Blood Clots: How They Get Dissolved

When you get a cut, your blood changes from a free-flowing liquid into a clump of gel — that’s a clot — to stop the bleeding. That’s like if a hose could patch itself after it springs a leak.

It’s a complicated process where platelets, a type of blood cell, and lots of different proteins all jump in at just the right time to plug things up.

As the wound heals, your body has another process to break them down. If a clot forms when it’s not supposed to — inside a blood vessel, for example — you might need a little help to make that happen.

How the Body Clears Clots

When your body senses that you’ve healed, it calls on a protein called plasmin. Here’s the clever part: Plasmin is actually built into the clot itself. It’s there the whole time, but it’s turned off. It just hangs out and waits.

To turn it on, your body releases a substance known as an activator. It wakes up plasmin and tells it to get to work tearing things down. That mainly means breaking up the mesh-like structure that helps the clot work so well.

How Medicine Clears Clots

Doctors use different medications based on the type of clot you have:

Blood thinners. Also called anticoagulants, these are some of the more common drugs for a deep vein thrombosis (DVT). That’s a blood clot that happens in one of your large veins, usually in your leg. Blood thinners are also used to help prevent clots after a stroke or pulmonary embolism (when a blood clot travels to an artery in your lungs).

Blood thinners don’t dissolve the clot, but they can stop it from getting bigger and keep new ones from forming. That gives your body time to break up the clot.

Different blood thinners work in different ways:

• Direct oral anticoagulants (DOACs) keep your body from making fibrin, the protein the forms the clot’s mesh.
• Heparin keeps one of your body’s key clotting proteins, thrombin, from doing its job.
• Warfarin (Coumadin) slows down your liver’s ability to make the proteins you need for clotting.

Thrombolytics. These clot-busting drugs are used for serious conditions, like a pulmonary embolism. Unlike blood thinners, they do break down the clot. They work by turning on plasmin, which jump-starts your body’s natural process for clearing things out.

How Long Does It Take to Recover?

It’s not something you feel instantly. A DVT or pulmonary embolism can take weeks or months to totally dissolve. Even a surface clot, which is a very minor issue, can take weeks to go away.

If you have a DVT or pulmonary embolism, you typically get more and more relief as the clot gets smaller. The pain and swelling from a DVT usually start to get better within days of treatment.

Symptoms from a pulmonary embolism, like shortness of breath or mild pain or pressure in your chest, can linger 6 weeks or more. You might notice them when you’re active or even when you take a deep breath. Exercise can help with this.

A blood clot puts serious stress on your body. So it’s not just about clearing it away, but also giving your body and mind time to recharge.

Long-Term Effects

Sometimes a clot can leave behind scars and other damage that can cause problems.

Continued

Almost half of people who get a DVT may end up with post-thrombotic syndrome. That’s where swelling, pain, or skin color changes last much longer. You also may get sores called ulcers.

About 4 in 100 people with a pulmonary embolism have long-term lung damage known as pulmonary hypertension. This means you have high blood pressure in your lungs, which can lead to issues like shortness of breath, tiredness, and chest pain.

Can Blood Clots Dissolve on their own?

Blood clotting processes in the body are natural. The body manufactures a number of components involved in the development of blood clots to begin the clotting process. This is essential to stop bleeding when a blood vessel is injured through blunt force trauma, a cut, or other types of injuries.

The clotting process also initiates repair and healing of such injury.

Blood clots, depending on the severity of the injury, can dissolve on their own. How does this work?

Blood clots formation and dissolving

Blood clots develop from a process that involves a number of blood components including proteins and platelets. This process forms a clot over a blood vessel injury. The same process in reverse has the capability of breaking the clot down.

In scenarios where blood clot is formed, it can dissolve on its own when a protein known as plasmin (a component of the clot itself) is activated by another substance in the body known as an activator. This triggers a process similar to a “self-destruct” button that breaks up the net-like structure of the clot.

Some clotting processes are visible and take place on the outside of the body, such as a cut, scratch, or more specifically, during the formation and dissolving of a scab.

A blood clot that forms inside the blood vessel, and is not necessarily caused by an injury but sluggish blood flow, narrowed arteries, or other factors often associated with poor lifestyle habits, may require man-made interventions such as anticoagulation therapy or drugs known as clot busters.

Blood thinners or anticoagulants are a common resource when it comes to dealing with deep vein thrombosis or DVT, otherwise known as blood clots that develop in the large veins, most commonly the leg. The danger with a DVT is the potential of the blood clot to dislodge from the wall of the artery and travel through the bloodstream until it reaches the lung, resulting in a pulmonary embolism (PE) that cuts off blood supply in the lung. This prevents the lung from oxygenating blood returning to the heart. This scenario is potentially life-threatening.

Drugs known as blood thinners don’t dissolve clots per se, but prevent them from growing larger and also prevent the formation of new blood clots. This allows the body the time to naturally break up the clot on its own.

Clot-busting drugs designed specifically to treat pulmonary embolisms are capable of breaking down the blood clot by instigating the release of plasmid, which like with natural blood clot dissolving scenarios, gives the body a head start in also destroying the pulmonary embolism.

Regaining health

Some blood clots are relatively harmless, while others can be life-threatening. DVTs and pulmonary embolisms are not to be underestimated. It can take weeks for such clots to dissolve and for an individual to recover. With proper medical care however, these blood clots will eventually dissolve, but individuals who have experienced such clots must be aware that they have a potential to return when lifestyle habits such as poor diet, smoking, or immobility are involved.

Blood Clots: 10 Things to Know

Thousands of Americans experience blood clots every year. Knowing if you’re at risk and what symptoms to look out for are important to ensure you get prompt treatment.

As a nurse practitioner at the Michigan Medicine Frankel Cardiovascular Center, my heart patients often come to me with questions about blood clots, also known as deep vein thrombosis. Here are answers to some of the most common questions I’m asked.

1. What is a blood clot?

A blood clot is a collection of blood in the body that has changed from liquid to a semi-solid mass. The body does this to stop bleeding when injured, but sometimes a clot forms inside a blood vessel and does not dissolve on its own.

Platelets — cells that float in the blood — become sticky in response to injury and begin to attach to one another as well as to a blood vessel wall. Next, web-like strands in the blood, called fibrin, attach to the platelets and form a net that traps red blood cells. This reaction usually stops when the injury is repaired, and the body breaks down the clot. Sometimes, the action continues and becomes a blood clot that prevents blood from flowing through that vessel.

The most common type of blood clot is called deep vein thrombosis or DVT. This is a clot in one of the deep veins of the body, usually in the leg. When the clot is new, a piece of it can break off and travel to the lungs. This is known as a pulmonary embolism.

2. What are the symptoms of a blood clot?

Symptoms of a DVT include swelling of the affected leg, pain, redness, warmth and new visible veins in the area. Symptoms of a pulmonary embolism include shortness of breath, chest pain, cough or coughing up blood and fast breathing.

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Although these symptoms can be associated with many different health problems, if you suspect you have a clot, call your health care provider right away or go to the nearest emergency room.

3. How is a blood clot diagnosed?

Your provider will ask you a series of questions. If a blood clot is suspected, you will likely undergo one of these tests:

• A blood test called a d-dimer. This is a compound released from blood clots. It is high when you have a new clot.

• An ultrasound of the leg. This uses sound waves to watch blood flow in the veins.

• A CT scan of the chest if a pulmonary embolism is suspected.

4. What causes a blood clot?

Many risk factors and illnesses increase your risk of getting a blood clot. Risk factors include:

• Inactivity related to an injury or a long car or plane trip

• Having surgery or being in the hospital for an extended period

• Damage to your blood vessel from an injury

• Taking some medications such as birth control pills

• Inherited blood clotting tendencies

• Cancer

• Pregnancy

• Being over 60 years’ old

• Obesity

5. Why do those factors increase the risk of a blood clot?

Much of the risk is due to blood flow slowing down when you’re not able to move around. Blood that is stagnant or still tends to clot. Injury also causes a reaction in your blood that increases the risk of clotting. The genetic makeup of your blood, as well as illness, can also make clotting more likely.

6. How can I prevent blood clots?

The best way to prevent blood clots is to stay active and avoid sitting for long periods of time. Other things to keep in mind:

• When traveling by car or plane, take frequent breaks and move around.

• Maintain a good body weight and stay hydrated.

• Don’t smoke.

• Talk to your doctor about preventing clots after surgery.

• Know your family history of blood clotting.

7. How is a blood clot treated?

If you’re diagnosed with a blood clot, you may have to take a blood thinning medication, also called an anticoagulant. This type of medication stops the clot from growing and allows your body to break it down naturally, before it can travel to other areas of your body.

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If the clot is very large or life threatening, you may need to be hospitalized to receive clot-dissolving medication or to get a clot removal. Blood thinners are usually prescribed for three months, or until the health issue that caused the clot is gone. The decision of when to stop taking your blood thinning medication should be made with your doctor.

8. Once I have a blood clot, am I more likely to have another one?

A blood clot sometimes leaves a scar in the vein where it occurred. This makes the vein “abnormal” or different and more likely to clot again. Being aware of this risk and taking the necessary precautions helps to prevent another clot.

9. How are COVID-19 patients treated to prevent blood clots?

Patients who are hospitalized with COVID infection are at high risk for blood clots. They may be treated with blood thinners while they are in the hospital, and some for a short time after. The risk of blood clots is assessed in everyone who is admitted to the hospital. If your risk is high, you will receive low doses of blood thinners while in the hospital.

10. I have COVID-19 – am I at risk for blood clots?

Patients with COVID infection who are not hospitalized do not seem to have a high risk of blood clots. Talk to your doctor about your concerns and keep an eye on the symptoms listed above, getting care immediately if you’re concerned.

Blood Clots – Hematology.org

Blood clotting, or coagulation, is an important process that prevents excessive bleeding when a blood vessel is injured. Platelets (a type of blood cell) and proteins in your plasma (the liquid part of blood) work together to stop the bleeding by forming a clot over the injury. Typically, your body will naturally dissolve the blood clot after the injury has healed. Sometimes, however, clots form on the inside of vessels without an obvious injury or do not dissolve naturally. These situations can be dangerous and require accurate diagnosis and appropriate treatment.

Clots can occur in veins or arteries, which are vessels that are part of the body’s circulatory system. While both types of vessels help transport blood throughout the body, they each function differently. Veins are low-pressure vessels that carry deoxygenated blood away from the body’s organs and back to the heart. An abnormal clot that forms in a vein may restrict the return of blood to the heart and can result in pain and swelling as the blood gathers behind the clot. Deep vein thrombosis (DVT) is a type of clot that forms in a major vein of the leg or, less commonly, in the arms, pelvis, or other large veins in the body. In some cases, a clot in a vein may detach from its point of origin and travel through the heart to the lungs where it becomes wedged, preventing adequate blood flow. This is called a pulmonary (lung) embolism (PE) and can be extremely dangerous.

It is estimated that each year DVT affects as many as 900,000¹ people in the United States and kills up to 100,000.² Despite the prevalence of this condition, the public is largely unaware of the risk factors and symptoms of DVT/PE. Do you understand your risk? Check out ASH’s five common myths about DVT. 

How DVT Can Lead to Pulmonary Embolism

Arteries, on the other hand, are muscular, high-pressure vessels that carry oxygen- and nutrient-rich blood from the heart to other parts of the body. When your doctor measures your blood pressure, the test results are an indicator of the pressure in your arteries. Clotting that occurs in arteries is usually associated with atherosclerosis (hardening of the arteries), a deposit of plaque that narrows the inside of the vessel. As the arterial passage narrows, the strong arterial muscles continue to force blood through the opening, and the high pressure can cause the plaque to rupture. Molecules released in the rupture cause the body to overreact and form an unnecessary clot in the artery, potentially leading to a heart attack or stroke. When the blood supply to the heart or brain is completely blocked by the clot, a part of these organs can be damaged as a result of being deprived of blood and its nutrients.

Blood Clots: A Patient’s Journey

Am I at Risk?

The risk factors for developing a venous clot are different from those for an arterial clot, and people at risk for getting one are not necessarily at risk for getting the other. Different risk factors or events can cause unnatural clotting; however, each factor may initiate clotting in a different way. There are molecules in your system that signal your body to let it know when, where, and how quickly to form a clot, and genetics plays a role in how quickly your body reacts to these signals. Certain risk factors, such as obesity, slow the flow of blood in the veins, while others, such as age, can increase the body’s natural ability to clot. Even certain medications can affect how quickly your blood clots.

