Vena cava syndrome

Vena cava syndrome: description

Vena cava syndrome is a circulatory problem affecting mainly pregnant women. If the pregnant woman is lying on her back, the uterus with the unborn child can press on the inferior vena cava (compression) and interrupt the return of the blood from the lower half of the body to the heart. Therefore, doctors also speak of the vena cava compression syndrome. Since the child in the last months of pregnancy increases in size and weight, women especially at the end of their pregnancy (3rd Trimester) under the vena cava syndrome.

The syndrome can also be triggered by swelling and tumors – good as well as malignant. On the inferior vena cava, especially liver cancer diseases. Physicians then speak of the vena cava-inferior syndrome. If a tumor compresses the superior vena cava, the symptoms are summarized under the term superior vena cava syndrome (also: upper influence congestion). In the case of such space-occupying diseases, the symptoms usually occur creeping, but are constant, whereas the vena cava syndrome of the pregnant woman occurs suddenly and can be treated by appropriate measures.

Vena cava syndrome is strictly speaking not an independent disease. Rather, it describes a complex of several symptoms of decreased blood flow, such as sudden drop in blood pressure and even fainting. In pregnant women, the Vena cava syndrome can also lead to poor child care. In extreme cases, both develop a life-threatening situation. Since the inferior vena cava can be completely closed (occluded) by the pressure of the uterus, some doctors use the term vena cava occlusion syndrome.

About 30 to 40 percent of pregnant women suffer vena cava syndrome during the second trimester or, more specifically, third trimester.

Vena cava syndrome: symptoms

There are a number of complaints that sufferers can suffer from. In pregnant women, the following symptoms may occur in the vena cava syndrome:

• sudden drop in blood pressure
• dizziness
• sweat
• cold-sweaty skin
• nausea
• Edema on the legs
• paleness
• Fainting (or feeling of incipient syncope)
• Rapid heartbeat (tachycardia), later also strongly retarded heartbeat possible (bradycardia)
• difficulty in breathing

Not all of these symptoms occur. However, the signs get worse if the vena cava syndrome is not resolved quickly. In the vena cava compression syndrome, the baby also suffers from poor blood circulation. Because this means that not enough oxygen can be transported to the fetus (fetal hypoxia). In extreme cases, those affected develop a cardiovascular shock and the unborn child dies.

Signs of upper influence

In the vena cava syndrome of the superior vena cava, especially the jugular veins are blocked. But also the veins on the arms and on the head can emerge. Many patients also suffer from pressure in the head to headache. If the diseased swelling or the tumor presses on other organs, further symptoms can be added: For example, in a narrowing of the esophagus swallowing problems (dysphagia). If the trachea is compressed, the respiratory distress (dyspnea) increases. According to the symptoms, the vena cava syndrome of the superior vena cava is divided into five degrees of severity (from mild to no longer treatable).

Vena cava syndrome: causes and risk factors

In the case of the vena cava syndrome, the lower (inferior vena cava) or superior vena cava (superior vena cava) is compressed. Oxygenated blood flows from the lower or upper parts of the body back to the right heart via the great vena cava (right atrium and right ventricle, the right atrium also contains the confluence of vena cava inf. And sup.). From there, the blood enters the lungs, where it is oxygenated, and finally back to the heart. The left ventricle pumps the now oxygen-rich blood back into the systemic circulation. The inferior vena cava lies on the right in front of the spine and in pregnant women behind the uterus. The superior vena cava runs in close proximity to the lungs, the esophagus and the esophagus.

Vena cava syndrome in pregnancy

In the nine months of pregnancy, the child steadily grows in the maternal uterus. Consequently, the weight of the fetus also increases. If the mother is lying on her back, the uterus with the heavy child presses it on the inferior vena cava. This prevents the blood from returning to the right heart as usual. As a result, the amount of blood that can pump the left heart into the body (by as much as 30 percent of the normally circulating blood) also decreases. The blood pressure drops so (hypotension). In supine position, it takes about three to seven minutes until the blood pressure drops measurably.

The body tries to balance the vena cava syndrome with different mechanisms. For example, the heart beats faster (tachycardia) in order to pump the reduced amount of blood fast enough into the circulation. In addition, very small arteries narrow, allowing less oxygen-rich blood to flow through. This is instead redirected to important organs (e.g., the brain). However, the uterine vessels contract (placental insufficiency). As a result, less oxygen-rich blood flows to the child. There is a risk of a shortage of the fetus, which in the worst case can end with his death.

Risk factor cancer

In addition to pregnancy, there are other circumstances that can cause a vena cava syndrome. In general, any puffiness in the abdomen may press on the inferior vena cava. Because this is right in front of the spine, especially advanced, malignant liver (liver cancer, liver metastases) or right-sided kidney disease (kidney cancer) can cause a vena cava syndrome. In connection with liver diseases, it often comes to so-called ascites (ascites). This accumulation of fluid in the abdomen can also lead to a vena cava compression syndrome in the advanced stage.

