Grandma Wang is 73 years old this year. She was a porter at the dock when she was young. She has always been in good health and is still strong after retirement. She can move freely with her grandson and travel outside the country. She can carry her children to 4-5 floors, climb

Source: First Affiliated Hospital of Guangzhou Medical University

Grandma Wang is 73 years old this year. When she was young, she was a porter at the dock. She has always been in good health and is still strong after retirement. She can move freely with her grandson and travel outside the country. She can carry her children to 4-5 floors, climb mountains and wading without breathing at all. However, in the past few months, I have always felt that I was not breathing enough after the activity (it was particularly obvious after walking 500 meters and climbing two or three floors of stairs).

Grandma Wang and her family were very anxious. They went to the local hospital for repeated treatment. There was no obvious abnormality in blood tests. They had chest CT scans and cardiac color ultrasound examinations, but no clear lesions were found.

Doctor repeatedly asked about the medical history and learned that it turned out that due to the death of his family, Grandma Wang was in a depressed mood recently. Combined with the test results, she was considered to be very likely to be caused by anxiety (psychopathic dyspnea). The family suddenly breathed a sigh of relief and found the cause of the disease. It turned out that it was the difficulty of breathing caused by "mind".

However, after a stage of anti-anxiety medication treatment, Grandma Wang's symptoms of dyspnea did not improve significantly, and her activity tolerance further decreased, and even after climbing one floor of the stairs, she would experience dyspnea. What the hell is going on?

In order to further clarify the diagnosis, Grandma Wang came to Respiratory Medicine Pulmonary Vascular Professional Group, First Affiliated Hospital of Guangzhou Medical University, for treatment. After listening to Grandma Wang's medical history, Professor Liu Chunli checked her finger pulse oxygen and found that the index was low. Is it really because of psychopathic dyspnea? Have the causes of dyspnea been checked?

At the doctor's advice, Grandma Wang was hospitalized for more detailed examination and found that she had difficulty breathing, low blood oxygen, and increased D dimer after repeated activities. "This is likely to be pulmonary embolism !" Professor Liu Chunli immediately realized the severity of the problem. Through pulmonary artery venous CT symptomography (CTPA), she found that the patient had multiple thrombosis in the right upper pulmonary artery and the lower right pulmonary artery, and pulmonary embolism was considered.

On the day of admission, Grandma Wang started to treat pulmonary embolism. On the second day of taking the medicine, Grandma Wang said that her breathing difficulties had improved. The stone in the hearts of the family finally fell to the ground. It turned out that it was not the "heart" that was actually the "blocking matter".

Venous thrombosis embolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE), and is the third most common cardiovascular disease in the world. According to foreign literature, the annual incidence of VTE is 2/1000. Epidemiological research on VTE in my country shows that from 2007 to 2016, the incidence of PE rose from 1.1/100,000 to 63/100,000, and the number of new VTE cases after hospitalization increased year by year. VTE is called the "silent killer" because of its insignificant clinical manifestations and a high rate of misdiagnosis and misdiagnosis.

Who is prone to thrombosis?

People who have been hospitalized for a long time, surgery (orthodontic surgery is especially common) and long-distance travel restrictions are obese, have a family history of thrombosis, pregnancy, people over 75 years old, tumors, acute infections, long-term use of hormone therapy, respiratory failure, heart failure and other groups are more likely to have thrombosis.

What are the dangers of thrombosis?

After deep vein thrombosis, it can cause redness in the skin, local pain in the limbs, and asymmetric limb swelling. Patients with a long course of the disease can gradually develop post-thrombotic syndrome (PTS). PTS is mainly manifested as lower limb edema, pigmentation, eczema, varicose veins, and lower limb ulcers in severe cases.

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Thrombosis can also be refluxed to right ventricle through blood circulation, and then pumped from the right ventricle into the pulmonary artery blood vessel to form pulmonary embolism (PE). The most common clinical manifestations of PE are: chest pain, hemoptysis, dyspnea, etc. Severe PE patients can experience blood pressure drop within a few minutes, shock or even die.

How to screen for thrombosis?

Select different methods of examination and screening for thrombosis according to the VTE site. Limb area DVT can be used to determine whether there is thrombosis through venous color ultrasound and limb venography; PE is mainly screened through pulmonary angiography (CTPA), pulmonary ventilation perfusion scan, pulmonary angiography, etc.

Infrared Thermal Imaging Detection Technology (IRTI) is a new functional imaging detection technology that can screen DVT in the lower limb without trauma, non-contact, radiation-free, rapid and highly sensitive. It is a very common and important screening and treatment evaluation method.

What should I do if I get VTE?

According to the location of the thrombus, the thrombus load and the severity, thrombus treatment is divided into anticoagulant therapy and thrombolytic therapy.

Anticoagulant therapy is the cornerstone of VTE treatment. Currently, anticoagulant therapy drugs include low molecular weight heparin, vitamin K antagonist (warfarin, etc.) and new oral anticoagulant drugs (rivaroxaban, dabigatran, etc.). The course of anticoagulant drugs is generally 3-6 months. Thrombosis should be re-evaluated after 3-6 months. Based on the evaluation results, consider whether to extend the medication time. Some patients need lifelong anticoagulant therapy.

. When thrombosis causes critical situations such as blood pressure drop and shock, VTE patients need to initiate thrombolytic treatment. thrombolytic treatment can quickly dissolve thrombo and restore normal hemodynamic homeostasis.

In addition, when the thrombus is located in the large proximal vein such as the inferior vena cava, iliac vein, a filter should be placed first to prevent the thrombus from falling and returning to the pulmonary artery system.

How to prevent thrombosis?

gradient pressure elastic socks

intermittent inflatable pressurization device

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