The following factors increase your risk of developing a blood clot:

• Obesity
• Pregnancy
• Immobility (including prolonged inactivity, long trips by plane or car)
• Smoking
• Oral contraceptives
• Certain cancers
• Trauma
• Certain surgeries
• Age (increased risk for people over age 60)
• A family history of blood clots
• Chronic inflammatory diseases
• Diabetes
• High blood pressure
• High cholesterol
• Prior central line placement

What Are the Symptoms of a Blood Clot?

In addition to knowing your risk factors, it is also important to be aware of the symptoms of blood clots, which vary depending upon where the clot is located:

• Heart – chest heaviness or pain, discomfort in other areas of the upper body, shortness of breath, sweating, nausea, light-headedness
• Brain – weakness of the face, arms or legs, difficulty speaking, vision problems, sudden and severe headache, dizziness
• Arm or Leg – sudden or gradual pain, swelling, tenderness and warmth
• Lung – sharp chest pain, racing heart, shortness of breath, sweating, fever, coughing up blood
• Abdomen – severe abdominal pain, vomiting, diarrhea

How Are Blood Clots Treated?

Blood clots are treated differently depending on the location of the clot and your health. If you are experiencing symptoms and suspect you may have a blood clot, see a doctor immediately.

There have been many research advances that have improved the prevention and treatment of blood clots. Some current treatments include:

• Anticoagulants – medicine that prevents clots from forming
• Thrombolytics – medicine that dissolves blood clots
• Catheter-directed thrombolysis – a procedure in which a long tube, called a catheter, is surgically inserted and directed toward the blood clot where it delivers clot-dissolving medication
• Thrombectomy – surgical removal of a clot

If you are diagnosed with a venous clot, your doctor may refer you to a hematologist, a doctor who specializes in treating blood diseases. People diagnosed with arterial disease who are at risk for developing a clot in their arteries may have several doctors involved in their care, including a cardiologist (a doctor who specializes in conditions of the heart), a neurologist, and possibly a hematologist.

For some patients, participating in a clinical trial provides access to novel therapies. If diagnosed, you can talk with your doctor about whether joining a clinical trial is right for you.

Are Blood Clots Preventable?

Blood clots are among the most preventable types of blood conditions. There are several ways to decrease your chances of developing a blood clot, such as controlling your risk factors when possible. If you think you may be at risk because of genetic or behavioral factors, talk with your doctor. Also, make sure your doctor is aware of all the medications you are taking and any family history of blood clotting disorders.

Thrombotic Thrombocytopenic Purpura: A Patient’s Journey

Where Can I Find More Information?

If you find that you are interested in learning more about blood diseases and disorders, here are a few other resources that may be of some help:

Results of Clinical Studies Published in 

Blood

Search Blood, the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, patients interested in viewing an access-controlled article in Blood may obtain a copy by e-mailing a request to the Blood Publishing Office.

Patient Groups

A list of Web links to patient groups and other organizations that provide information.

References

1. Beckman et al. Venous Thromboembolism: A Public Health Concern. AJPM April 2010.
2. Raskob et al. Surveillance for Deep Vein Thrombosis and Pulmonary Embolism: Recommendations from a National Workshop. AJPM April 2010.

Related Content

• DVT: Myths vs. Facts

  Deep vein thrombosis (DVT) affects thousands of people each year in the United States, but despite the prevalence of this condition, the public is largely unaware of the risk factors and symptoms of DVT/PE. Do you understand your risk? Check out ASH’s five common myths about DVT.

Leg clots (aka deep-vein thrombosis): an immediate and long-term health hazard

When it comes to under-the-radar health conditions, deep-vein thrombosis is at the top of the list. Most of my patients have never heard of this common problem. Yet deep-vein thrombosis puts more than one-quarter million Americans in the hospital each year, and complications from it are responsible for upwards of 100,000 deaths.

Deep-vein thrombosis (DVT) is the medical term for a blood clot that forms in a leg vein. Some DVTs cause no symptoms; others hurt, or make the leg swell. There are two big worries with a DVT:

Pulmonary embolism. A piece of a clot can break away, travel through the bloodstream, and become lodged in the lungs. This is called a pulmonary embolism. Almost all DVT-related deaths are due to a pulmonary embolism.

Post-phlebitis syndrome. A clot can permanently damage the vein it is lodged in. This problem, called post-phlebitis syndrome, causes persistent leg pain, swelling, darkened skin, and sometimes hard-to-heal skin ulcers. Up to 40% of people with a DVT develop post-phlebitis syndrome.

Treating DVT

Deep-vein thrombosis is initially treated with an anticoagulant. Today there are many choices, such as one of the newer oral direct acting agents, intravenous heparin or subcutaneous low-molecular weight heparin or fondaparinux. Anticoagulants can stop a DVT from getting larger and can prevent new clots from forming. Use of these drugs substantially decreases the risk of developing a pulmonary embolism.

But anticoagulants can’t quickly dissolve a clot that has already formed. That’s the job of drugs called thrombolytics (commonly known as clot busters), such as streptokinase and alteplase. Studies have had mixed results. However, they are sometimes considered in people with massive leg clots to prevent long-term leg swelling and pain (called post-phlebitis syndrome).

Delivering a clot-dissolving drug directly into the clot—instead of having it circulate through the bloodstream via standard intravenous delivery—allows the use of a lower dose, which decreases the risk of bleeding elsewhere in the body.

Not everyone with a DVT needs direct clot-dissolving therapy. Anticoagulants, along with support stockings to reduce swelling and improve blood flow, are enough for most people. For those with a very large clot, especially one high up in the leg or in the pelvis, direct injection of a thrombolytic agent may help protect the affected vein from post-phlebitis syndrome.

Prevention is preferable to treatment

Anyone can develop a DVT, although some people are more likely to have one than others. You are at increased risk if you or a close family member have had a DVT before, have an inherited condition that causes your blood to clot more readily than normal, have cancer, are immobile for a long time (confined to bed, long-duration plane or car trip, etc.), or use birth control pills.

Here are some good ways that everyone can use to help prevent a DVT from forming:

• Stay physically active. At work or at home, get up from your chair frequently. Short walks contract the muscles in your legs that help pump blood back toward your heart.
• Avoid dehydration. This is especially important when you are going to be sitting for a prolonged time, such as in an airplane.
• Move your legs. If you are bedridden and can’t take frequent walks, contracting your leg muscles will help prevent blood from pooling and clotting.
• Maintain a healthy body weight. Obesity increases the risk of DVT.
• If you are hospitalized for some reason, ask your doctors and nurses to make sure you are receiving measures—such as wearing special stockings or getting low-dose heparin—to prevent blood clots.

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Pulmonary Embolism: Symptoms, Causes, Treatments

Overview

What is a pulmonary embolism?

A pulmonary embolism is a blood clot in the lung that occurs when a clot in another part of the body (often the leg or arm) moves through the bloodstream and becomes lodged in the blood vessels of the lung. This restricts blood flow to the lungs, lowers oxygen levels in the lungs and increases blood pressure in the pulmonary arteries.

If a clot develops in a vein and it stays there, it’s called a thrombus. If the clot detaches from the wall of the vein and travels to another part of your body, it’s called an embolus.

If PEs are not treated quickly, they can cause heart or lung damage and even death.

Who is at risk of developing a blood clot?

People at risk for developing a blood clot are those who:

• Have been inactive or immobile for long periods of time due to bed rest or surgery.
• Have a personal or family history of a blood clotting disorder, such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Have a history of cancer or are receiving chemotherapy.
• Sit for prolonged periods.

People at risk for developing a pulmonary embolism include those who:

• Are inactive for long periods of time while traveling via motor vehicle, train or plane.
• Have a history of heart failure or stroke.
• Are overweight or obese.
• Have recently had trauma or injury to a vein, possibly after a recent surgery, fracture or due to varicose veins.
• Are pregnant or have given birth in the previous 6 weeks.
• Are taking birth control pills (oral contraceptives) or hormone replacement therapy.
• Placement of central venous catheters through the arm or leg If you have any of these risk factors and you have had a blood clot, please talk with your health care provider so steps can be taken to reduce your personal risk.

How serious is a pulmonary embolism?

A pulmonary embolism may dissolve on its own; it is seldom fatal when diagnosed and treated properly. However, if left untreated, it can be serious, leading to other medical complications, including death. A pulmonary embolism can:

• Cause heart damage.
• Be life-threatening, depending on the size of the clot.

Symptoms and Causes

What are the symptoms of pulmonary embolism?

Symptoms of pulmonary embolism vary, depending on the severity of the clot. Although most people with a pulmonary embolism experience symptoms, some will not. The first signs are usually shortness of breath and chest pains that get worse if you exert yourself. You may cough up bloody sputum. If you have these symptoms get medical attention right away. Pulmonary embolism is serious but very treatable. Quick treatment greatly reduces the chance of death.

Symptoms may include:

• Sudden shortness of breath — whether you’ve been active or at rest.
• Unexplained sharp pain in your chest, arm, shoulder, neck or jaw. The pain may also be similar to symptoms of a heart attack.
• Cough with or without bloody sputum (mucus).
• Pale, clammy or bluish-colored skin.
• Rapid heartbeat (pulse).
• Excessive sweating.
• In some cases, feeling anxious, light-headed, faint or passing out.
• Wheezing.

It is also possible to have a blood clot and not have any symptoms, so discuss your risk factors with your health care provider.

If you have any symptoms of pulmonary embolism, get medical attention immediately.

What causes pulmonary embolism?

Pulmonary embolism may occur:

• When blood collects (or “pools”) in a certain part of the body (usually an arm or leg). Pooling of blood usually occurs after long periods of inactivity, such as after surgery or bed rest.
• When veins have been injured, such as from a fracture or surgery (especially in the pelvis, hip, knee or leg).
• As a result of another medical condition, such as cardiovascular disease (including congestive heart failure, atrial fibrillation and heart attack) or stroke.
• When clotting factors in the blood are increased, elevated, or in some cases, lowered. Elevated clotting factors can occur with some types of cancer or in some women taking hormone replacement therapy or birth control pills. Abnormal or low clotting factors may also occur as a result of hereditary conditions.

Diagnosis and Tests

How is a pulmonary embolism detected?

Pulmonary embolism is commonly detected through the following tests:

• Computed tomography (CT) scan.
• Lung scan.
• Blood tests (including the D-dimer test).
• Pulmonary angiogram.
• Ultrasound of the leg — helps to identify blood clots in patients who cannot have an X-ray due to dye allergies or who are too sick to leave their hospital room.
• Magnetic resonance imaging (MRI) of the legs or lungs.

Management and Treatment

How is pulmonary embolism treated?

Treatment for pulmonary embolism is typically provided in a hospital, where your condition can be closely monitored.

The length of your treatment and hospital stay will vary, depending on the severity of the clot.

Depending on your medical condition, treatment options may include anticoagulant (blood-thinner) medications, thrombolytic therapy, compression stockings, and sometimes surgery or interventional procedures to improve blood flow and reduce the risk of future blood clots.

Anticoagulant medications

In most cases, treatment consists of anti- coagulant medications (also called blood thinners). Anticoagulants decrease the blood’s ability to clot and prevent future blood clots.

Anticoagulant medications include warfarin (Coumadin®), heparin, low-molecular weight heparin (such as Lovenox® or Dalteparin®) and fondaparinux (Arixtra®).

• Warfarin comes in tablet form and is taken orally (by mouth).
• Heparin is a liquid medication and is given either through an intravenous (IV) line that delivers medication directly into the vein, or by subcutaneous (under the skin) injections given in the hospital.
• Low molecular-weight heparin is injected beneath or under the skin (subcutaneously). It is given once or twice a day and can be taken at home.
• Fondaparinux (Arixtra) is a new medication that is injected subcutaneously, once a day.

You and your family will receive more information about how to take the anticoagulant medication that is prescribed. As with any medication, it’s important that you understand how and when to take your anticoagulant and to follow your doctor’s guidelines.

The type of medication you were prescribed, how long you need to take it, and the type of follow-up monitoring you’ll need depends on your diagnosis. Be sure to keep all scheduled follow-up appointments with your doctor and the laboratory so your response to the medication can be monitored closely.

