What're the symptoms of deep vein thrombosis?
Signs and symptoms suggestive of deep vein thrombosis include: sudden unilateral swelling of an extremity; presence of pain or aching of an extremity; low-grade fever; and possibly discoloration. If DVT is suspected, anticoagulation therapy will be promptly started and aggressively managed. Hospitalized patients may be started on intravenous anticoagulation until an oral anticoagulant pill takes effect. If the extremity is swollen, bed rest, elevation, and elastic compression support (e.g. Ace
bandages, elastic stockings) will be ordered. Depending on the cause of the DVT and other risk factors, oral therapy will be continued for at least 3 months. Lifelong therapy with elastic stockings may be indicated in order to prevent or treat a major DVT complication, post-phlebitic syndrome.
Because deep vein thrombosis usually causes little inflammation, pain and redness of the skin over the vein are usually minimal. About half of the people with deep vein thrombosis have no symptoms at all. In these people, chest pain caused by pulmonary embolism may be the first indication that something is wrong. When deep vein thrombosis blocks blood flow in a large leg vein, the calf swells and may be painful, tender to the touch, and warm. The ankle, foot, or thigh may also swell, depending on which veins are involved.
Some thrombi heal by being converted to scar tissue, which may damage the valves in the veins. Because the damaged valves prevent the veins from functioning normally, fluid accumulates (a condition called edema) and the ankle swells. The edema can extend up the leg and even affect the thigh if the blockage is high enough in the vein. Edema is worse toward the end of the day, because blood must flow upward, against gravity, to reach the heart when a person is standing or sitting. Overnight, edema subsides because the veins empty well when the legs are horizontal.
Many patients with a DVT have no symptoms at all unless the clot dislodges, travels to the lung, and causes a pulmonary embolism. In this case, the patient may develop a rapid heart rate, shortness of breath, sharp chest pain that worsens with deep breathing, or cough up blood. If the pulmonary emboli are large and block one or both of the major pulmonary arteries sending blood to the lungs, the patient may develop a very low blood pressure, pass out, and possibly die from lung or heart failure. As is the case with DVTs, however, many other conditions, for example, a heart attack or pneumonia, can mimic a pulmonary embolism. Therefore, specific tests must be done to confirm the diagnosis.
Chronic deep vein insufficiency occurs late in the course of deep vein thrombosis. The valves in the deep veins and connecting veins of the legs are destroyed. Consequently, blood is not adequately returned to the heart from the legs. Eventually, the affected veins may be obliterated. Edema in the legs is always present, generally worsening at the end of the day. The skin on the inside of the ankle becomes scaly and itchy and may turn a reddish brown. The discoloration is caused by red blood cells that escape from swollen (distended) veins into the skin. The discolored skin is vulnerable, and even a minor injury, such as that from scratching or a bump, can break it open, resulting in an ulcer. Varicose veins may be present. In addition to ulcer pain, there may be throbbing pain when standing or walking. If edema is severe and persistent, scar tissue develops and traps fluid in the tissues. As a result, the calf permanently enlarges and feels hard. In such cases, ulcers are more likely to develop, and they heal less easily. |
