Archive for the ‘Diagnosis’ Category
Clotting Disorders (Thrombophilia): Who Should Be Tested? What To Test?
Stephan Moll, MD writes… A publication today in the journal Vascular Medicine discusses – for patients and family members – (a) in which patient with blood clots (DVT, PE) to consider testing for a clotting disorder, (b) what tests might be appropriate to do, (c) how the test results influence management with blood thinners, (d) what birth control methods are safe in women with history of blood clots or a clotting disorder, and (e) in which family members to consider thrombophilia testing (link here for the article).
Disclosures: None
Last updated: April 1st, 2015
Diagnosis of recurrent DVT and PE: A patient’s guide to the clinical care guidance used by healthcare professionals
Beth Waldron, Clot Connect program director, writes…
If you’ve experienced deep vein thrombosis (DVT) or pulmonary embolism (PE), a recurrence of a blood clot in the future is a concern. Diagnosing a recurrent clot can be a challenge because it is sometimes difficult to tell if symptoms are the result of a new clot or the signs of chronic damage from the initial clot.
- Around 40% of patients with DVT develop long-term pain and swelling, known as post-thrombotic syndrome. Such pain and swelling can fluctuate, and be particularly pronounced after standing for prolonged periods of time or being overly active.
- Around 4% of patients with PE develop long-term shortness of breath, known as pulmonary hypertension.
How do healthcare professionals know when symptoms are the result of a past blood clot or due to a new clot? Read the rest of this entry »
Thrombophilia and Insurance
Liz Varga, Certified Genetic Counselor, Nationwide Children’s Hospital, Columbus OH writes….
Some people may have concerns about genetic testing for clotting disorders (thrombophilias) for fear of genetic discrimination. Fortunately in the United States, we have laws in place that can alleviate this concern. Read the rest of this entry »
Chronic Lung Damage after PE – Pulmonary Hypertension (CTEPH)
Blood clots in the lung (pulmonary embolism, PE) often completely dissolve within a few weeks or months and a patient’s symptoms of shortness and breath and chest pain disappear. Many people return to their normal self and have no physical limitations thereafter. Other people have some residual symptoms of shortness of breath or chest discomfort, but adjust to it well. However, in a few patients, clots do not completely dissolve and significant chronic damage to the lung results. Read the rest of this entry »
PFO = Patent Foramen Ovale
Anatomy
Some people have a “hole in the heart”, called a “patent foramen ovale” (PFO). This is a connection between the right and the left chamber (atrium) of the heart. We are all born with it – the unborn needs this connection for proper blood circulation. In most people the hole closes in the first few weeks after birth. However, in up to 25 % of people it stays open, equally often in men and women. A PFO usually does not cause symptoms. However, when a person has an acute DVT (deep vein thrombosis) and a clot breaks off and travels with the blood stream, it may cause problems.
DVT and PE in the person without PFO
In the person who does not have a PFO, a clot that breaks off from a DVT travels with the blood stream through the main vein in the abdomen to the chambers of the right side of the heart (color blue in figure 1 and 2). From there, it travels into the lung vessels, where it gets lodged, causing a pulmonary embolism (figure 1).
Figure 1. DVT and PE, no PFO present (graphic design: Jeff Harrison, Wilmington, NC; ©Stephan Moll)
Family Member Testing for Thrombophilia
Stephan Moll, MD writes…
Background
If a thrombophilia (clotting disorder) has been identified in a patient with blood clots (venous thromboembolism = VTE), the question arises whether other family members should be tested for the same thrombophilia.
My Clinical Approach
My approach in clinical practice to thrombophilia testing in family members is summarized in table 1: Testing of Family Members. Read the rest of this entry »