While taking anticoagulants, your follow-up will include frequent blood tests, such as:

• PT-INR: The Prothrombin time (PT or protime)/ International Normalized Ratio (INR) test: Your INR will help your health care provider determine how fast your blood is clotting and whether your medication dose needs to be changed. This test is used to monitor your condition if you are taking Coumadin.
• Activated partial thromboplastin (aPTT): Measures the time it takes blood to clot. This test is used to monitor your condition if you are taking heparin.
• Anti-Xa or Heparin assay: Measures the level of low molecular-weight heparin in the blood. It is usually not necessary to use this test unless you are overweight, have kidney disease or are pregnant.

What are other treatment options?

Compression stockings

Compression stockings (support hose) aid blood flow in the legs and should be used as prescribed by your doctor. The stockings are usually knee- high length and compress your legs to prevent the pooling of blood.

Talk with your doctor about how to use your compression stockings, for how long, and how to care for them. It is important to launder compression stockings according to directions to prevent damaging them.

Procedures

If a pulmonary embolism is life-threatening, or if other treatments aren’t effective, your doctor may recommend:

• Surgery to remove the embolus from the pulmonary artery.
• An interventional procedure in which a filter is placed inside the body’s largest vein (vena cava filter) so clots can be trapped before they enter the lungs.

Thrombolytic therapy

Thrombolytic medications (“clot busters”), including tissue plasminogen activator (TPA), are used to dissolve the clot. Thrombolytics are always given in a hospital where the patient can be closely monitored. These medications are used in special situations, such as if the patient’s blood pressure is low or if the patient’s condition is unstable due to the pulmonary embolism.

Prevention

How do I prevent pulmonary embolism?

• Exercise regularly. If you can’t walk around due to bed rest, recovery from surgery or extended travel, move your arms, legs and feet for a few minutes each hour. If you know you will need to sit or stand for long periods, wear compression stockings to encourage blood flow.
• Drink plenty of fluids, like water and juice, but avoid excess alcohol and caffeine.
• If you need to be stationary for long periods of time, move around for a few minutes each hour: move your feet and legs, bend your knees, and stand on tip-toe.
• Do not smoke.
• Avoid crossing your legs.
• Do not wear tight-fitting clothing.
• Lose weight if you are overweight.
• Elevate your feet for 30 minutes twice a day.
• Talk to your doctor about reducing your risk factors, especially if you or any of your family members have experienced a blood clot.

Living With

What is follow-up care after a pulmonary embolism?

Be sure you discuss and understand your follow- up care with your doctor. Follow your doctor’s recommendations to reduce the risk of another pulmonary embolism.

Keep all appointments with your doctor and the laboratory so your response to prescribed treatments can be monitored.

Your Guide to Preventing and Treating Blood Clots

Blood clots are a serious medical condition. It is important to know the signs and get treated right away. This guide describes ways to prevent and treat blood clots; symptoms; and medication side effects as well as when to go to the emergency room.

This guide was funded by the Agency for Healthcare Research and Quality (AHRQ) under grant No. U18 HS015898-01.

Contents

Introduction
Causes of Blood Clots
Symptoms of a Blood Clot
Preventing Blood Clots
Treatment of Blood Clots
Side Effects of Blood Clots
List of Terms
Figure 1: Illustration of a Blood Clot
Acknowledgments, Disclaimer, and Licensing

Introduction

Blood clots (also called deep vein thrombosis [throm-BO-sis]) most often occur in people who can’t move around well or who have had recent surgery or an injury. Blood clots are serious. It is important to know the signs and get treated right away. This guide tells about ways to prevent and treat blood clots. Figure 1 provides an illustration of a blood clot in the leg.

*In this guide, the term “doctor” is used. It can mean doctor, nurse, physician’s assistant, nurse practitioner, pharmacist, or other heath care professional.

Return to Contents

Causes of Blood Clots

Blood clots can form if you don’t move around a lot. You may also get a blood clot if you:

• Have had recent surgery.
• Are 65 or older.
• Take hormones, especially for birth control. (Ask your doctor about this).
• Have had cancer or are being treated for it.
• Have broken a bone (hip, pelvis, or leg).
• Have a bad bump or bruise.
• Are obese.
• Are confined to bed or a chair much of the time.
• Have had a stroke or are paralyzed.
• Have a special port the doctor put in your body to give you medicine.
• Have varicose (VAR-e-kos) or bad veins.
• Have heart trouble.
• Have had a blood clot before.
• Have a family member who has had a blood clot.
• Have taken a long trip (more than an hour) in a car, airplane, bus, or train.

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Symptoms of a Blood Clot

You may have a blood clot if you see or feel:

• New swelling in your arm or leg.
• Skin redness.
• Soreness or pain in your arm or leg.
• A warm spot on your leg.

Blood clots can be dangerous. Blood clots that form in the veins in your legs, arms, and groin can break loose and move to other parts of your body, including your lungs. A blood clot in your lungs is called a pulmonary embolism (POOL-mo-nar-e EM-bo-liz-em). If this happens, your life can be in danger. Go to the emergency room or call 911.

A blood clot may have gone to your lungs if you suddenly have:

• A hard time breathing.
• Chest pain.
• A fast heartbeat.
• Fainting spells.
• A mild fever.
• A cough, with or without blood.

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Preventing Blood Clots

You can help prevent blood clots if you:

• Wear loose-fitting clothes, socks, or stockings.
• Raise your legs 6 inches above your heart from time to time.
• Wear special stockings (called compression stockings) if your doctor prescribes them.
• Do exercises your doctor gives you.
• Change your position often, especially during a long trip.
• Do not stand or sit for more than 1 hour at a time.
• Eat less salt.
• Try not to bump or hurt your legs and try not to cross them.
• Do not use pillows under your knees.
• Raise the bottom of your bed 4 to 6 inches with blocks or books.
• Take all medicines the doctor prescribes you.

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Treatment for Blood Clots

If you have been told you have a blood clot, your doctor may give you medicine to treat it. This type of medicine is called a blood thinner (also called an anticoagulant [an-te-ko-AG-u-lent]). In most cases, your doctor will tell you to follow this treatment plan:

• For the first week you will receive medicine called heparin (HEP-a-rin) that works quickly.

• This medicine is injected under the skin. You will learn how to give yourself these shots, or a family member or friend may do it for you.

• You will also start taking Coumadin® (COO-ma-din)—generic name: warfarin (WAR-far-in)—pills by mouth. After about a week of taking both the shots and the pills, you will stop taking the shots. You will continue to take the Coumadin®/warfarin pills for about 3 to 6 months or longer.

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Side Effects of Blood Thinners

Blood thinners can cause side effects. Bleeding is the most common problem. Your doctor will watch you closely. If you notice something wrong that you think may be caused by your medication, call your doctor.

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List of Terms

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Figure 1: Illustration of a Blood Clot

Text Description

This figure is a drawing of a human body with the heart and veins shown in the abdominal area and down to the legs. There is a large oval with an arrow pointing to a vein in the groin area. Within the oval is an illustration showing a close-up of a blood clot in the vein and the swelling in the area. Below the drawing is the text: “Blood clots can form in any deep veins of the body. Most often they form in the legs, arms, or groin.”

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Acknowledgments, Disclaimer, and Licensing

This guide is based on a product developed by Ann Wittkowsky, Pharm.D., Brenda K. Zierler, Ph.D., R.N., R.V.T., and the V.T.E. Safety Toolkit Team at the University of Washington, Seattle, under Agency for Healthcare Research and Quality Grant No. U18 HS015898-01.

This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.

90,000 Why are blood clots dangerous and why do they occur?

Blood clots.

Many people with venous diseases have probably heard this word. Moreover, doctors often describe blood clots as one of the health threats.

They are right.

Blood clots – are blood clots that interfere with blood circulation and sometimes endanger life.

But how do such harmful formations appear in the body?

Did the body take up arms against us?

Not really.

Blood clots can indeed be very dangerous, but not always. Initially, they serve to protect blood vessels – prevent blood loss in case of injury and trauma.

The body reacts to damage – next to them blood clots form in a gel-like or semi-solid state. These clots close the wound. Then the damage heals, and the protection from the blood cells gradually dissolves.

This is how events should develop ideally.

Unfortunately, sometimes blood clots remain in the vessels for too long and interfere with blood circulation.

The defense mechanism makes other errors as well. Often, a blood clot in a leg or other part of the body appears even for no reason. It ceases to protect the vessels and turns into a serious threat that can lead to death.

Blood clots form not only in the veins, but also in the arteries. Arterial blood clots cause severe pain or paralysis of a part of the body. Sometimes both. Signs of a blood clot are immediate and the patient needs immediate treatment. Otherwise, a heart attack or stroke will occur.

Venous clots are also dangerous, although they do not attack vital organs instantly – they grow slowly, but with timely treatment they do not cause fatal complications.

The most severe form of venous blood clots is deep vein thrombosis.

Complications of deep vein thrombosis

According to research, every fourth person dies from thrombosis. That is, this killer has more victims than car accidents, breast cancer or AIDS.

Fatal complications often develop with deep vein thrombosis.This is the name of a disease in which blood clots occur in the largest veins of the legs, arms, lungs, pelvis and brain.

Why is it dangerous?

The main cause of is deep vein thrombosis, which often causes pulmonary embolism. That is, a fragment of a blood clot enters the bloodstream and floats to the heart, and along the way it can get stuck in the vessels of the lungs. In this case, breathing may stop. Up to 30% of patients with pulmonary embolism die.

As you can see, if a blood clot in the leg comes off, the consequences can be tragic and people with this pathology need immediate help.

But the high risk of embolism is only part of the problem.

The disease is still difficult to detect.

Only 50% of patients show signs of deep vein thrombosis:

• Pain
• Edema
• Increased sensitivity
• Skin redness

Even these symptoms are similar to signs of other diseases, and it is difficult for the doctor to diagnose. Thrombosis betrays itself as symptoms that are concentrated in one limb, but if there are symptoms on two legs, then another disease causes them.Most likely. This is not a guarantee, but such features help the doctor diagnose.

Usually, the appearance depends on the size of the thrombus in the leg. Small blood clots cause only slight swelling and mild pain. Large blood clots are another matter. Around the vessels with such formations, the skin swells greatly, and the patient often experiences acute pain.

Pulmonary embolism symptoms:

• Difficulty breathing
• Chest pain, especially severe with deep breaths and coughing
• Rapid heartbeat
• Dizziness and fainting
• Cough with blood

Fragments of blood clots in the lungs are not the only complication of deep vein thrombosis.Also, patients suffer from post-phlebitis syndrome, which occurs when the venous valves are damaged. With it, bleeding slows down.

Symptoms appear:

• Leg pain
• Persistent edema
• Skin discoloration
• Ulcers

Remember the symptoms of thrombosis and its complications – this will help you see a doctor in time for a full diagnosis.

How to identify a blood clot in the leg

Again, only half of the patients show signs of thrombosis.Therefore, many people live for years with blood clots in deep veins and are unaware of the disease and its deadly complications.

It is impossible to diagnose blood clots at home. It is necessary to go to the doctor.

We recommend that you visit a phlebologist regularly to check your veins. Even without symptoms of leg thrombosis. So you will not only save yourself from possible discomfort, but also prevent complications that are often fatal.

If signs of a detached blood clot in the leg are noticeable, then going to the doctor is not a luxury, but an urgent need.Each day of procrastination may be the last. People die from pulmonary embolism. Sometimes in hospitals. Without urgent help, a person with breathing disorders is at great risk, so if you have symptoms of the disease, be sure to go through an examination with a phlebologist.

The doctor will carry out diagnostics using ultrasound equipment and identify any irregularities in the work of blood vessels. Both in the legs and in other organs.

The phlebologist will also explain the cause of the thrombosis.

Why does deep vein thrombosis occur?

Blood clots in the vessels are formed for three main reasons:

1. Damage to the venous walls
2. Circulatory disorders
3. Hypercoagulation – increased blood clotting

These problems arise from a variety of risk factors.They do not guarantee the occurrence of deep vein thrombosis, but they significantly increase the likelihood of the disease.

