Blood Clots

Deep Vein Thrombosis · Thrombophlebitis · Phlebitis

Symptoms and Complications

Blood clots that result in a heart attack may cause chest pain (angina) that usually starts in the center of the chest and moves to the jaw, the back, the left arm, or occasionally the right arm. Less commonly, the pain may be felt in the abdomen.

Heart attack pain is usually severe but not always. Some people have "silent heart attacks" without any symptoms. Some people have reported feeling a sense of impending doom as a heart attack comes on. There's tightness and often a pounding in the chest. The heart may speed up and beat irregularly. Shortness of breath or difficulty breathing, nausea or vomiting, fainting, or collapse may also occur.

Women may experience slightly different heart attack symptoms than men. Women are more likely than men to have nausea, and less likely to have sweating as a symptom of a heart attack. Women may not feel the chest pain as distinctly as men. The most common places for women's chest pain to spread to are the neck, jaw, or back.

Blood clots that result in a stroke usually cause symptoms on the opposite side of the body from where they are causing the blockage in the brain. This may result in loss of feeling on one side of the face, arm or leg, or blindness. If the left side of the brain is affected, speech problems can occur. Affected people may be unable to speak or to understand spoken words. Other symptoms of stroke include confusion, a severe headache, or sudden loss of coordination or balance.

Signs of stroke should not be ignored, however brief or seemingly insignificant. Even if symptoms only last a few minutes and then vanish completely, it is important to seek medical attention right away.

Inflammation in superficial or surface veins (such as those used to insert intravenous (IV) lines in the arm or to draw blood) produces pain and discomfort but it usually isn't considered serious. Blood clots that form in superficial veins rarely break loose and travel in the blood to cause blockage (thromboembolism) and complications in organs such as the lungs.

In the case of DVT, a blood clot in the leg may cause pain, swelling, redness, and increased warmth. The leg may ache when standing. This usually occurs in one leg only. While many people with DVT have no signs or symptoms, the classic symptoms are:

  • firm swelling
  • pain or tenderness over a vein
  • sharp pain when the foot is flexed upwards
  • redness
  • warm sensation over the affected area
  • dull, aching tightness in the calf, especially with walking
  • dilation (widening) of the surface veins of the leg

DVT can lead to serious complications. A blood clot that formed in deeper and larger veins, such as those of the legs, abdomen, and pelvis, can break away and become a traveling blood clot, or embolus. The embolus can travel and lodge in the lung, a condition called pulmonary embolism.

Because a clot in a deep vein may not cause symptoms early on, the first sign may occur when the clot has broken loose and traveled to the lung. Symptoms of a pulmonary (lung) embolism are breathlessness, chest pain, and bloody sputum. If you have any of these symptoms, get emergency medical care right away.

Making the Diagnosis

Tests to check for presence of blood clots may include:

  • computed tomography (CT or CAT scan; a special technique that uses a computer to combine many X-ray images into a detailed image of an area body that is 100 times more clear than a regular X-ray)
  • magnetic resonance imaging (MRI)
  • ultrasound studies of leg veins or the arteries of the head and neck
  • angiograms or venograms
  • an ultrasound of the heart (echocardiogram)
  • electrocardiograms (ECGs)

Certain specialized blood tests may indicate if someone has had a recent heart attack.

Superficial thrombophlebitis is usually diagnosed according to your symptoms. A doctor will take your medical history by asking about your symptoms and conducting a physical examination.

In the case of thrombophlebitis, an ultrasound of the suspected veins may be done to confirm the diagnosis. Since the leg pain associated with DVT is very similar to muscle pain, your doctor might look for signs of swelling and enlargement of the calf due to swollen leg veins.

A diagnosis of DVT is usually confirmed with a compression ultrasound. Compression ultrasound detects differences in echoes or sounds made by flowing blood, and can easily detect the presence of blood clots in deep veins.

Treatment and Prevention

Medications are usually used to stop progression of DVT and prevent the blood clot from worsening, breaking away, and moving to the lungs. If you think you may have DVT, seek medical attention right away.

Blood-thinning medications such as warfarin* or heparin are usually recommended. These medications may be continued for several months after a blood clot has been diagnosed. Most people do not require admission to a hospital to treat DVT, and those with DVT can usually return to normal activities within 2 to 3 weeks.

For some people, long-term treatment with warfarin (an anticoagulant) may be necessary to prevent new blood clots from forming. Your doctor may also recommend that you wear an elastic support stocking on your leg to prevent DVT. Painkillers may be used to reduce the pain.

To relieve mild inflammation and discomfort, the affected area should be elevated and warm, moist packs applied for 15 to 20 minutes at a time throughout the day. For people with superficial thrombophlebitis, activities such as walking are recommended. If the inflammation and symptoms last longer than a day or two, or if symptoms become worse, see a doctor as soon as possible.

In cases where the thrombophlebitis is due to an infection, treatment with antibiotics often takes care of the problem. In rare cases, when the antibiotics aren't enough to control the infection, surgical removal of the inflamed portion of the vein may be required.

To help prevent DVT, avoid long periods of immobility such as those during long car trips or airplane flights. Try to walk around and stretch for a few minutes every hour or so. Elevate your legs above your heart level if possible, and if you have a history of blood clots, wear support stockings or socks.

Prevention of blood clots is the best way to deal with the problems of heart disease and stroke. It is important to reduce or quit smoking and to control high blood pressure. High cholesterol levels also present a risk for blood clots and may be checked by your doctor. A healthy diet and regular exercise also help to reduce the risk of heart attack and stroke.

For more information, see our articles on heart attack and stroke.

 


*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.

Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College, and in private practice specializing in cardiovascular disease in Greenwich, CT. Review provided by VeriMed Healthcare Network.

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