The most common cause of upper vena cava syndrome is lung cancer. Rarely are cancerous metastases from other organs responsible. But also cancers of the lymph gland or thyroid gland may lead to a vena cava syndrome. Very rarely, a benign swelling such as the goiter (goiter) presses on the superior vena cava.

The symptoms of a vena cava syndrome can also be caused by blood clots (thrombi) in the vena cava. Such thrombi often arise as a result of long-term compression of the vein.

Vena cava syndrome: diagnosis and examination

The diagnosis of the vena cava syndrome in pregnant women is usually quite simple. The obstetrician and obstetrician (gynecologist) or experienced midwives can usually recognize a vena cava syndrome quickly.

If you have circulatory problems during pregnancy, be sure to call a doctor. If you are not pregnant but suffer from typical symptoms of the vena cava syndrome, it is best to make an appointment with your family doctor or internist (specialist in internal medicine). If you already have any medical conditions (such as cancer), your doctor will help you. Depending on the specialty, the physician asks questions such as:

• Do you have previous illnesses?
• When and how often do you suffer from circulation problems?
• Have you lost consciousness for a short time? Did you feel black?
• Did you have blood pressure problems before you became pregnant or before your cancer?
• Do the symptoms increase in certain situations, for example, if you lie longer on your back?
• Do you feel better if you lie down or sit down differently?

When suspecting a vena cava syndrome of the upper vena cava, the doctor pays particular attention to jammed veins in the neck region or a whistling during inhalation (Stridor, evidence of a narrowing of the trachea). He also stops the heart (auscultation) and measures both blood pressure and heart rate. Affected persons are usually first examined sitting or standing and then supine. If the circulation values ​​then deteriorate, this provides a decisive indication of the vena cava syndrome.

With the help of ultrasound (sonography), the doctor can check organs in the abdomen and exclude other causes of a drop in blood pressure (especially internal bleeding).

Heartbeat of the child

In the case of the pregnant woman’s vena cava syndrome, the doctor performs what is known as cardiotocography (CTG). The device records the heartbeat of the unborn child (and the labor activity). The mother lies on the back during the examination. If there is insufficient blood supply to the fetus due to a vena cava syndrome, this can be seen in the CTG. Typically, the heart beats slower (bradycardia). Sometimes the fetal heart rate through the vena cava syndrome only occasionally falls into a critical area. The CTG curve is trough-shaped. Then doctors speak of sporadic or prolonged decelerations.

Diagnosis of cancer

The ultrasound device also plays a decisive role in cancer. In these cases, the vena cava syndrome usually occurs only in the advanced stage of an already known disease. Here, too, imaging studies (computed tomography, sonography) help to rule out further reasons for the complaints. In addition, it should be noted that the vena cava syndrome of the superior vena cava is significantly less dependent on the position than the vena cava syndrome of the inferior vena cava.

Vena cava syndrome: treatment

Leaving the supine position is the first and most important measure of a vena cava syndrome. In many cases, the mere placing in an upright position is sufficient. Often the patients are turned to the left side. Sometimes the right hip is raised and a pillow or the like placed underneath. In this way, the blood can flow back to the heart more easily.

If the vena cava syndrome leads to a cardiovascular shock (loss of consciousness, strong heart rate, barely measurable blood pressure) despite a rearrangement, the emergency physician must be alerted immediately. After delivery to an intensive care unit, the circulation is stabilized, inter alia, by fluid administration. In addition, the doctors examine the unborn child. In life-threatening situations, a caesarean section follows immediately.

The vena cava syndrome in malignant tumors usually needs to be treated surgically. Until then, special reclining positions (lateral, sitting) help to reduce discomfort. Sometimes doctors use a stent – a sturdy wire mesh or tube that prevents the vena cava from being squeezed. Irradiation can also help alleviate the discomfort by reducing the size of the tumor.

Vena cava syndrome: disease course and prognosis

The complaints of a lower vena cava syndrome can usually be eliminated by a rapid rearrangement. Only rarely do they assume life-threatening proportions for mother and child. But even such courses can be successfully treated by an immediate hospital admission and appropriate therapy. In some vena cava syndromes in addition the main artery (aorta) is compressed. However, it has a much more stable vessel wall and usually narrows only slightly. Doctors speak of the aortocaval compression syndrome.

In upper vena cava vena cava syndrome, symptoms tend to increase over time. But you can also lose weight again after some time new vessels (“bypass circuits”) have formed, which bridge the compression.

Prevent vena cava compression syndrome

To prevent vena cava syndrome, pregnant women from the second ternal should avoid longer, flat supine positions. Change your lying position regularly. Above all, the left side position is advantageous (but not permanent and exclusive). As a result, the uterus shifts away from the inferior vena cava, which runs more in the right half of the body. Lay flat pillows under your right side of the body to support the lateral position. Also special side sleepers or pregnancy pillows can one Vena cava syndrome prevent.