SAVED FROM SUDDEN DEATH !!! [DEEP VEIN THROMBOSIS]

SAVED FROM SUDDEN DEATH !!! [DEEP VEIN THROMBOSIS]

Historically, many prominent public figures have been afflicted with DEEP VEIN THROMBOSIS but received little attention. However, several tragic cases of fatal PULMONARY EMBOLISM received widespread media coverage. In 2000, a 28-year-old woman who had been a spectator at the Sydney Olympics collapsed and died of PULMONARY EMBOLISM after deplaning in London. In 2003, a renowned reporter who was embedded with a US infantry unit during the Second Gulf War complained of leg discomfort for several days and then died suddenly of PULMONARY EMBOLISM . These events, coupled with a recent public awareness campaign, "Killer Legs", have raised unprecedented interest in this previously overlooked but common condition.

What Is Deep Vein Thrombosis?

Deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation of a blood clot ("thrombus") in a deep vein. It is a form of thrombophlebitis (inflammation of a vein with clot formation).
Deep vein thrombosis commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis. Occasionally the veins of the arm are affected (if spontaneous, this is known as Paget-Schrötter disease). A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the superficial veins may be engorged. The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). DVT is a medical emergency, present in the lower extremity there is 3% chance of a PE killing the patient. A late complication of DVT is the post-phlebitic syndrome, which can manifest itself as edema, pain or discomfort and skin problems.

What causes DVT?
When something goes wrong with your body's blood clotting system, DVT can occur. Once a small clot forms in your vein, it can cause an inflammation that may encourage more blood clots to form.
Often, poor blood flow, or stagnation of blood flow, in your leg veins increases the risk for DVT. This poor flow can occur when you are not able to move for long periods of time. As a result, when your blood pools in your veins, clots are more likely to form. Some specific causes of DVT include:
Major surgery on your hip, knee, leg, calf, abdomen, or chest;
A broken hip or leg;
Prolonged travel (this is sometimes called economy class syndrome because people flying coach on airplanes have less room to move their legs);
Inherited blood clotting abnormalities; and
Cancer.
Although it is true that long airplane flights can increase your risk of DVT, this rarely occurs. Most cases of DVT occur in sick, hospitalized patients.
You have a greater chance of developing DVT if you are obese, have a history of heart attack, stroke or congestive heart failure, are pregnant, nursing or taking birth control pills, or have inflammatory bowel disease.
Most cases of DVT affect the legs, but DVT in the upper body is becoming more commonly recognized. Some factors that increase your chances of developing DVT in the upper body include:
Having a long, thin flexible tube called a catheter inserted in your arm vein. Catheters can irritate your vein wall and cause clots to form;
Having a pacemaker or implantable cardioverter defibrillator (ICD) for the same reason;
Having cancer near a vein; and
Performing vigorous repetitive activities with your arms. This type of DVT is rare and occurs mostly in athletes such as weight lifters, swimmers and baseball pitchers.

Signs and symptoms
There may be no symptoms referable to the location of the DVT, but the classical symptoms of DVT include pain, swelling and redness of the leg and dilation of the surface veins. In up to 25% of all hospitalized patients, there may be some form of DVT, which often remains clinically inapparent (unless pulmonary embolism develops).
There are several techniques during physical examination to increase the detection of DVT, such as measuring the circumference of the affected and the contralateral limb at a fixed point (to objectivate edema), and palpating the venous tract, which is often tender. Physical examination is unreliable for excluding the diagnosis of deep vein thrombosis.
In phlegmasia alba dolens, the leg is pale and cool with a diminished arterial pulse due to spasm. It usually results from acute occlusion of the iliac and femoral veins due to DVT.
In phlegmasia cerulea dolens, there is an acute and nearly total venous occlusion of the entire extremity outflow, including the iliac and femoral veins. The leg is usually painful, cyanosed and oedematous. Venous gangrene may supervene.
About half of all DVT cases do not cause symptoms. The symptoms you feel can depend on the location and size of your blood clot. They include swelling, tenderness, leg pain that may worsen when you walk or stand, a sensation of warmth, and skin that turns blue or red.

DIAGNOSIS/TESTS
The gold standard is intravenous venography, which involves injecting a peripheral vein of the affected limb with a contrast agent and taking X-rays, to reveal whether the venous supply has been obstructed. Because of its invasiveness, this test is rarely performed.
Physical examination
1. Homans' test: Dorsiflexion of foot elicits pain in posterior calf. However, it must be noted that it is of little diagnostic value and is theoretically dangerous because of the possibility of dislodgement of loose clot.
2. Pratt's sign: Squeezing of posterior calf elicits pain.

BLOOD TESTS
Other blood tests usually performed at this point are
complete blood count
Primary coagulation studies: PT, APTT, Fibrinogen
liver enzymes
renal function and electrolytes

IMAGING THE LEG VEINS
Impedance plethysmography , Doppler ultrasonography, compression ultrasound scanning of the leg veins, combined with duplex measurements (to determine blood flow), can reveal a blood clot and its extent (i.e. whether it is below or above the knee). Duplex Ultrasonography,due to its high sensitivity, specificity and reproducibility, has replaced venography as the most widely used test in the evaluation of the disease. This test involves both a B mode image and Doppler flow analysis.

COLOUR DOPPLER ULTRASOUND
Duplex ultrasound uses high-frequency waves higher than human hearing can detect. Duplex ultrasound allows your physician to measure the speed of blood flow and to see the structure of your veins and sometimes the clots themselves. Duplex ultrasound is used in many radiology departments as the first line of investigation for symptomatic deep venous thrombosis.

