Influence congestion refers to impaired venous return of blood from the systemic circulation via the superior or inferior vena cava to the right atrium. Congestion occurs in one or both vena cavae as a result of internal blockage in either vein or externally induced compression. Right heart failure can also cause inflow congestion with the same symptoms.
What is influence congestion?
Venous return of blood from the systemic circulation is central via the superior vena cava and inferior vena cava, both of which drain into the right atrium. If the return flow of venous blood is disturbed in one of the two vena cavae, an influence congestion is present. Depending on which of the two vena cavae is affected, it is referred to as upper or lower inflow congestion. If the cause is not in or on one of the two vena cavae themselves, but on the right atrium, because it cannot fully absorb the venous blood due to right heart failure, both vena cavae are equally affected. Upper or lower inflow congestion may also basically occur because of an occlusion within one of the two vena cavae or be caused by an external blockage, for example, compression.
Causes
The causes of inflow congestion are very diverse and differ in frequency distribution for superior and inferior inflow congestion. Internal obstruction of both vena cavae by clotted blood (thrombi) is relatively rare. The most common cause of isolated upper influence congestion is tissue proliferation (carcinoma), which can lead to compression of the superior vena cava and even complete obstruction. These are usually bronchial carcinomas, lymphomas, thyroid carcinomas, or acute lymphoblastic leukemia (T-ALL). The causes of isolated lower influence congestion are usually thrombi that become lodged directly in the inferior vena cava or cause occlusion of deep veins (phlebothrombosis). Lower influence congestion is also frequently caused by compression of single or multiple main veins. Compression may be caused by malignant or benign tissue growths or by an aneurysm in the descending abdominal aorta. In heavily pregnant women, transient lower influence congestion may occur when the uterus displaces the inferior vena cava in the supine position. In many cases in which symptoms of both upper and lower influence congestion occur simultaneously, right heart failure is present, in which proper emptying and refilling of the right atrium is impaired.
Symptoms, complaints, and signs
Upper and lower influence congestion are accompanied and characterized by different symptoms and complaints. Common symptoms and signs that characterize both forms of inflow congestion include outwardly visible dilated veins in the area of the inflow congestion. Other visible signs may include a blue discoloration of the skin (cyanosis) and edema. Cyanosis results from inadequate oxygen supply during persistent inlet congestion, and edema can form, for example, due to an increase in hydrostatic pressure in the area of the capillaries. In addition to swollen neck veins, swelling of the so-called jugular vein (vena jugularis externa) is characteristic of upper influence congestion. It runs from the neck in the direction of the collarbone and is clearly visible when swollen. In the supine recumbent position, the symptomatically swollen jugular veins are particularly visible because support for blood return to the right atrium is eliminated by gravity.
Diagnosis and course
The signs of the presence of influence congestion are usually identifiable, but the causes of the pathologic changes are not. If upper and lower influence congestion occur simultaneously, right heart failure is suspected and its causes can be clarified. If upper congestion occurs and its underlying causes are not readily apparent, the use of imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), or even a chest x-ray can provide further clarity. The course of an influence congestion depends on the course and therapy of the causative underlying disease.For example, successful containment of a tumor by radiation and/or chemotherapy may result in rapid relief of venous compression, so that symptoms of influence congestion improve equally rapidly.
Complications
The symptoms and complications of influence congestion depend relatively on the area affected. In most cases, however, there is swelling and pain in the affected regions, so that the patient is severely restricted in his or her movement and daily life. In most cases, the skin turns blue and the regions are no longer supplied with sufficient oxygen. In the event of a prolonged undersupply of oxygen, serious consequential damage and complications can occur. In the worst case, extremities may die or be irreversibly damaged. If the inflow congestion is caused by a tumor, it is usually removed surgically. However, 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 in this case. In the case of a blood clot, medication can be used to dissolve it. In most cases, this does not lead to any further complications. In severe cases, the heart can also be affected, in which case insufficiency can occur. In the worst case, this can also lead to death. Life expectancy is reduced by the disease.
When should you see a doctor?
