Cardiovascular system - deep vein thrombosis

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This essay will describe a condition of the cardiovascular system. The condition this essay will describe is deep vein thrombosis (DVT). We will examine the definition, the symptoms the complications, the diagnostic tests, the risk factors, the treatment and the prevention of DVT. DVT typically occurs in the larger veins in the lower leg or thigh, although it is most common in the calf. It can also occur in your arms or pelvis but rarely does. It is a blood clot, known as a thrombus which forms within a deep vein in the body, it is also known as venous thrombosis. "Each year, one in every 1,000 people in the UK is affected by DVT" NHS Choices, (2012). Bristol has a population of approximately 432,500 people and is the largest city in the South West, Bristol City Council (2013). Therefore approximately 432 people are affected in Bristol each year.

These blood clots occur in the veins when the blood clumps together and becomes thickened, NHS Choices (2012). Veins are vessels that take deoxygenated blood back to the heart. The larger veins in the legs that DVT typically occurs in are deep veins that pass though the muscles in the calf or thigh. They are not just under the surface of the skin, like the one you can see. They are deep within the leg. DVT is when there is a complete blockage that prevents blood flow or a partial blockage with restricted blood flow. This then leads to cell hypoxia beyond the clot, which can result in an area of ischemia (penumbra) and/or infarction.

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Symptoms of a DVT include; swelling, pain, tenderness, temperature changes as well as colour changes, NHS Choices (2012). This is due to the blood being diverted to outer veins because of the blockage, causing warmth and redness. Sometimes a DVT does not present any signs or symptoms and would only be diagnosed if other complications occur such as a pulmonary embolism (PE). DVT and pulmonary embolism, these together are known as venous thromboembolism (VTE).

A PE occurs when all or a small piece of the clot dislodges itself and becomes loose, NHS Choices (2012). It is now known as an embolus. The embolus then travels up thought the veins which eventually reaches the lungs and becomes lodged again, but this time in an artery and not a vein which also prevents blood flow and hypoxia. This is the pulmonary artery which carries blood from the heart to the lungs. The main symptoms of a PE include: shortness of breath which can have a fast or gradual onset; chest pain which can be worse on inspiration and feel like a sharp stabbing pain; coughing which may bring up blood and/or mucus and feeling like you may pass out, dizzy or faint. This is a very serious condition which can result in death if undiagnosed or untreated. Approximately 1 in 10 individuals will develop a PE server enough to bring on some or all of these symptoms if the DVT goes untreated.

Another common complication of DVT, although not as server as a PE is post phlebitic syndrome (NHI, 2011). This is signs and symptoms that often follow DVT which can lead to socioeconomic changes and a reduced quality of life. This is more likely to surface if an individual has had a history of DVT, the DVT is in the thigh, the individual is overweight or has had more than one DVT in the same leg. This can cause the following symptoms; an ache, skin irritation, changes of colour to the skin, a rash, persistent edema, varicose veins and chronic ulcers.

Diagnostic tests that may be recommended to find out if you have a DVT are as follows (NHI, 2011). The most common test is ultrasound. This test creates pictures of blood flow in the arteries and veins to see if there is any blockage in the suspected areas of concern. This is done by using sound waves to create the pictures.

D-dimer test or venography tests are also used, (NHI, 2011). A D-dimer test tests for substances in the blood that are released when a clot dissolves. The higher the level of the substance the more likely you are to have DVT. Venography is when a dye is intravenously put in the suspected leg. The dye can be seen on an x-ray and will show if there is sufficient or slow blood flow, which could indicate a DVT.

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DVT becomes more common with age but anyone can develop it, Bupa (2013). Other risk factors include; inactivity (such as long hauled flights or coach trips, along with sitting on a couch day after day), being overweight, pregnancy or having recently had a baby, had a previous DVT, history of DVT in the family, thrombophilia; this condition is inherited and causes your blood to easily clot, antiphospholipid syndrome; this condition causes your blood to be at greater risk of clotting than usual, medical conditions such as cancer and heart failure and taking a contraceptive pill that contains oestrogen, or taking hormone replacement therapy (HRT).

The treatment of DVT can vary but the main objective is to; prevent the thrombus from growing, to prevent the thrombus from becoming an embolism travelling to the lungs and to reduce the chance of recurrence, NHI (2011). The treatment involves medications called anticoagulants, these are used for treatment and prevention. They are more commonly known as blood thinners although this is a common misconception. Anticoagulants actually alter the chemicals in blood, which hinders the ability of clot formation. Heparin and warfarin are the main two types of anticoagulants used to treat DVT.

Heparin is most often prescribed first, this is due to its immediate effects to prevent further clotting, NHI (2011). Warfarin is then also prescribed to prevent future clots. Warfarin takes 2-3 days to work. They are both used together and once warfarin is in the system the heparin can be stopped. Warfarin is taken my mouth in pill form and heparin is administered either by a subcutaneous injection or an intravenous injection. This depends on the type of heparin you are given. The two types are; standard (unfractioned) heparin and low molecular weight heparin (LMWH). As warfarin is dangerous to use during pregnancy, generally only heparin is used to treat DVT in pregnant women. Frequent blood samples are tested to ensure the correct dose is given. Bleeding is the most common side effect of anticoagulants and this can occur if your dose is too high. Normally this shows through nose bleeds. Bleeding can also be internal which is also why PT and PTT tests are regularly done to measure the clotting ability of the blood.

Anticoagulant treatment for DVT last approximately 6 months, (Patient.co.uk, 2012) Factors that can alter the length of treatment include; if the clot is considered short term risk, they may reduce treatment time, if you have recurrent clots, they may increase treatment time and if you have specific illnesses your treatment may last for as long as you have that illness.

Other types of treatment include; thrombin inhibitors which alter the bloods clotting process and are used in patients who are allergic to heparin, thrombolytics which dissolve large blood clots extremely quickly which can result in fast onset bleeding and are therefore only used in life threatening situations and if the patient cannot take any anticoagulants or they are deem to not be working a temporary vena cava filter can be put in place (Patient.co.uk, 2012). It is placed in a large vein called the vena cava which prevents clots from travelling up towards the lungs. It is umbrella shaped and acts as a filter to catch the clots, this prevents progression of the clot into even more unwanted areas.

Wearing anti-embolic stockings can also prevent the risk of developing DVT (Patient.co.uk, 2012). They are generally used in hospitals for inpatients, pre and post operation patients and can also be use at home. They work by asserting pressure on your legs to promote blood circulation. They can also help to reduce swelling and come in three different strengths.

As we can see occasionally DVT can occur for no apparent reason but unfortunately can also be a hereditary condition. If this is the case a change in life style can certainly reduce the risk of developing DVT. There are different tests to suit different types of patients, which allows the doctors to choose the right one for each individual.

References

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Bristol City Council. http://www.bristol.gov.uk/page/council-and-democracy/population-bristol. [Accessed on 16.10.2013]

Bupa. http://www.bupa.co.uk/individuals/health-information/directory/d/deep-vein-thrombosis. [Accessed on 15.10.2013]

National Institute Of Health (NHI). [Last updated 28.10.2011]. http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/treatment.html. [Accessed on 08.11.2013]

NHS Choices. [Last updated 25.03.2012]. http://www.nhs.uk/Conditions/Deep-vein-thrombosis/Pages/Introduction.aspx. [Accessed on 15.10.2013]

Patient.co.uk.[Last updated 31.08.2012]. http://www.patient.co.uk/health/deep-vein-thrombosis-leaflet. [Accessed on 08.11.2013]

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