism, such symptoms can also mean a heart attack or aggravation of another vascular disease.
• Attention! Call an "ambulance" immediately if someone suddenly loses consciousness.