Most common risk factors:

• Long immobility

When a person sits motionless for a long time, for example, when traveling by car, blood circulation in the body slows down. The muscles in your legs don’t work and don’t help your veins pump blood. Therefore, more blood clots appear.

• Recent Activity

During procedures on the legs, heart and blood vessels, the venous walls are often damaged.As a result, blood clots accumulate on them. These blood clots do not always disappear after treatment – they remain in the vessels and interfere with blood circulation.

• Lower body injuries

Fractures of the thigh or lower leg often damage adjacent veins. Blood circulation is impaired for several reasons. First, blood clots appear in the damaged vessels, which should reduce blood loss. Second, fracture treatment restricts the patient’s movement and reduces the rate of circulation.The result is a high risk of thrombosis.

There is a lot of blood in a large body and it strongly presses on the venous walls. Sometimes it damages them. As a result, blood clots grow.

• Pregnancy and the puerperium

In expectant mothers, the vessels are exposed to great stress – they are pressed by an enlarged uterus, as well as an increased volume of blood in the body. Veins dilate and blood flow slows down. Favorable environment for thrombosis.

• Heart attack or heart failure

Because of these problems, the heart is not working at full strength. As a result, blood circulation deteriorates.

• Estrogen therapy or contraceptive drugs

Due to hormones, the blood becomes thicker and blood clots are more likely to form in it.

Certain forms of cancer increase the risk of blood clots.The fight against cancer is no less dangerous. Certain treatments increase the density of the blood and its ability to form blood clots.

• Rare genetic disorders

These inherited conditions affect the blood’s ability to thrombus. The risk of thrombosis increases.

• Age over 60 years old

Deep vein thrombosis affects people of all ages. However, the disease is especially common in older people.

• Vein pathology

Inflammation of the venous walls and varicose veins affect blood circulation, so that blood clots often fill diseased vessels.

• Superficial vein thrombosis

Blood clots in the subcutaneous vessels are not very dangerous, but they increase the risk of blood clots in large deep veins.

Because of this disease, the blood does not thicken properly, which causes not only thrombosis, but also bleeding.The main causes are infections and organ failure.

• History of thrombosis

One third of people who have cured deep vein thrombosis will get it again within 10 years.

As you can see, there are a lot of risk factors. Therefore, it is not surprising that complications of thrombosis are one of the main causes of death in the modern world.

Blood clots are often killed. Especially when the patient allows them to grow uncontrollably and spread to the heart, lungs and brain.To fight the disease, timely diagnosis is needed.

Diagnostics of the deep vein thrombosis of the lower extremities

Finally.

You have entered the phlebologist’s office.

Diagnosis of deep vein thrombosis of the legs begins with a survey. The patient talks about symptoms that are not visible externally. Next, the doctor examines the legs and notes possible manifestations of blood clots, for example, swelling or discoloration of the skin.

Examination does not always help to make a diagnosis.

Then the phlebologist orders tests:

• Ultrasound scan

The doctor conducts a special device (ultrasound) along the vein, which sends ultrasound waves into the vessels. The sound is reflected back and the vein is displayed on the monitor. As well as her damage and blood clots. If a blood clot has been found, additional testing may be needed to confirm that the clot has grown.

This test is called the D-dimer test.All blood clots are made up of fibrin. When blood clots appear, the body does not ignore this – it produces plasmin, which destroys blood clots. The analysis shows the level of plasmin, but not the location of the clot. The doctor looks for him with ultrasound.

In rare cases, ultrasound scanning does not give clear results, and then the phlebologist injects a contrast into the veins – a special substance that helps to see the vessels well on an X-ray.

These types of tomography show a three-dimensional image of veins.Such methods are rarely used. Their disadvantages are time consuming and difficulties in deciphering the results.

It may take more or less time to diagnose, but usually doctors can easily find blood clots in the veins. Timely detection of blood clots helps prevent complications of the disease. For example, detachment of a blood clot in the leg.

How to identify thromboembolism

We have already talked about the signs of pulmonary embolism. When they appear, you need to see a doctor as soon as possible, since your life often depends on the speed of assistance.

Yes, not all symptoms are intimidating.

Sometimes people ignore a rapid heart rate or shortness of breath. All this cannot be compared with hemoptysis, but it is definitely not worth postponing the visit to the doctor until more severe symptoms of the disease appear. Delay will prove disastrous.

Even better, do not wait for the symptoms of embolism and begin to fight the cause of the formation of blood clots in the lungs. A blood clot in your leg can come off suddenly. You simply will not have time to get the help you need, especially if you are away from the village and doctors.

The first line of defense against embolism is prevention of thrombosis.

Prevention of venous thrombosis

At the heart of prevention is the fight against risk factors.

Yes, it is impossible to eliminate them all.

You cannot get rid of genetic disorders or regain youthfulness. However, the fight is not lost. By removing at least a few risk factors, you can reduce the likelihood of thrombosis.

Doctors advise:

• Avoid prolonged immobility

Even with bed rest after surgery, try to move as much as possible.Make regular stops on long car rides. Get out of your car every hour and walk for at least five minutes. It could be longer. Raise and lower your heel as you sit – this is how you move your leg muscles and help your veins pump blood.

• Charge every day

Any simple exercise accelerates the blood in the vessels. Just 10 minutes to exercise every morning, and blood clots will be less frequent.

• Change your lifestyle

First of all – fight obesity.Excess weight paves the way not only for deep vein thrombosis, but also for many other diseases.

• Use contraceptive estrogen pills as little as possible

The less hormones affect the blood vessels, the less the risk of blood clots in the superficial or deep veins.

Unfortunately, sometimes preventive measures do not help. Because there are too many other risk factors, or the patient is too late in the fight for vascular health.

The reason is not the main thing.

The main thing is not to start the disease and undergo treatment.

Treatment of deep vein thrombosis of the lower extremities

It is difficult to predict in advance which treatment method the phlebologist will choose. It depends on the location and size of the blood clot – some patients get rid of blood clots without the intervention of a doctor, while others have to go through surgery.

Let’s start with simple cases.

Small blood clots in the vessels below the knee rarely come off.Therefore, doctors do not prescribe any medications to the patient and simply monitor his condition. The person is regularly examined. This is how doctors know immediately if blood clots are increasing.

Do not forget – the body produces plasmin to destroy blood clots. There is a chance that they will disappear on their own.

Of course, not all patients are so lucky.

When the disease develops, phlebologists prescribe anticoagulants that thin the blood and stop the growth of blood clots. There are a lot of such drugs for the treatment of leg thrombosis and the following factors influence their choice:

• Cancer
• Reaction to substances in the composition of anticoagulants
• Wounds and trauma
• Pregnancy

While the patient is taking blood-thinning medications, doctors regularly do blood tests and check the effectiveness of anticoagulants.

Sometimes people do not have to go to the hospital.

Treatment of venous thrombosis without complications is possible at home. Family members give the patient injections of anticoagulants, and he comes to the clinic for blood tests.

In case of complications, this is not possible.

People with an additional serious illness or during pregnancy should be under constant supervision in the hospital.

Duration of treatment?

Doctors prescribe anticoagulants for different periods – from 3 to 12 months.Or longer. If blood clots appear due to temporary risk factors, for example, after many hours of driving, then you only need to take medication for three months.

For people with constant and multiple risk factors, we recommend preparing for long-term treatment – longer than 12 months.

Not all blood clots respond well to therapy. Against resistant formations, doctors use more powerful drugs – thrombolytics, which destroy blood clots.

These drugs must be injected directly into the blood clots and are handled by a surgeon or other qualified specialist.Independent use is prohibited.

Some patients need alternative treatment. Common examples are when there is bleeding in the stomach or intestines. Anticoagulants thin the blood. Taking them will increase bleeding and can even lead to death.

Phlebologists use a temporary solution – a cava filter. It is placed in a large vessel through which all the blood from the veins of the lower extremities passes, and therefore all the blood clots. The filter stops blood clots and gives doctors time to eliminate bleeding.It is not used all the time.

In rare cases, the removal of a blood clot on the leg is performed. This is necessary if blood clots completely block large veins and it is impossible to get rid of such a congestion in other ways. However, then the patient is still prescribed anticoagulants.

An important part of the therapy is compression hosiery, which puts pressure on the diseased vessels and prevents the complications of deep vein thrombosis. It is recommended to wear it for at least a year after receiving the diagnosis.

We have tried to outline what the future holds for people with thrombosis.How the disease develops without treatment. What methods do doctors use to deal with blood clots in the deep veins of the legs, lungs and heart.

This information will be helpful.

Although we hope that you will not face complications of thrombosis.

It is difficult to fully disclose such a topic even in a thick book, and we advise you to consult with a phlebologist to clarify any questions that arise.

Where to go?

It’s up to you to decide. There are specialists in vascular diseases in many medical centers, but blind selection is unlikely to help you get to an experienced doctor.There is also a more reliable option.

Make an appointment at the Vein Institute clinic.

We have phlebologists who have been eliminating venous diseases for more than 15 years. Individual specialists take twice as long. They have accumulated a wealth of experience in treating patients with a wide variety of individual characteristics: injuries, pregnancy, serious illnesses.

Doctors will quickly compose an individual therapy program. Treatment by the most experienced phlebologists in Kiev and Kharkov will allow you to return to the society of people who are not tormented by problems with blood vessels.

Doctors of the Venin Institute have successfully operated on over 4,000 people. They have cured even more with the right medication, compression hosiery and preventive measures. These patients returned to full, healthy lives. Without a thrombotic gun attached to the head.

However, our employees are engaged not only in medical, but also in research work. In his free time from medical exploits. For example, Rustem Osmanov regularly writes scientific articles. Over 70 publications.He also patented nine inventions.

Doctors of the Vein Institute give reports at world phlebological forums. To the best vessel specialists. In 2018-19, Oksana Ryabinskaya took part in such conferences three times – in Yaremche, Melbourne and Krakow.

Come to our medical center, where you will receive an accurate diagnosis and prescribe an effective treatment for venous diseases of any severity.

Surgeon of the highest category, phlebologist

Experience: 21 years

Surgeon of the highest category, phlebologist

Work experience: 20 years

Phlebologist of the highest category

Work experience: 34 years

Dermatologist higher.cat., director

Work experience: 20 years

First category surgeon

Work experience: 15 years

Surgeon, phlebologist

Work experience: 17 years

Surgeon, phlebologist

Work experience: 5 years

First category surgeon

Work experience: 12 years

Vascular surgeon, phlebologist

Work experience: 10 years

Vascular surgeon, chief physician

Work experience: 11 years

Vascular surgeon, phlebologist

Work experience: 8 years

Vascular surgeon, phlebologist

Work experience: 5 years

90,000 why it is important to control and treat it

WHAT IS POLYP?

Every month the endometrium in the uterus changes its structure under the influence of hormones in order to successfully accept an embryo.If fertilization does not occur, then the upper layer of the endometrium, the functional one, is separated and exits the body in the form of menstruation, and the lower layer – the basal – re-“builds” the endometrium.

Unfortunately, in some cases this system fails – and, regardless of the day of the cycle, the endometrium changes on its own. As a result, polyp may appear – neoplasms from endometrial cells . This polyp looks like a mushroom on a leg and in a hat. And in fact, this is an incorrect, too active locally overgrown endometrium.

WHY DOES POLYPS APPEAR?

One of the most probable theories of the appearance of polyps is overreaction of cells to hormones . That is, the point is not that the body produces more or less female hormones, but that a mutation occurs in the endometrial cell, due to which the cell begins to be absolutely illogical, incorrect, too active to react to estrogens.

That is why polyps are more common in women of reproductive age .The polyp found in a woman in menopause, most likely, had been with her for a long time, it just did not cause complaints, and she did not do any examinations to detect it.

WHAT ARE THE SYMPTOMS?

Polyps – the number one cause of bleeding , not related to menstruation. Most often it is bloody, smearing discharge in the middle of the cycle, before and after menstruation. Menstruation seems to be getting longer: women complain that spotting appears immediately after menstruation or after a few days….

Pain is rare. It often happens that symptoms are not present at all – then the polyp in most cases is found “by accident”, for example, during ultrasonography. Quite a rare option: the polyp grows, gets stronger and reaches such a size that it prevents pregnancy – a woman is sent for examination due to infertility and thus a polyp is found. Such cases, however, are exceptional – pregnancy polyps are not a hindrance, since they rarely reach such an impressive size.