In case of influence congestion, a doctor must be consulted immediately. If left untreated, this condition can, in the worst case, lead to the death of the affected person or irreversible damage to the internal organs. The doctor should be consulted if the patient shows a blue discoloration of the skin or has difficulty breathing. As a rule, the respiratory rate is significantly increased. Furthermore, swollen and enlarged veins in the neck may also indicate the influence congestion and should be immediately examined by a doctor. Especially in a lying position, these symptoms can be quickly identified. If the affected person loses consciousness due to the influence congestion, an emergency physician must be called or the hospital visited immediately. Treatment in this case is usually surgical and involves an inpatient stay in the hospital. Life expectancy is also usually reduced as a result. Furthermore, the affected person is dependent on regular checks and examinations to prevent a renewed influence congestion.
Treatment and therapy
Influence congestion is always based on a causative underlying disease, so treatments are usually aimed at treating the underlying disease. This means, for example, that venous compression can be improved by treatment or surgical removal of causative tumors, so influence congestion also improves. If a thrombus, a blood clot “blocks” an important vein, therapy may consist of dissolving the thrombus with medication or creating a bypass around the blocked vein. Appropriate stents are available for use as vein substitutes. In the case of right heart failure, the causes must be clarified in order to begin specific therapy. If insufficiency of the tricuspid valve is present, it may be necessary to replace the valve with an artificial valve. The tricuspid valve is a so-called leaflet valve, which is used to control blood flow from the right atrium to the right ventricle.
Outlook and prognosis
The prognosis of influence congestion is tied to the causative disease or disorder. In severe cases, the patient suffers premature death. Swelling around the brain or airway prevents natural blood flow. This causes an undersupply of oxygen to the organism. There is a risk of irreversible damage to nerves or muscle fibers. In addition, individual limbs may die. Amputations are necessary to prevent further spread of the damage. In exceptional cases, the affected person of an influence congestion suffers an acute life-threatening condition. Blocked vessels can cause damage to the vessel walls and cause ruptures. Without intensive medical care, the patient will die or suffer lifelong severe health impairment. If the patient suffers from a blood clot, it is possible to alleviate the symptoms by administering medication.If blood-thinning preparations are administered at an early stage, the clot dissolves and the congestion is relieved. In the case of heart failure, clarification of the cause is decisive for therapy and prognosis. If an artificial heart valve is implanted, there is a good chance that the congestion will be cured. Nevertheless, side effects and restrictions of the general lifestyle are to be expected in normal cases due to the surgical intervention and its consequences.
Prevention
Preventive measures to avoid influence congestion must usually be directed toward preventive measures to avoid one of the underlying diseases that can cause influence congestion. Direct preventive measures do not exist. Basically, an immune-strengthening lifestyle and diet is recommended. This includes alternating periods of increased stressors with periods of relaxation, so that a natural interplay between the sympathetic and parasympathetic nervous systems occurs.
Aftercare
In the case of influence congestion, the affected person is usually first in need of medical treatment to prevent further complications to the body. In the worst case, the affected person will die from this complaint if no treatment is initiated in time. Life expectancy is also reduced by the influence congestion in most cases. The measures of an aftercare are not available to the affected person thereby as a rule. The treatment itself always depends on the exact cause of the congestion, so that no general prognosis can be given. In many cases, however, surgical intervention is necessary. After such an operation, the affected person should in any case rest and take care of his body. Exertion or other stressful activities should be avoided in any case, so as not to put unnecessary strain on the body. A healthy lifestyle with a balanced diet also usually has a very positive effect on the further course of the influence congestion. Those affected are not infrequently also dependent on the help and care of family or friends.
What you can do yourself
When influence congestion is present, close medical monitoring is indicated. The medical practitioner must observe the symptoms with regard to the underlying disease and treat them in a targeted manner, as this is the only way to rule out any complications. Those affected cannot do much themselves, but should consult a doctor immediately if they experience unusual symptoms. Apart from that, the underlying disease must be treated. In the case of cancer, self-help measures are limited to a healthy lifestyle and avoiding stress. Growths of the tissue require surgical treatment, which can be supported by rest and bed rest. In the case of thrombosis, sparing is also important in the first instance. In the later course, measures to promote blood circulation can also be implemented. For example, regular exercise or even comprehensive physiotherapy can promote recovery and thus also contribute to a rapid resolution of the influence congestion. A suitable diet supports these measures. The new diet plan is best drawn up together with a nutritionist and with regard to any allergies, intolerances or previous illnesses. If the influx congestion does not recede in spite of everything, the doctor must be consulted again. In most cases, a surgical intervention is then necessary.