Prevention of Deep Vein Thrombosis and Pulmonary Embolism
Venous thromboembolism comprises deep vein thrombosis (DVT) and pulmonary embolism (PE) and strikes more than 1 in 1000 adults per year, causing discomfort, suffering, and occasionally death. DVT is defined as blood clots in the pelvic, leg, or major upper-extremity veins. These clots can break off from the veins, travel through the heart, and lodge in the lung arteries, causing potentially deadly PE. Although thousands of new cases are diagnosed yearly in Nigeria , probably 3 to 4 times as many cases occur without obvious symptoms and are never detected. This illness is often "silent" and can mimic other common conditions such as heart attack, pneumonia, and anxiety. Its aftermath spans a wide spectrum, from inconsequential to fatal.
Awareness of DVT and PE is the best way to prevent this condition. Medical professionals have recognized DVT for almost 2 centuries, but until recently, only about half of Nigerians were informed about the disease. Without knowledge of DVT as a medical problem, the public could not engage healthcare providers to discuss lifestyle changes and more intensive measures that usually succeed in preventing this illness.
Prevention is the best policy to combat DVT and PE. Although preventing venous thromboembolism is more mundane and less glamorous than treatment of DVT, it remains more effective than waiting for a DVT to develop, performing complex diagnostic tests, and then treating a newly established blood clot. Strategies for prevention of DVT .
DVT Prevention Strategies

Lifestyle Changes:The most common lifestyle risk factors for venous thromboembolism are the same problems that plague our society: obesity, inactivity, and cigarette smoking. Nevertheless, most inquiries about DVT prevention come from patients about to embark on long-haul air travel. Despite the drama of collapse and death from PE while in flight or after disembarking, the chance of this happening is only about 1 in 1 000 000 travelers.

Mechanical Measures:For many patients at low risk of DVT, graduated elastic compression stockings will suffice. Vascular compression stockings usually lose their elasticity after about 3 months and should be replaced to maintain their effectiveness. Pneumatic compression boots are not practical unless the patient is hospitalized or homebound.

What can I do to reduce the risk of travel-related DVT?
Whilst travelling on a long journey, particularly on a long-haul plane, train or bus trip :
Exercise your calf and foot muscles regularly:
Every half hour or so, bend and straighten your legs, feet and toes when you are seated.
Press the balls of your feet down hard against the floor or foot-rest every so often. This helps to increase the blood flow in your legs
Take a walk up and down the aisle every hour or so, when the aircraft crew say it is safe to do so.
If you are allowed, get off the plane and walk about if the plane stops for refueling.
Consider buying a leg exerciser for the journey .
Drink plenty of water (to avoid dehydration).
Do not drink too much alcohol. (Alcohol can cause dehydration and immobility.)
Do not take sleeping tablets, which cause immobility.
Consider wearing compression stockings .

Elastic compression stockings:There is some evidence to suggest that compression stockings can help to prevent travel related DVT. Many doctors recommend that you wear them if you are in any of the 'at risk' groups listed above. Some doctors advise that all adults should wear them on long-haul flights. You can buy the stockings from pharmacies. Ask the pharmacist for advice about the correct sort. They need to be 'graduated compression' stockings, worn to the knee, with the correct amount of compression (class 2). The slight pressure from the stocking helps to prevent blood 'pooling' in the calf. Stockings do not replace the need for regular exercises. They are in addition to exercises.

Anticoagulant medication:Some people at particularly high risk of DVT may be advised to have a heparin injection before a long-haul flight. Heparin is an anticoagulant (it 'thins the blood' and makes it less likely to clot). Treatment with heparin is controversial as there is only limited evidence to say that it helps. However, see your doctor before the journey to discuss this option if you:
Have had a previous DVT or pulmonary embolus.
Have a family history of clotting conditions.
Have cancer, or had treatment for cancer in the past.
Had major surgery in the last three months. In particular if you had a hip or knee replacement within the last three months. (Many doctors advise if you have had hip or knee replacements then you should not go on a long-haul flight for for at least three months after the operation.)
Have had a stroke.
Some people at high risk may also be advised to take anticoagulant medication.

Note: aspirin is not used to prevent DVT. (Aspirin is widely used to help prevent blood clots in arteries which can cause strokes and heart attacks. However, aspirin does not seem to be very effective at preventing clots in veins.)
Further research may clarify the value of compression stockings and heparin, or find other ways of preventing DVT.

After the journey
Have a little walk straight after the journey to 'get the circulation going'. The vast majority of travellers have no problems. However, if you develop a swollen painful calf or breathing difficulties shortly after a long journey, then see a doctor urgently. (But note: slight painless puffiness of feet and ankles is common after a long journey and is not due to a DVT.)


What Should We Do If Preventive Efforts Fail?
The failure rate is low, less than 10%. Nevertheless, if preventive efforts do not succeed, effective therapy exists to manage successfully most cases of DVT and PE. The cornerstone of therapy after failed prophylaxis is intensive anticoagulation, administered in doses higher than those used for prevention.
However if prevention fails, it is highly adviseable to see your physician


At JOAS MEDICAL DIAGNOSTIX Ikotun Lagos Nigeria ,with our latest 4D Colour Doppler Ultrasound Scan Machine , we offers comprehensive check of the lower limb veins for Deep Vein Thrombosis [DVT], for all vascular ultrasound scans for DVT [limbs], Carotids [neck vessels] and Arteries [limbs] contact JOAS MEDICAL DIAGNOSTIX Ikotun lagos Nigeria.

Regards
Dr. Victor Efughi
Consultant Clinical Specialist Sonographer

For FREE Consultation and FREE Counseling. Also for Quality and Accurate Medical Diagnostic Tests ContactJOAS MEDICAL DIAGNOSTIX

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