Separately, it is possible to distinguish a polyp that has grown not in the uterus, but below – in its cervix or outside of it. Additional symptoms here may be spotting after intercourse . Such a polyp, as a rule, does not need a special diagnosis – it can be seen on a routine gynecological examination.

HOW TO FIND A POLIP?

The primary and main method for diagnosing polyps is ultrasonography. The method has its own characteristics – firstly, it matters on what day of the cycle the patient comes for an examination.So, polyps are best diagnosed on the 8-9th day of cycle , when the endometrium looks dark on ultrasound, and the polyps against its background are bright and light. If an ultrasound scan is done to a patient after ovulation, when the endometrium is already covered with a network of vessels, has grown with glands – it is very easy to overlook polyps – the endometrium will be the same color with them. Of course, if the polyp is really large, then it can be seen in the second half of the cycle – but to confirm the diagnosis, the patient will be sent for a second ultrasound at the “right” time.

Sometimes on ultrasound is impossible to say unambiguously whether it is a polyp . Sometimes a polyp can be confused with a fibroid, pseudopolyp – endometrial clots that come out of the uterus during menstruation.

The sensitivity is much higher in sonohysterography – the gold standard for polyp diagnostics. In fact, this is the same ultrasonography, only in more detail — first, a thin, flexible catheter is inserted into the uterine cavity, through which saline is injected into it, expanding the cavity and improving the view.And only then, with intravaginal ultrasound, the doctor looks for the cause of the complaints and symptoms.

Another “but” – neither ultrasound nor sonohysterography will be able to distinguish a benign polyp from potentially malignant cells . Let’s figure it out: the polyp itself is an exceptionally benign phenomenon. But if suddenly on the surface of the polyp – the epithelium, changes occur – the cells begin to intensively, uncontrollably divide, change visually – then we are talking about atypia, a harbinger of malignant formation.Of course, with the same success, atypical cells can appear not on the polyp, but on any other part of the endometrium. But malignancy of the polyp is still possible. Precisely in order to be sure that the polyp is benign, , even if there are no symptoms, it is advisable to remove and examine the polyp.

There are four types of polyps: fibrous, glandular fibrous, glandular, and adenomatous. From the names it is clear that some polyps grow from fibrous tissues, in others glandular ones predominate, and still others are of a mixed type.Adenomatous are extremely rare. But these are exactly those polyps that are considered precancerous, since they are composed of atypical cells. Adenomatous polyps are more common just before menopause.

HOW TO TREAT POLIP?

If the patient has no complaints, the polyp does not grow – it is not necessary to treat it, but it is important to control it! You need to do ultrasound on a regular basis, take aspirate – cells from the uterine cavity. But no diagnostics gives one hundred percent certainty as to whether it is a polyp, so the best option is still to remove it.

Important point: hormonal treatment in the case of a real polyp does not work!

The only possible treatment is hysteroresectoscopy ( hysteroscopy) . This is both the diagnosis and treatment of a polyp. The essence of the procedure is to insert a hysteroscope, a tube with a micro-video camera, into the uterus, which makes it possible to assess the polyp visually (the diagnostic part of the procedure) and, if necessary, remove it with a special tool (the therapeutic part of the procedure).On average, everything takes 15-20 minutes.

HOW TO PREPARE FOR THE SURGERY?

The patient is admitted on the day of surgery, having previously undergone standard training: tests for general health (blood test), examination of the vaginal microflora, smear for the presence of precancerous or cancerous cells of the vagina and cervix, electrocardiography and fluorography.

The procedure is usually performed under short-term general anesthesia in a day hospital. After the hysteroscope is in the uterine cavity, under the control of vision, the polyp is removed with special endoscopic instruments.This manipulation is fast, without a single seam. The material of the operation must be sent for a special histological analysis. Already 2-3 hours after the operation, the patient can safely go home.

WHAT TO EXPECT AFTER THE PROCEDURE?

Thanks to modern equipment, technique of the procedure and highly qualified doctors, complications after hysteroscopy are rare.

The classic situation is drawing pains in the abdomen on the first day after the procedure and spotting spotting a few days after, which will definitely go away without additional intervention.

Of the most severe possible, but unlikely complications – perforation of the uterus, trauma to nearby organs (bladder, bowel) and fluid overload syndrome. However, if the operation is performed by a certified highly qualified specialist, such troubles are minimized. The likelihood of complications is no more than 0.1-0.2%.

Important: a correctly removed polyp does not grow back (does not recur), and already in the next cycle after its removal, a healthy and happy woman can plan a pregnancy.However, from time to time it is necessary to do control ultrasounds to know if new polyps have grown.

In the clinic LIPEX consultations on gynecological problems and minimally invasive operations are carried out by a certified gynecologist Anton BABUSHKIN.

Make an appointment with Anton Babushkin:

(+371) 67333322, (+371) 67579208

Clinic Lipex, st.Dzirnavu 23, Riga

Heart attack

Heart attack symptoms

Common signs and symptoms of a heart attack include:

• Chest pain or discomfort (angina) may manifest as a feeling of tightness, tightness, fullness, or pain in the center of the chest. With a heart attack, pain usually lasts for a few minutes and may increase and decrease in intensity.
• Discomfort in the upper body, including arms, neck, back, jaw, or abdomen.
• Difficulty breathing.
• Nausea and vomiting.
• Cold sweat.
• Dizziness or fainting.
• Women are less likely to have chest pain.

Emergency treatment for heart attack

The American Heart Association and the American College of Cardiology recommend:

• If you think you are having a heart attack, call (03) right away. After calling (03), you need to chew an aspirin tablet.Be sure to inform the paramedic about this, then an additional dose of aspirin is not required.
• Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure that must be performed within 90 minutes of the onset of a heart attack. Patients suffering from a heart attack must be transported to a hospital equipped to perform PCI.
• Fibrinolytic therapy should be given within 30 minutes of a heart attack if the center performing PCI is not available.The patient should be transferred to the PCI unit without delay.

Secondary prevention of heart attack

Additional preventive measures are needed to help prevent another heart attack. Before discharge, you need to discuss with your inpatient doctor:

• Control of blood pressure and cholesterol levels (statins, ACE inhibitors, beta-blockers are prescribed at discharge).
• Aspirin and the antiplatelet drug clopidogrel (Plavix), which many patients must take on a regular basis.Prasugrel (Effient) is a new drug that can be used as an alternative to clopidogrel for patients.
• Cardiac rehabilitation and regular exercise.
• Weight normalization.
• Smoking cessation.

Introduction

The heart is a complex organ of the human body. Throughout his life, he constantly pumps blood, supplying all tissues of the body with oxygen and vital nutrients through the arterial network.To accomplish this strenuous task, the heart muscle itself needs a sufficient amount of oxygenated blood, which is delivered to it through the network of coronary arteries. These arteries carry oxygen-rich blood to the muscular wall of the heart (myocardium).

A heart attack (myocardial infarction) occurs when blood flow to the heart muscle is blocked, the tissue is deprived of oxygen and part of the myocardium dies.

Ischemic heart disease is the cause of heart attacks.Coronary artery disease is the end result of atherosclerosis, which interferes with coronary blood flow and reduces the delivery of oxygenated blood to the heart.

Heart attack

Heart attack (myocardial infarction) is one of the most serious outcomes of atherosclerosis. It can happen for two reasons:

• If a crack or rupture develops in an atherosclerotic plaque. Platelets are trapped in this area for sealing and a blood clot (thrombus) forms.A heart attack can occur if a blood clot completely blocks the passage of oxygen-rich blood to the heart.
• If an artery becomes completely blocked due to a gradual increase in atherosclerotic plaque. A heart attack can occur if insufficient oxygen-rich blood passes through this area.

Angina

Angina, the main symptom of coronary artery disease, is usually perceived as chest pain.There are two types of angina pectoris:

• Stable angina pectoris. This is predictable chest pain that can usually be managed with lifestyle changes and certain medications, such as low doses of aspirin and nitrates.
• unstable angina pectoris. This situation is much more serious than stable angina and is often an intermediate stage between stable angina and heart attack. Unstable angina is part of a condition called acute coronary syndrome.

Acute coronary syndrome

Acute coronary syndrome (ACS) is a severe and sudden heart condition that, with the necessary intensive treatment, does not turn into a full-blown heart attack. Acute coronary syndrome includes:

• unstable angina. Unstable angina is a potentially serious condition in which chest pain is persistent but blood tests do not show markers of heart attack.
• myocardial infarction without ST-segment elevation (not Q-myocardial infarction).Diagnosed when blood tests and ECGs reveal a heart attack that does not capture the full thickness of the heart muscle. The damage to the arteries is less severe than with a major heart attack.

Patients diagnosed with acute coronary syndrome (ACS) may be at risk of heart attack. Doctors analyze the patient’s medical history, various tests, and the presence of certain factors that help predict which ACS patients are most at risk of developing a more serious condition.The severity of chest pain alone does not necessarily indicate the severity of the heart injury.

Risk factors

The risk factors for heart attack are the same as the risk factors for coronary heart disease. They include:

Age

The risk of coronary heart disease increases with age. About 85% of people who die from cardiovascular disease are over 65 years of age. In men, on average, the first heart attack develops at the age of 66.

Floor

Men are at a greater risk of developing coronary artery disease and heart attacks at an earlier age than women.The risk of cardiovascular disease in women increases after menopause, and they begin to suffer from angina more than men.

Genetic factors and family inheritance

Several genetic factors increase the likelihood of developing risk factors such as diabetes, high cholesterol, and high blood pressure.

Race and ethnicity

African Americans have the highest risk of heart disease due to their high incidence of high blood pressure, diabetes and obesity.

Medical prerequisites

Obesity and metabolic syndrome. Excessive fat storage, especially around the waist, can increase the risk of heart disease. Obesity also contributes to the development of high blood pressure, diabetes, which affect the development of heart disease. Obesity is especially dangerous when it is part of metabolic syndrome, a pre-diabetic condition associated with heart disease. This syndrome is diagnosed when three of the following conditions are present:

• Abdominal obesity.
• Low HDL cholesterol.
• High triglyceride levels.
• High blood pressure.
• Insulin resistance (diabetes or prediabetes).

Elevated cholesterol levels. Low-density lipoprotein (LDL) is the “bad” cholesterol responsible for many heart problems. Triglycerides are another type of lipids (fatty molecules) that can be harmful to the heart. High density lipoprotein cholesterol (HDL) is the “good” cholesterol that helps protect against heart disease.Doctors analyze a “total cholesterol” profile, which includes measurements of LDL, HDL, and triglycerides. The ratios of these lipids can affect the risk of developing cardiovascular disease.

High blood pressure. High blood pressure (hypertension) is associated with the development of coronary artery disease and heart attack. Normal blood pressure figures are below 120/80 mm Hg. High blood pressure is generally considered to be blood pressure greater than or equal to 140 mmHg. (systolic) or greater than or equal to 90 mm Hg.Art. (diastolic). Prehypertension is blood pressure with numbers 120 – 139 systolic or 80 – 89 diastolic, it indicates an increased risk of developing hypertension.

Diabetes. Diabetes, especially for people whose blood sugar levels are not well controlled, significantly increases the risk of developing cardiovascular disease. In fact, heart disease and strokes are the leading causes of death in people with diabetes. People with diabetes also have a high risk of developing hypertension and hypercholesterolemia, bleeding disorders, kidney disease, and nerve dysfunctions, all of which can lead to heart damage.

Lifestyle factors

Reduced physical activity. Exercise has a number of effects that benefit the heart and circulation, including cholesterol and blood pressure levels and weight maintenance. People who are sedentary are almost twice as likely to have heart attacks as people who exercise regularly.

Smoking. Smoking is the most important risk factor for cardiovascular disease.Smoking can raise blood pressure, disrupt lipid metabolism, and make platelets very sticky, increasing the risk of blood clots. Although heavy smokers are at the greatest risk, people who smoke as little as three cigarettes a day have a high risk of blood vessel damage, which can lead to impaired blood supply to the heart. Regular exposure to secondhand smoke also increases the risk of heart disease in nonsmokers.

Alcohol. Drinking alcohol in moderation (one glass of dry red wine a day) can help raise your “good” cholesterol (HDL) levels.Alcohol can also prevent blood clots and inflammation. In contrast, drunkenness harms the heart. In fact, cardiovascular disease is the leading cause of death for alcoholics.

