As cava an impaired venous return of blood from the systemic circulation on the upper or the lower vena cava in the right atrium is referred to. A backwater build-up occurs in one or both vena cava, which is caused by an internal blockage in one of the two veins or by an external compression. Right heart failure can also lead to influence congestion with the same symptoms.

What is an influence congestion?

According to topbbacolleges, the venous return flow of the blood from the body’s circulation runs centrally via the superior vena cava (superior vena cava) and the inferior vena cava (inferior vena cava), both of which open into the right atrium. If the return flow of the venous blood in one of the two vena cava is disturbed, there is a congestion.

Depending on which of the two vena cava is affected, one speaks of upper or lower infiltration congestion. If the cause is not in or in one of the two vena cava itself, but in the right atrium because it cannot fully absorb the venous blood due to right heart failure, both vena cava are equally affected.

An upper or lower congestion of the influence can in principle also occur through an occlusion within one of the two vena cava or through an external blockage, for example through compression.

Causes

The causes of influence congestion are very diverse and their frequency distribution differs for the upper and lower influence congestion. Internal obstruction of the two vena cava due to clumped blood (thrombi) is relatively rare.

Tissue growths (carcinomas), which can lead to compression of the superior vena cava or even to complete occlusion, are the most common cause of an isolated upper congestion.

These are mostly bronchial carcinomas, lymphomas, thyroid carcinomas or acute lymphatic leukemia (T-ALL). The causes of an isolated lower infeed congestion are usually thrombi that attach themselves directly to the inferior vena cava or cause the occlusion of deep veins (phlebothrombosis). The lower congestion of the influence is often caused by compression of one or more main veins.

Compression can be caused by malignant or benign tissue growth or by an aneurysm in the descending aorta in the abdominal area. In heavily pregnant women, a temporary lower congestion can occur if the uterus obstructs the inferior vena cava in the supine position.

In many cases in which symptoms of both the upper and lower influx congestion occur at the same time, there is a right heart failure, in which the proper emptying and refilling of the right atrium is disturbed.

Symptoms, ailments & signs

Upper and lower congestion of influence are accompanied and characterized by different symptoms and complaints. General symptoms and signs that characterize both forms of inlet congestion are visibly dilated veins in the area of ​​the inlet congestion. Other visible signs may include blue discoloration of the skin (cyanosis) and edema.

Cyanosis is caused by an inadequate supply of oxygen if the inlet congestion persists, and edema can form, for example, as a result of an increase in hydrostatic pressure in the area of ​​the capillaries. In addition to swollen neck veins, a swelling of the so-called jugular vein (external jugular vein) is characteristic of the upper congestion.

It runs from the neck towards the collarbone and is clearly visible when it is swollen. In the lying position on the supine position, the symptomatically swollen neck veins are particularly well visible because gravity does not support the blood flow back into the right atrium.

Diagnosis & course

The signs of the presence of an accumulation of influence are usually recognizable, but not the causes of the pathological changes. If the upper and lower congestion occurs at the same time, a right heart weakness is suspected, the causes of which can be clarified.

In the event of a congestion at the top, the underlying causes of which are not readily apparent, the use of imaging methods such as computed tomography (CT), magnetic resonance imaging (MRT) or a chest x-ray can provide further clarification.

The course of an accumulation of influence depends on the course and treatment of the underlying disease that is causing it. For example, a successful containment of a tumor by radiation and / or chemotherapy can bring about rapid relief of venous compression, so that the symptoms of the congestion of influence also improve rapidly.

Complications

The complaints and complications of an accumulation of influence depend to a large extent on the affected area. In most cases, however, there is swelling and pain in the affected regions, so that the patient is severely restricted in his movement and in everyday life. In most cases, the skin turns blue and the regions are no longer adequately supplied with oxygen.

A long-term undersupply of oxygen can lead to serious consequential damage and complications. In the worst case, extremities can die or be irreversibly damaged. If the congestion is caused by a tumor, it is usually removed surgically. The further course of the disease depends on the type and spread of the tumor, so that no general course of the disease can be predicted.

If a blood clot has a blood clot, drugs can be used to dissolve it. There are usually no further complications. In severe cases, the heart can also be affected, which can lead to insufficiency. In the worst case, this can also lead to death. Life expectancy is reduced by the disease.

When should you go to the doctor?

In the event of a build-up of influence, a doctor must be consulted immediately. If left untreated, this disease can, in the worst case, lead to the death of the person affected or to irreversible damage to the internal organs. A doctor should be seen if the patient has blue skin or has difficulty breathing. As a rule, the breathing rate is significantly increased. Furthermore, swollen and enlarged veins in the neck can indicate the congestion and should be examined by a doctor immediately.

