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Circulation Problems and DVT

Deep vein thrombosis (DVT) creates circulation problems, making it difficult for blood to properly move through the body. Though DVT often causes leg circulation problems, there are other ways in which DVT can impact blood circulation.

DVT can lead to pulmonary embolism, where a clot formed in the legs makes its way into the lungs. Once a clot is in the lungs, it can get trapped and restrict or entirely cut off blood flow. Pulmonary embolism can result in pulmonary hypertension, a significant possible complication of DVT.

Pulmonary Hypertension and DVT

Multiple occurrences of DVT can lead to the accumulation of pulmonary emboli, which results in pulmonary hypertension. Pulmonary hypertension occurs when the pressure of the blood vessels that lead from the heart to the lungs is abnormally high. This puts an added strain on the heart and can enlarge it over time.

If the pressure becomes too high, blood is no longer able to be easily pumped into the lungs, resulting in shortness of breath and a variety of related symptoms.

Symptoms of Pulmonary Hypertension

Pulmonary hypertension is more often seen in patients with emphysema or bronchitis, but can also result from DVT. It is important to consider pulmonary hypertension in patients with DVT who present any of the following symptoms:

chest pain
dizzy spells
fainting
fatigue
shortness of breath
swollen ankles.

The first noticeable pulmonary hypertension symptom is often shortness of breath. Often people will experience shortness of breath even when performing mild activities, such as unloading the dishwasher.

Many of the other symptoms of pulmonary hypertension will not appear until the disorder has progressed to a later stage.

In addition to the above symptoms, a significant effect of pulmonary hypertension is the extra strain put on the heart. This strain could eventually result in congestive heart failure, where the heart can no longer pump blood efficiently.

Causes and Risk Factors of Pulmonary Hypertension

There are multiple causes of pulmonary hypertension:

In primary pulmonary hypertension, the cause is unknown. This type of pulmonary hypertension is rare: Only two people in 1 million will have primary pulmonary hypertension.
In secondary pulmonary hypertension, the cause is known.

DVT contributes to one known cause of secondary pulmonary hypertension: thromboembolic disease. This is where a blood clot (embolism) or multiple blood clots (emboli) get trapped in a pulmonary artery, reducing the blood flow and causing hypertension.

Other causes of pulmonary hypertension also exist. If any of these conditions are present along with DVT, it is more likely that pulmonary hypertension will result:

family history of pulmonary hypertension
heart diseases, including aortic valve disease, mitral valve disease, left heart failure and congenital heart disease
liver diseases or lung conditions (chronic liver disease, liver cirrhosis, emphysema, chronic obstructive pulmonary disorder and pulmonary fibrosis)
obesity
past use of fen-phen (a diet drug that has been taken off the market)
scleroderma or lupus
smoking.

Treatments for Pulmonary Hypertension

The prognosis for pulmonary hypertension resulting from pulmonary emboli, as is the case in patients with DVT, is generally poor. New treatments are helping to improve the survival rate, though curing the disorder is usually not possible.

Treatment of pulmonary hypertension includes both medications and surgery. Some of the possible medications that may be used include:

anticoagulants (blood thinners, such as heparin and warfarin)
bosentan (a medication that blocks signals that narrow lung blood vessels)
oxygen
vasodilators (these open up blood vessels, lowering pulmonary blood pressure).

There are three main surgical treatments used on pulmonary hypertension:

heart and lung transplantation (a very rare treatment, used only when the heart and lungs have both failed as a result of advanced pulmonary hypertension)
lung transplantation (the only possible cure in advanced stages, though many patients die while waiting for a lung)
pulmonary thromboendarterectomy (surgical removal of the clot).

Resources

Cleveland Clinic. (n.d.). Pulmonary Hypertension Causes, Symptoms, Diagnosis, Treatment. Retrieved July 19, 2007, from the Cleveland Clinic Web site: http://www.clevelandclinic.org/health/health-info/docs/0600/0622.asp?index=6530

Madani, M.M., Jamieson, S.W. (2003). An Insider's Guide to Pulmonary Thromboendarterectomy: Proven Techniques to Achieve Optimal Results. Advances in Pulmonary Hypertension. Retrieved July 19, 2007, from the Pulmonary Hypertension Association Web site: http://www.phassociation.org/Medical/Advances_in_PH/Spring_2

003/Pulmonary-Thromboendarterectomy.asp

Pulmonary Hypertension Association. (n.d.). What is PH? Retrieved July 19, 2007, from the Pulmonary Hypertension Association Web site: http://www.phassociation.org/Learn/What-is-PH.

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