Diet. Diet can play an important role in protecting the heart, especially by reducing dietary sources of trans fat, saturated fat, and cholesterol, and limiting salt intake, which contributes to high blood pressure.

NSAIDs and COX-2 inhibitors

All non-steroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, are a risk factor for the heart.NSAIDs and COX-2 inhibitors may increase the risk of death in patients who have had a heart attack. The risk is greatest at higher doses.

NSAIDs include over-the-counter drugs such as ibuprofen (Advil, Motril) and prescription drugs such as diclofenac (Cataflam, Voltaren). Celecoxib (Celebrex), a COX-2 inhibitor that is available in the United States, has been associated with cardiovascular risks such as heart attack and stroke. Patients who have had heart attacks should consult their doctor before taking any of these medications.

The American Heart Association recommends that patients who have or are at risk of heart disease primarily use non-drug methods of pain relief (eg, physical therapy, exercise, weight loss to reduce stress on joints, and heat or cold therapy). If these methods do not work, patients should take low doses of acetaminophen (Tylenol) or aspirin before using NSAIDs, and the COX-2 inhibitor celecoxib (Celebrex) should be used last.

Forecast

Heart attacks can be fatal, become chronic, or lead to complete recovery. The long-term prognosis for life expectancy and quality of life after a heart attack depends on its severity, the damage to the heart muscle, and the preventive measures taken thereafter.

Patients who have had a heart attack have a higher risk of having another heart attack. Although there are no tests that can predict whether another heart attack will occur, patients themselves can avoid another heart attack by following a healthy lifestyle and adhering to treatment.Two thirds of patients who have had a heart attack do not take the necessary steps to prevent it.

A heart attack also increases the risk of other heart problems, including abnormal heart rhythms, heart valve damage, and stroke.

Persons at greatest risk. A heart attack is always more serious in some people, such as:

• Elderly.
• People with heart disease or multiple risk factors for cardiovascular disease.
• People with heart failure.
• People with diabetes.
• People on continuous dialysis.
• Women are more likely to die of a heart attack than men. The risk of death is highest in young women.

Factors that occur during a heart attack that increase the severity.

The presence of these conditions during a heart attack can contribute to a worsening prognosis:

• Arrhythmias (heart rhythm disturbances).Ventricular fibrillation is a dangerous arrhythmia and one of the leading causes of early death from heart attack. Arrhythmias are more likely to occur within the first 4 hours of a heart attack and are associated with high mortality. However, patients who are successfully treated have the same long-term prognosis as patients without arrhythmias.
• Cardiogenic shock. This very dangerous situation is associated with very low blood pressure, decreased urinary output, and metabolic disturbances. Shock occurs in 7% of heart attacks.
• Heart block, also called atrioventricular (AV) block, is a condition in which the electrical conduction of nerve impulses to the muscles in the heart is slowed down or interrupted. Although heart block is dangerous, it can be effectively treated with a pacemaker and rarely causes any long-term complications in surviving patients.
• Heart failure. The damaged heart muscle is unable to pump the blood necessary for the tissues to function.Patients experience fatigue, shortness of breath, and fluid retention in the body.

Symptoms

Heart attack symptoms vary. They may come on suddenly and be severe, or they may progress slowly, starting with mild pain. Symptoms can differ between men and women. Women are less likely than men to experience classic chest pain; they are more likely to experience shortness of breath, nausea or vomiting, back pain and jaw pain.

Common signs and symptoms of heart attack include:

• Chest pain.Chest pain or discomfort (sore throat) is the main symptom of a heart attack and can be felt as a feeling of tightness, tightness, fullness, or pain in the center of the chest. Patients with coronary artery disease who have stable angina often experience chest pain that lasts a few minutes and then goes away. With a heart attack, pain usually lasts more than a few minutes and may go away but then return.
• Discomfort in the upper body. People who are experiencing a heart attack may feel discomfort in their arms, neck, back, jaw, or stomach.
• Difficulty breathing may be accompanied by chest pain or no pain.
• Nausea and vomiting.
• Cold sweat.
• Dizziness or fainting.

The following symptoms are less common with a heart attack:

• Sharp pain when breathing or coughing.
• Pain that is mainly or only in the middle or lower abdomen.
• Pain that can be caused by touch.
• Pain that may be caused by movement or pressing on the chest wall or arm.
• Pain that is constant and lasts for several hours (do not wait several hours if you suspect that a heart attack has begun).
• Pain that is very short and lasts for a few seconds.
• Pain that spreads to the legs.
• However, these signs do not always rule out serious heart disease.

Painless ischemia

Some people with severe coronary artery disease may not have angina. This condition is known as painless ischemia. It is a dangerous condition because patients do not have alarming symptoms of heart disease. Some studies show that people with painless ischemia have a greater risk of complications and mortality than those with angina pain.

What to do in case of a heart attack

People who are experiencing symptoms of a heart attack should follow these steps:

• For angina patients, take one dose of nitroglycerin (sublingual or aerosolized tablet) when symptoms appear.Then another dose every 5 minutes, up to three doses, or until pain decreases.
• Call (03) or dial the local emergency number. This should be done first if three doses of nitroglycerin do not relieve chest pain. Only 20% of heart attacks occur in patients with previously diagnosed angina. Therefore, anyone who develops symptoms of a heart attack should contact emergency services.
• The patient should chew aspirin (250 – 500 mg), which should be reported to the arrived emergency service, as an additional dose of aspirin in this case does not need to be taken.
• A patient with chest pain should be transported immediately to the nearest emergency room, preferably by ambulance. Traveling on your own is not recommended.

Diagnostics

When a patient with chest pain is admitted to the hospital, the following diagnostic steps are taken to identify heart problems and, if present, their severity:

• The patient should inform the doctor about any symptoms that may indicate heart problems or possibly other serious medical conditions.
• Electrocardiogram (ECG) – a record of the electrical activity of the heart. It is a key tool for determining if chest pains are related to heart problems and, if so, how severe they are.
• Blood tests detect an increase in the levels of certain factors (troponins and CPK-MB) that indicate heart damage (the doctor will not wait for results before starting treatment, especially if he suspects a heart attack).
• Imaging techniques, including echocardiography and perfusion scintigraphy, can help rule out a heart attack if you have any questions.

Electrocardiogram (ECG)

An electrocardiogram (ECG) measures and records the electrical activity of the heart, the ECG waves correspond to the contraction and relaxation of certain structures in different parts of the heart. Certain waves on the ECG are named with the corresponding letters:

• R. P-waves are associated with atrial contractions (two chambers in the heart that receive blood from the organs).
• QRS. The complex is associated with ventricular contractions (the ventricles are the two main pumping chambers in the heart.)
• T and U. These waves accompany ventricular contractions.

Doctors often use terms such as PQ or PR interval. This is the time it takes for an electrical impulse to travel from the atria to the ventricles.

The most important in the diagnosis and treatment of a heart attack are the ST segment elevation and the definition of the Q wave.

ST segment elevation: Heart attack. Elevation of the ST segment is an indicator of a heart attack. It indicates that the artery of the heart is blocked and the heart muscle is damaged to its full thickness.Q-myocardial infarction (myocardial infarction with ST-segment elevation) develops.

However, ST elevation does not always mean that the patient is having a heart attack. Inflammation of the bursa (pericarditis) is another cause of ST segment elevation.

Without ST segment elevation: angina pectoris and acute coronary syndrome.

A depressed or horizontal ST segment suggests conduction abnormalities and cardiovascular disease, even if there is no angina at present.ST segment changes occur in about half of patients with various heart diseases. However, in women, ST segment changes can occur without heart problems. In such cases, laboratory tests are needed to determine the extent of damage to the heart, if any. Thus, one of the following conditions may develop:

• Stable angina (blood test or other test results do not show any major problems and chest pain disappears).During this period, in 25 – 50% of people with angina pectoris or painless ischemia, normal ECG values ​​are recorded.
• Acute coronary syndrome (ACS). It requires intensive treatment until it turns into a massive heart attack. ACS includes either unstable angina or myocardial infarction without ST-segment elevation (not Q-myocardial infarction). Unstable angina is a potentially serious event with persistent chest pain, but blood tests do not reveal markers of heart attack.In non-Q myocardial infarction, blood tests detect a heart attack, but the damage to the heart is less severe than in a full-blown heart attack.

Echocardiogram (ECHOKG)

An echocardiogram is a non-invasive technique that uses ultrasound to visualize the heart. It is possible to determine the damage and mobility of areas of the heart muscle. Echocardiography can also be used as an exercise test to detect the location and extent of damage to the heart muscle during illness or shortly after hospital discharge.

Radionucleide methods (stress test with thallium)

Allows to visualize the accumulation of radioactive tracers in the heart area. They are usually given intravenously. This method allows you to evaluate:

• The severity of unstable angina when less expensive diagnostic methods are not effective.
• Severity of chronic coronary heart disease.
• Success of surgery for coronary heart disease.
• Whether a heart attack has occurred.
• The location and extent of damage to the heart muscle during illness or shortly after discharge from the hospital after suffering a heart attack.

The procedure is non-invasive. It is a reliable method for a variety of severe heart conditions and can help determine if damage is due to a heart attack. The radioactive isotope thallium (or technetium) is injected into the patient’s vein. It binds to red blood cells and travels with the blood through the heart.The isotope can be traced to the heart using special cameras or scanners. Images can be synchronized with ECG. The test is performed at rest and during exercise. If damage is detected, the image is retained for 3 or 4 hours. Damage caused by a heart attack will persist when re-scanned, and damage caused by angina will be leveled.

Angiography

Angiography is invasive. It is used for patients with angina pectoris confirmed by stress tests or other methods and for patients with acute coronary syndrome.Procedure progress:

• A narrow tube (catheter) is inserted into an artery, usually an arm or leg, and then passed through the vessels to the coronary arteries.
• A contrast agent is injected through a catheter into the coronary arteries and a recording is made.
• This results in images of the coronary arteries showing obstructions to the blood flow.

Biological markers

When heart cells are damaged, they release various enzymes and other substances into the bloodstream.Elevated levels of these markers of heart damage in the blood or urine can help identify a heart attack in patients with severe chest pain and help guide treatment. Tests like these are often done in the emergency room or hospital if a heart attack is suspected. Most commonly identified markers:

• troponins. Cardiac troponin T and I proteins are released when the heart muscle is damaged. These are the best diagnostic signs of heart attacks.They can help diagnose and confirm the diagnosis in patients with ACS.
• myocardial creatine kinase (CPK-MB). CPK-MB is a standard marker, but its sensitivity is less than that of troponin. Elevated levels of CPK-MB can be observed in people without heart disease.

Treatment

Treatments for heart attack and acute coronary syndrome include:

• Oxygen therapy.
• Relief of pain and discomfort with nitroglycerin or morphine.
• Correction of arrhythmia (abnormal heart rhythm).
• Blocking further blood clotting (if possible) using aspirin or clopidogrel (Plavix) and anticoagulants such as heparin.
• The opening of the artery in which the cow flow has been disturbed should be made as soon as possible by performing angioplasty or with the help of drugs that dissolve the blood clot.
• Beta blockers, calcium channel blockers, or angiotensin-converting enzyme inhibitors are prescribed to improve the function of the heart muscle and coronary arteries.

Immediate actions

The same for patients with both ACS and heart attack.

Oxygen. It is usually given through a tube into the nose or through a mask.

Aspirin. The patient is given aspirin if it has not been taken at home.

Medicines for relieving symptoms:

• Nitroglycerin. Most patients will receive nitroglycerin both during and after a heart attack, usually under the tongue. Nitroglycerin lowers blood pressure and dilates blood vessels, increasing blood flow to the heart muscle.Nitroglycerin is sometimes given intravenously (recurrent angina, heart failure, or high blood pressure).
• Morphine. Morphine not only relieves pain and reduces anxiety, but also dilates blood vessels, increasing the flow of blood and oxygen to the heart. Morphine can lower blood pressure and make it easier for the heart. Other drugs can be used as well.

Removal of obstruction of coronary flow: emergency angioplasty or thrombolytic therapy

In a heart attack, clots form in the coronary arteries that obstruct coronary flow.Removal of clots in the arteries should be done as soon as possible, this is the best approach to improve survival and reduce the amount of damage to the heart muscle. Patients should be admitted to specialized medical centers as quickly as possible.