These symptoms can be identified quickly, especially in a lying position. If the person concerned loses consciousness due to the accumulation of influence, an emergency doctor must be called immediately or the hospital must be visited. The treatment is usually performed surgically and is associated with an inpatient stay in the hospital. Life expectancy is also usually reduced as a result. Furthermore, the person concerned is dependent on regular controls and examinations in order to prevent a renewed accumulation of influence.

Treatment & Therapy

Influence congestion is always based on a causative underlying disease, so that treatments are usually aimed at treating the underlying disease. This means that, for example, venous compression can be improved through treatment or surgical removal of the tumors that have caused it, so that the congestion of the influence is also improved.

If a thrombus, or blood clot, “blocks” an important vein, therapy may consist of dissolving the thrombus with medication or by bypassing the blocked piece of vein. Corresponding stents are available for use as a vein replacement.

In the case of right heart failure, the causes must be clarified in order to begin targeted therapy. If there is insufficiency of the tricuspid valve, it may be necessary to replace the valve with an artificial valve. The tricuspid valve is a so-called leaflet valve, with the help of which the blood flow is controlled from the right atrium to the right ventricle.

Outlook & forecast

The prognosis of the accumulation of influence is tied to the causal disease or disorder. In severe cases, the patient suffers premature death. Swelling in the brain or airways prevents natural blood flow. This triggers an insufficient supply of oxygen to the organism. There is a risk of irreversible damage to the nerves or muscle fibers. In addition, individual limbs can die off. Amputations are necessary to prevent further spread of the damage.

In exceptional cases, the person affected by an accumulation of influence suffers an acute, life-threatening condition. Clogged vessels can damage the vessel walls and cause cracks. Without intensive medical care, the patient dies or lifelong severe health impairments occur.

If the person concerned suffers from a blood clot, there is the possibility of relieving the symptoms by administering medication. If blood-thinning preparations are administered at an early stage, the clot dissolves and the congestion is cleared.

In the case of heart failure, clarifying the cause is crucial for therapy and prognosis. If an artificial heart valve is used, there is a good chance that the influence congestion will heal. Nevertheless, side effects and restrictions in general lifestyle are to be expected in normal cases due to the surgical procedure and its consequences.

Prevention

Preventive measures to avoid a congestion of influence must generally focus on preventive measures to avoid one of the underlying diseases that can cause a congestion of influence. There are no direct preventive measures.

Basically, an immune-boosting lifestyle and diet is recommended. This also means that phases with increased stressors and relaxation phases alternate, so that a natural interplay between the sympathetic and parasympathetic nervous system arises.

Aftercare

In the event of a build-up of influence, the person concerned is usually first dependent on medical treatment so that there are no further complications on the body. In the worst case, the person concerned will die of this complaint if treatment is not initiated in good time. Life expectancy is also reduced in most cases due to the accumulation of influence.

The follow-up measures are usually not available to the affected person. The treatment itself is always based on the exact cause of the accumulation of influence, so that no general prognosis can be given. In many cases, however, surgery is necessary. After such an operation, the person concerned should definitely rest and take care of his body.

Exertion or other stressful activities must be avoided in any case in order not to unnecessarily burden the body. A healthy lifestyle with a balanced diet also usually has a very positive effect on the further course of the accumulation of influence. Those affected are not infrequently dependent on help and care from family or friends.

You can do that yourself

Close medical monitoring is indicated if the influence is stagnant. The doctor must observe the complaints with regard to the underlying disease and treat them in a targeted manner, because this is the only way to rule out any complications. Those affected cannot do much themselves, but should see a doctor immediately if they have unusual symptoms. From then on, the underlying disease must be treated.

In the case of cancer, self-help measures are limited to a healthy lifestyle and the avoidance of stress. Growths in the tissue require surgical treatment, which can be supported by rest and bed rest.

Even with a thrombosis, protection is primarily important. In the later process, measures to promote blood circulation can also be carried out. Regular exercise or even extensive physiotherapy can promote recovery and thus also contribute to a rapid dissolution of the accumulation of influence. A suitable diet supports these measures. The new nutrition plan is best drawn up together with a nutritionist and with a view to any allergies, intolerances or previous illnesses.

If, in spite of everything, the accumulation of influence does not decrease, the doctor must be spoken to again. Surgical intervention is then usually necessary.