Thrombosis can occur in both veins – vessels that carry blood to the heart – or arteries – vessels that carry blood away from the heart.Thrombosis is associated with the following symptoms:
In venous thrombosis:
- Inflammation
- Overheating
- Edematous swelling* (e.g., tightness, swelling of the calf).
- Increased vein drawing as well as amplification in the upright position.
- Cyanosis (blue discoloration of the skin)/livid discoloration of an extremity* ; skin appears shiny
- Local pain* /pain in the area of the affected veins.
- Fever
- Tachycardia (heartbeat too fast: > 100 beats per minute).
* Classical leading symptoms a deep vein thrombosis (DVT).
Localization
- All blood vessels possible
- Leg veins more common than arm veins (the latter more common in men)
Phlegmasia coerulea dolens: bes. severe course of venous thrombosis characterized by acute, very painful, livid swelling (pale; poorly perfused, pale tissue). It is a life-threatening emergency because of the possible sequelae or complications (motor weakness, gangrene (tissue death due to reduced blood flow or other damage), hypovolemic shock (shock due to acute volume deficiency)).
Notice.
- The symptomatology of deep vein thrombosis (DVT) can be very nonspecific.
- Many venous thromboses, especially lower leg vein thromboses, are clinically inapparent (asymptomatic, i.e., without symptoms).
- In bedridden and recurrent thrombosis (recurrence of thrombosis) of the same limb, symptoms may be very mild or absent.
- In the case of phlebitis (inflammation of a venous vessel) of the epifascial veins (= superficial venous thrombosis, OVT), a duplex sonographic examination should also be performed, since, if necessary, additional involvement of the deep veins may escape clinical diagnosis.
- Wells score to determine the clinical probability of deep vein thrombosis (DVT): see below “Physical examination” and “Laboratory diagnostics“.
- Always watch for clinical signs of pulmonary embolism (see “Warning signs (red flags)” below).
In case of arterial thrombosis:
- Pain
- Partial ischemia – lack of blood flow.
- Complete ischemia – sometimes complete absence of blood flow to an organ.
- Localized peripheral cyanosis
In Anglo-Saxon, the mnemonic 6 P according to Pratt is used to memorize the clinical signs of acute arterial occlusion:
- Pain = pain
- Pallor = pallor
- Paresthesia = disturbance of sensation
- Pulselessness = pulselessness
- Paralysis = inability to move
- Prostration = shock
Warning signs (red flags)
- Acute onset of thoracic pain (chest pain)* , sometimes felt as annihilation pain (70-80%) Dyspnea (shortness of breath)* and tachypnea (increased or excessive respiratory rate; typical: acute onset; but may also increase slowly) (80-90%), fear, anxiety, vegetative symptoms (e.g. sweating) (50%), cough (40%), syncope (brief loss of consciousness) (10-20%), hypoxemia (decreased oxygen content in arterial blood), or hypocapnia (decreased partial pressure of carbon dioxide in arterial blood), Tachycardia (excessively rapid pulse at > 100 beats/min), hemoptysis (coughing up blood) (10%), palpitations (heart actions self-perceived by the affected person as unusually rapid, forceful, or irregular) (10%) → think of: Pulmonary embolism
* Atemsynchronous pain with resting dyspnea.