Standard medical and surgical procedures include:

• Angioplasty, also called percutaneous coronary intervention (PCI), is the preferred procedure for emergency opening of arteries.Angioplasty should be performed promptly for patients with a heart attack, preferably within 90 minutes of arriving at the hospital. In most cases, a stent is placed in the coronary artery, which creates an internal scaffold and improves the patency of the coronary artery.
• Thrombolytics dissolve the clot and are the standard drugs used to open arteries. Thrombolytic therapy should be given within 3 hours of symptom onset. Patients who are admitted to a hospital unable to perform PCI should receive thrombolytic therapy and be transferred to a PCI center without delay.
• Coronary artery bypass grafting (CABG) is sometimes used as an alternative to PCI.

Thrombolytics

Thrombolytic or fibrinolytic drugs are recommended as an alternative to angioplasty. These drugs dissolve the clot, or blood clot, that is responsible for blocking an artery and causing cardiovascular death.

Generally speaking, thrombolysis is considered a good choice for patients with myocardial infarction in the first 3 hours. Ideally, these medications should be given within 30 minutes of arriving at the hospital unless angioplasty is being performed.Other situations where thrombolytics are used:

• The need for long-term transportation.
• Long period of time before PCI.
• Failed PCI.

Thrombolytics should be avoided or used with great caution in the following patients after a heart attack:

• In patients over 75 years of age.
• If symptoms persist for more than 12 hours.
• Pregnant women.
• People who have recently suffered an injury (especially a head injury) or surgery.
• People with exacerbation of peptic ulcer disease.
• Patients who have undergone long-term cardiopulmonary resuscitation.
• When taking anticoagulants.
• Patients who have suffered a major loss of cows.
• Stroke patients.
• Patients with uncontrolled high blood pressure, especially when the systolic pressure is above 180 mm.Hg

Standard thrombolytic drugs are recombinant tissue plasminogen activators (TAP): Alteplase (Actelize) and Reteplase (Retalize), as well as a new agent tenecteplase (Metalize). A combination of antiplatelet and anticoagulant therapy is also used to prevent clot enlargement and the formation of a new one.

Rules for the administration of thrombolytics. The sooner thrombolytics are given after a heart attack, the better. Thrombolytics are most effective during the first 3 hours.They can still help up to 12 hours after a heart attack.

Complications. Hemorrhagic stroke usually occurs on the first day and is the most serious complication of thrombolytic therapy, but fortunately this rarely occurs.

Revascularization procedures: angioplasty and bypass surgery

Percutaneous coronary intervention (PCI), also called angioplasty, and coronary artery bypass grafting are standard surgeries to improve coronary blood flow.These are known as revascularization surgeries.

• Emergency angioplasty / PCI is a standard procedure for heart attacks and must be performed within 90 minutes of its onset. Studies have shown that balloon angioplasty and stenting are not able to prevent heart complications in patients when they are performed 3 to 28 days after a heart attack.
• Coronary artery bypass grafting is usually used as elective surgery, but can sometimes be done after a heart attack, if angioplasty or thrombolytic therapy has failed.It is usually performed over several days to allow the heart muscle to heal.
  Most patients are suitable for thrombolytic therapy or angioplasty (although not all centers are equipped for PCI).

Angioplasty / PCI includes the following steps:

• A narrow catheter (tube) is inserted into the coronary artery.
• The vessel lumen is restored when a small balloon is inflated (balloon angioplasty).
• After deflation of the balloon, the vessel lumen increases.
• A device called a coronary stent is used to keep the lumen of an artery open for a long time. This is an expandable metal mesh tube that is implanted into an artery during angioplasty. The stent can consist of bare metal, or it can be coated with a special drug that is slowly released into the adjacent wall of the vessel.
• The stent restores the lumen of the vessel.

Complications occur in about 10% of patients (about 80% of them during the first day). Best results are achieved in hospitals with experienced staff. Women who undergo angioplasty after a heart attack have a higher risk of death than men.
Restenosis after angioplasty. Narrowing after angioplasty (restenosis) can occur within a year after surgery and requires a repeat of the PCI procedure.

Drug eluting stents coated with sirolimus or paclitaxel may help prevent restenosis.They may be better than a bare metal stent for patients who have had a heart attack, but they can also increase the risk of blood clots.

It is very important for patients with drug eluting stents to take aspirin and clopidogrel (Plavix) for at least 1 year after stenting to reduce the risk of blood clots. Clopidogrel, like aspirin, helps prevent platelets from sticking together. If, for some reason, patients are unable to take clopidogrel along with aspirin after angioplasty and stenting, bare metal stents should be implanted without drug coverage.Prasugrel is a newer alternative to clopidogrel.

Coronary bypass surgery (CABG). It is an alternative to angioplasty in patients with severe angina pectoris, especially those with two or more occluded arteries. This is a very aggressive procedure:

• The chest opens and blood is pumped using a heart-lung machine.
• During the main phase of the operation, the heart stops.
• Bypassing the closed sections of the arteries, shunts are sutured, which are taken during the operation from the patient’s leg, or from the arm and chest. Thus, blood flows to the heart muscle through shunts bypassing the closed sections of the arteries.

Mortality in CABG after a heart attack is significantly higher (6%) than when the operation is performed as planned (1-2%). How and when it should be used after a heart attack remains controversial.

Treatment of patients with shock or heart failure

Seriously ill patients with heart failure or who are in a state of cardiogenic shock (it includes a decrease in blood pressure and other disorders) are intensively treated and monitored: they give oxygen, inject fluids, regulate blood pressure, dopamine, dobutamine and other drugs are used.

Heart failure. Furosemide is administered intravenously. Patients may also be given nitrates and ACE inhibitors if there is no sharp drop in blood pressure when indicated. Thrombolytic therapy or angioplasty may be done.

Cardiogenic shock. The intra-aortic balloon counterpulsation (IABP) procedure can help patients with cardiogenic shock when used in combination with thrombolytic therapy. A balloon catheter is used that inflates and descends into the aorta during certain phases of the cardiac cycle, thus increasing blood pressure.Also, an angioplasty procedure can be performed.

Treatment of arrhythmias

Arrhythmia is a heart rhythm disorder that can occur when oxygen is deficient and is a dangerous complication of a heart attack. A fast or slow heart rate is common in people with a heart attack and is usually not a dangerous sign.

Extrasystole or a very fast rhythm (tachycardia) can lead to ventricular fibrillation. This is a life-threatening arrhythmia in which the ventricles of the heart contract very quickly, not providing sufficient cardiac output.The pumping action of the heart, necessary to maintain blood circulation, is lost.

Prevention of ventricular fibrillation. People who develop ventricular fibrillation are not always exposed to arrhythmia prevention, and there are currently no effective drugs to prevent arrhythmias during a heart attack.

• Potassium and magnesium levels must be monitored and maintained.
• The use of intravenous and oral beta blockers may help prevent arrhythmias in some patients.

Treatment for ventricular fibrillation:

• Defibrillators. Patients who develop ventricular arrhythmias are given an electrical shock with a defibrillator to restore normal rhythm. Some studies show that implantable cardioverter-defibrillators (ICDs) can prevent further arrhythmias and are used in patients who remain at risk of recurrence of these arrhythmias.
• Antiarrhythmic drugs.Antiarrhythmic drugs include lidocaine, procainamide, or amiodarone. Amiodarone or another antiarrhythmic drug may be used later to prevent subsequent arrhythmias.

Treatment of other arrhythmias. People with atrial fibrillation are at high risk for stroke after a heart attack and should receive anticoagulants such as warfarin (Coumadin). There are also bradyarrhythmias (very slow rhythm disturbances) that often develop with a heart attack and can be treated with atropine or pacemakers.

Medicines

Aspirin and other antiplatelet agents

Anticoagulants are used in all stages of heart disease. They are classified as antiplatelet agents or anticoagulants. They are used along with thrombolytics and to prevent heart attacks. Anticoagulant therapy is associated with the risk of bleeding and stroke.

Antiplatelet drugs. They inhibit the adhesion of platelets in the blood and therefore help prevent blood clots. Platelets are very small and disc-shaped.They are essential for blood clotting.

• Aspirin. Aspirin is an antiplatelet drug. Aspirin should be taken immediately after the onset of a heart attack. An aspirin tablet can either be swallowed or chewed. Better to chew an aspirin tablet – this will speed up its action. If the patient has not taken aspirin at home, it will be given to him in the hospital, then it must be taken daily. The use of aspirin in patients with heart attack has been shown to reduce mortality.It is the most common antiplatelet agent used in people with cardiovascular disease and is recommended to be taken daily at a low dose on an ongoing basis.
• Clopidogrel (Plavix) – refers to drugs of the thienopyridine series, this is another antiplatelet drug. Clopidogrel is taken either immediately or after percutaneous intervention and is used in patients with heart attacks and after initiation after thrombolytic therapy. Patients receiving a drug eluting stent should take clopidogrel with aspirin for at least 1 year to reduce the risk of blood clots.Patients hospitalized for unstable angina should receive clopidogrel if they are unable to take aspirin. Clopidogrel should also be used in patients with unstable angina pectoris for whom invasive procedures are planned. Even conservatively treated patients should continue to take clopidogrel for up to 1 year. Some patients will need to take clopidogrel on an ongoing basis. Prasugrel is a new thienopyridine that can be used in place of clopidogrel.It should not be used by patients who have had a stroke or transient ischemic attack.
• Inhibitors of IIb / IIIa receptors. These are powerful blood-thinning drugs such as abciximab (Reopro), tirofiban (Aggrastat). They are given intravenously in a hospital and can also be used for angioplasty and stenting.

Anticoagulants. They include:

• Heparin is usually given during treatment with thrombolytic therapy for 2 days or more.
• Other intravenous anticoagulants may also be used – Bivalirudin (Angiomax), Fondaparinux (Arixtra) and enoxaparin (Lovenox).
• Warfarin (Coumadin).

There is a risk of bleeding with all of these drugs.

Beta-blockers

Beta-blockers reduce the oxygen demand of the heart muscle, slow down the heart rate and lower blood pressure. They are effective in reducing deaths from cardiovascular disease.Beta blockers are often given to patients early in their hospitalization, sometimes intravenously. Patients with heart failure or who may develop cardiogenic shock should not receive intravenous beta blockers. Long-term oral beta-blocker therapy for patients with symptomatic coronary artery disease, especially after heart attacks, is recommended in most cases.

These drugs include propranolol (Inderal), carvedilol (Koreg), bisoprolol (Zebeta), acebutolol (Sectral), atenolol (Tenormin), labetalol (Normodin), metoprolol, and esmolol (Breviblock).

Treatment of a heart attack. The beta blocker metoprolol may be given within the first few hours after a heart attack to reduce damage to the heart muscle.

Preventive use after a heart attack. Beta blockers are taken orally on a long-term basis (as maintenance therapy) after the first heart attack to help prevent recurrent heart attacks.

Side effects of beta blockers include fatigue, lethargy, vivid dreams and nightmares, depression, memory loss, and dizziness.They can lower your HDL (“good”) cholesterol levels. Beta-blockers are divided into non-selective and selective drugs. Non-selective beta-blockers such as carvedilol and propranolol can cause bronchial smooth muscle contraction, leading to bronchospasm. Patients with bronchial asthma, emphysema, or chronic bronchitis should not take non-selective beta-blockers.

Patients should not abruptly stop taking these drugs. Abruptly stopping beta blockers can lead to a sudden increase in heart rate and high blood pressure.It is recommended to slowly reduce the dosage until the intake is completely discontinued.

Statins and other lipid-lowering drugs that lower cholesterol

After admission to hospital for acute coronary syndrome or heart attack, patients should not interrupt statins or other drugs if their LDL (“bad”) cholesterol levels are elevated. Some doctors recommend that your LDL cholesterol should be below 70 mg / dL.

Angiotensin-converting enzyme inhibitors

Angiotensin-converting enzyme inhibitors (ACE inhibitors) are important drugs for the treatment of heart attack patients, especially those at risk of developing heart failure.ACE inhibitors should be given on the first day to all heart attack patients unless contraindicated. Patients with unstable angina or acute coronary syndrome should receive ACE inhibitors if they show signs of heart failure or signs of decreased left ventricular ejection fraction on echocardiography. These drugs are also widely used to treat high blood pressure (hypertension) and are recommended as first-line therapy for people with diabetes and kidney damage.

