The tachycardia; coughing (dry or with blood). Diagnostic Methods

The location of a VTE has a massive impact on the implications it can cause within the body. If the embolism presents in a deep vein in a patient’s leg, it is known as deep vein thrombosis (DVT).  The most common symptoms for this condition are pain and swelling of the leg in which the DVT is. Although extremely rare, it can also happen in a vein elsewhere in the body, in the arm for example, in which case the symptoms would present in this location 1. Sometimes a clot may break away from its original position and travel to the lungs where it blocks the pulmonary artery and the blood supply to the lungs. This is known as a pulmonary embolism and can be fatal. In 2012 the British Lung Foundation found that there were 2,300 deaths due to PEs, a 30% decrease from results in 2008. They believe a reason for this decline may be the fact that new patients are being risk assessed for the condition and thus can be treated more quickly if necessary. 9 If a clot remains undetected and blocks the blood supply in the lungs, a lower concentration gradient between the alveoli and the blood stream occurs, thus leading to less effective gas exchange and breathing difficulties occur. 1 The most common symptoms of a PE are: chest pain that worsens with inhalation; shortness of breath; tachycardia; coughing (dry or with blood). Diagnostic Methods for Deep Vein ThrombosisDeep vein thrombosis can be diagnosed through multiple methods. The first being a Doppler ultrasound scan which detects the speed of blood flow. It may show that the blood is not moving as fast as expected which is an indicator of a blockage. Another method used to diagnose DVT is the D-dimer test. This detects the number of broken pieces of clot within the bloodstream. The higher the fragment count, the higher the possibility the patient has a clot within a vein. This is not the most accurate method as it can be affected by other risk factors (e.g. pregnancy or an operation). If neither of these methods result in a diagnosis, a venogram may be used. For this they inject a contrast dye into the vein of the patient’s foot and allow it to travel up the patient’s leg. An x-ray will then highlight this dye and reveal any blockages. 10Diagnostic Methods for Pulmonary EmbolismsPulmonary embolisms are not as simple to diagnose because the symptoms are very similar to those of other conditions although it must be diagnosed correctly to ensure the correct treatment is provided. The initial test is usually a chest x-ray but if it cannot be diagnosed directly from this, some more specialized tests may be performed. As with DVT, the D-dimer test may be carried out but again, it is not always the most accurate. A computerized tomography pulmonary angiography (CTPA) may be carried out and is very similar to a venogram however with this process they inject you with dye that travels around the lungs rather than the leg. A CT scan is then carried out and the blockage is revealed as a pause in the blood supply. An alternative method is a ventilation-perfusion scan. For this the patient will have to inhale a slightly radioactive gas which highlights the airflow in the lungs. A small amount of radioactive liquid will also be injected to highlight the blood flow around the lungs. In a scan where there is a PE present, there may be air in the lungs but a lack of blood supply. 11Treatment of DVT and PEThe initial treatment for DVT is rapid initial anticoagulation – the most common types being Novel Anticoagulants (e.g. apixaban or edoxaban), Heparin and Warfarin. Although these do not reduce the clot size, they prevent thrombus extension or formation which is beneficial as treatment can be focused on the existing clots and there will not be any added pressure of distinguishing and treating new embolisms. If a patient is on warfarin they must regularly have an International Normalised Ratio (INR) test to ensure their blood is clotting correctly.12In some cases, patients are unable to be treated with anticoagulants so other options must be considered. Usually this would be an inferior vena cava filter (IVC). This is a small metal device that is placed into a vein to filter clots out of the blood. This option is more likely to be considered if the patient suffers from recurrent DVT as it helps to prevent clots from travelling to the lungs to cause PE. After having a DVT, doctors will usually try to put preventative measures in place, for example encouraging the patient to do more exercise or to wear compression stockings as both increase the blood flow in the legs thus easing symptoms and preventing future clots forming. 13 Chronic Venous Insufficiency may also occur where the venous wall or valves work incorrectly in ensuring the blood flows in the correct direction due to a previous clot. This can lead to stasis (pooling of blood within the vein) 14 which can cause pain and swelling at the site of the problem. 15.As pulmonary embolisms are a much more life threatening problem, they are often treated as a matter of urgency but most of the same anticoagulants are used (e.g. Heparin or Warfarin). As long as it is diagnosed early, it is expected that the patient will make a full recovery. 16 ReflectionIt is important that venous thromboembolisms are diagnosed and treated at the earliest possible stage in order to prevent them from developing into a more problematic situation. By doing this it is more likely to be caught in the DVT stage before it develops to a PE and is either fatal or causes long-lasting damage. A way in which this could be aided is by ensuring the symptoms for a blood clot are common knowledge to everyone so they can get help immediately rather than waiting for the problem to get worse.