ACE inhibitors include captopril (Capoten), ramipril, enalapril (Vasotec), quinapril (Accupril), Benazepril (Lotensin), perindopril (Aceon), and lisinopril (Prinivil).

Side effects. Side effects of ACE inhibitors are rare, but may include coughing, an excessive drop in blood pressure, and allergic reactions.

Calcium channel blockers

Calcium channel blockers may provide relief in patients with unstable angina, whose symptoms are not relieved by nitrates and beta-blockers, or are used in patients who are contraindicated in beta-blockers.

Secondary prevention

Patients can reduce the risk of a second heart attack by following certain preventive measures, which are explained when they are discharged from the hospital. Compliance with a healthy lifestyle, in particular a certain diet, is important in preventing heart attacks and must be followed.

Blood pressure. Target blood pressure numbers should be less than 130/80 mm Hg.

LDL cholesterol (“bad” cholesterol) should be substantially less than 100 mg / dL.All patients who have had a heart attack should receive a statin recommendation before they are discharged from the hospital. It is also important to control your cholesterol levels by reducing your saturated fat intake to less than 7% of your total calories. You need to increase your intake of omega-3 fatty acids (fish, fish oil rich in them) to reduce triglyceride levels.

Physical exercise. Duration 30-60 minutes, 7 days a week (or at least at least 5 days a week).

Weight loss.Combining exercise with a healthy diet rich in fresh fruits, vegetables and low-fat dairy can help you lose weight. Your body mass index (BMI) should be 18.5-24.8. Waist circumference is also a risk factor for developing a heart attack. Waist circumference for men should be less than 40 inches (102 cm) for women less than 35 inches (89 centimeters).

Smoking. It is absolutely important to quit smoking. In addition, exposure to tobacco smoke (secondhand smoke) should be avoided.

Disaggregates. Your doctor may recommend that you take aspirin (75-81 mg) on ​​a daily basis. If you have had a drug eluting stent implanted, you should take clopidogrel (Plavix) or prasugrel (Effient) along with aspirin for at least 1 year after your surgery. (Aspirin is also recommended for some patients as a primary prevention of heart attack.)

Other medicines. Your doctor may recommend that you take an ACE inhibitor or beta blocker on an ongoing basis.It is also important to get a flu shot every year.

Rehabilitation. Physical rehabilitation

Physical rehabilitation is extremely important after suffering a heart attack. Rehabilitation may include:

• Walking. The patient usually sits in a chair on the second day, and begins walking on the second or third day.
• Most patients have a low level of exercise tolerance early in their recovery.
• After 8-12 weeks, many patients, even those with heart failure, experience the benefits of exercise.Exercise advice is also given at discharge.
• Patients usually return to work after about 1–2 months, although the timing may vary depending on the severity of the condition.

Sexual activity after a heart attack is very low risk and generally considered safe, especially for people who engage in it regularly. The feelings of closeness and love that accompany healthy sex can help offset depression.

Emotional Rehabilitation

Depression occurs in many patients with ACS and heart attack. Research shows that depression is a major predictor of mortality for both women and men. (One reason may be that depressed patients take their medications less regularly.)

Psychotherapy, especially cognitive behavioral therapy, can be very helpful. For some patients, it may be advisable to take certain types of antidepressants.

Information provided by the website: www.sibheart.ru

Intrauterine adhesions (synechiae) – prices for treatment, symptoms and diagnosis of intrauterine adhesions (synechiae) in the “SM-Clinic”

Kapanadze Magda Yurievna

Obstetrician-gynecologist, Ph.D., doctor of the highest category

“CM-Clinic” on the street.Yartsevskaya (metro Molodezhnaya)

Children’s department on the street. Yartsevskaya (metro Molodezhnaya)

Askolskaya Svetlana Ivanovna

Obstetrician-gynecologist of the highest category, MD

“CM-Clinic” on the street.Novocheremushkinskaya (metro station “Novye Cheryomushki”)

“CM-Clinic” on Volgogradsky prospect (metro “Tekstilshchiki”)

“CM-Clinic” on the street. Yaroslavskaya (metro station VDNKh)

Ashurova Gulya Zakirovna

Obstetrician-gynecologist, Ph.M.Sc.

“CM-Clinic” on the street. Novocheremushkinskaya (metro station “Novye Cheryomushki”)

“CM-Clinic” on Simferopol Boulevard (metro station “Sevastopolskaya”)

Children’s department on the street. Novocheremushkinskaya (metro station “Novye Cheryomushki”)

Children’s department on Simferopol boulevard (metro Sevastopolskaya)

Bykova Svetlana Anatolyevna

Obstetrician-gynecologist of the highest category, Ph.M.Sc.

“CM-Clinic” on the street. Novocheremushkinskaya (metro station “Novye Cheryomushki”)

“CM-Clinic” on the street. Senezhskaya (station MCC “Koptevo”)

Remez Elena Anatolyevna

Gynecologist-endocrinologist, Ph.M.Sc.

“CM-Clinic” on the street. Novocheremushkinskaya (metro station “Novye Cheryomushki”)

Children’s department on the street. Novocheremushkinskaya (metro station “Novye Cheryomushki”)

Tretyakova Tatiana Vasilievna

Obstetrician-gynecologist of the highest category, Ph.M.Sc.

“CM-Clinic” on the street. Novocheremushkinskaya (metro station “Novye Cheryomushki”)

Baeva Irina Borisovna

Obstetrician-gynecologist, Ph.D.

“CM-Clinic” on the street.Senezhskaya (station MCC “Koptevo”)

Kamalova Elena Yurievna

Obstetrician-gynecologist, Ph.D.

“CM-Clinic” on the street. Senezhskaya (station MCC “Koptevo”)

Kuznetsova Tatiana Valerievna

Obstetrician-gynecologist, Ph.M.Sc.

“CM-Clinic” on the street. Senezhskaya (station MCC “Koptevo”)

Tikhomirov Alexander Leonidovich

Obstetrician-gynecologist, Doctor of Medical Sciences, Professor, Associate Professor

“CM-Clinic” on the street.Senezhskaya (station MCC “Koptevo”)

Solomonashvili Vera Nodarievna

Obstetrician-gynecologist, gynecologist-endocrinologist, Ph.D.

“CM-Clinic” on Volgogradsky prospect (metro “Tekstilshchiki”)

“CM-Clinic” in the 2nd Syromyatnichesky lane.(m. “Kurskaya”)

Verkhovykh Irina Viktorovna

Obstetrician-gynecologist, Category I doctor, Ph.D.

“CM-Clinic” on the street. Yaroslavskaya (metro station VDNKh)

Samoilov Alexander Redzhinaldovich

Obstetrician-gynecologist of the highest category, doctor-oncogynecologist, Ph.M.Sc.

“CM-Clinic” on the street. Yaroslavskaya (metro station VDNKh)

Khusainova Venera Haydarovna

Obstetrician-gynecologist, Ph.D.

“CM-Clinic” on the street. Yaroslavskaya (m.”VDNKh”)

Gayskaya Olga Viktorovna

Obstetrician-gynecologist of the first category, Ph.D.

“CM-Clinic” in Staropetrovsky proezd (metro station “Voykovskaya”)

Shmeleva Irina Evgenievna

Obstetrician-gynecologist, ultrasound diagnostician, doctor of the first category, Ph.M.Sc.

“CM-Clinic” in Staropetrovsky proezd (metro station “Voykovskaya”)

Zelenyuk Boris Igorevich

Obstetrician-gynecologist of the first category, ultrasound diagnostician, Ph.D. Deputy chief physician at the “CM-Clinic” on the street.Marshal Tymoshenko

“CM-Clinic” on the street. Marshal Timoshenko (metro station “Krylatskoe”)

Voronoi Svyatoslav Vladimirovich

Doctor-gynecologist of the highest category, candidate of medical sciences. Deputy chief physician for surgery at the Center for Reproductive Health “CM-Clinic”

“CM-Clinic” in the lane.Raskova (metro station “Belorusskaya”)

Center for Reproductive Health “CM-Clinic” (metro station “Belorusskaya”)

Gossen Valeria Alexandrovna

Obstetrician-gynecologist, reproductologist, ultrasound diagnostician, Ph.M.Sc.

“CM-Clinic” in the lane. Raskova (metro station “Belorusskaya”)

Center for Reproductive Health “CM-Clinic” (metro station “Belorusskaya”)

Kalinina Natalya Anatolievna

Reproductologist of the highest category, obstetrician-gynecologist, Ph.MD, head of the ART department

“CM-Clinic” in the lane. Raskova (metro station “Belorusskaya”)

Center for Reproductive Health “CM-Clinic” (metro station “Belorusskaya”)

Kotenko Roman Mikhailovich

Obstetrician-gynecologist, reproductologist, ultrasound diagnostician, Ph.M.Sc.

“CM-Clinic” in the lane. Raskova (metro station “Belorusskaya”)

Center for Reproductive Health “CM-Clinic” (metro station “Belorusskaya”)

Uskova Maria Alexandrovna

Obstetrician-gynecologist, reproductologist Ph.M.Sc.

“CM-Clinic” in the lane. Raskova (metro station “Belorusskaya”)

Center for Reproductive Health “CM-Clinic” (metro station “Belorusskaya”)

Klochkova Elena Alexandrovna

Obstetrician-gynecologist, gynecologist-endocrinologist, Ph.M.Sc.

“CM-Clinic” on the street. Lesnaya (metro station “Belorusskaya”)

Goniyants Gayana Georgievna

Obstetrician-gynecologist, Ph.D.

“CM-Clinic” on Simferopol Boulevard (m.”Sevastopolskaya”)

Children’s department on Simferopol boulevard (metro Sevastopolskaya)

Markova Evgeniya Vladimirovna

Obstetrician-gynecologist of the highest category, Ph.D.

“CM-Clinic” on Simferopol Boulevard (m.”Sevastopolskaya”)

Children’s department on Simferopol boulevard (metro Sevastopolskaya)

Scar Elena Ivanovna

Obstetrician-gynecologist, ultrasound diagnostician, Ph.D.

“CM-Clinic” on Simferopol Boulevard (m.”Sevastopolskaya”)

Children’s department on Simferopol boulevard (metro Sevastopolskaya)

Vilkova Diana Maulitovna

Obstetrician-gynecologist, oncologist-mammologist, doctor of the highest category, Ph.M.Sc. Deputy Chief for CED in “CM-Clinic” in the 2nd Syromyatnichesky lane.

“CM-Clinic” in the 2nd Syromyatnichesky lane. (m. “Kurskaya”)

90,000 Colon polyps. Symptoms Treatment

Diagnostics and removal of polyps of the large intestine, rectum is carried out in our clinic at st. Kuznechnaya, 83, Yekaterinburg.

Colon polyp is a small focal overgrowth of cells that forms on the wall of the colon.While most colon polyps are harmless, some become cancerous over time.

Any person can develop colon polyps. But the risk is higher in people over 50 who are overweight, who smoke, eat high-fat, low-fiber foods, and have relatives with polyps or colon cancer.

Colon polyps usually do not cause any symptoms.This is why doctors recommend regular preventive examinations. Removing polyps that are in the early stages of development is usually safe. Prophylactic screening helps prevent colon cancer, a common disease that can be fatal if found only in its advanced stages.

Symptoms of colon polyps

Colon polyps vary in size from a pea up to the size of a golf ball.Small polyps may not cause symptoms. You may not know you have them until they are found during a colonoscopy.

However, sometimes polyps can manifest themselves with the following symptoms::

• Rectal bleeding. You may notice bright scarlet blood on toilet paper or on the toilet after stool. While it can be a sign of colon polyps or cancer, rectal bleeding can be caused by other causes, such as hemorrhoids or a fissured anus.If bleeding from the rectum appears, it is imperative to consult a doctor.
• Blood in the stool. Blood may appear as red streaks in the stool or evenly stain the entire stool black. You should be aware that discoloration of stool is not always indicative of a problem – iron supplements and some antidiarrheals can make stools black, while beets and licorice root can cause redness in stool.
• Constipation or diarrhea (diarrhea).While changes in bowel function that last longer than a week may indicate the presence of a large colon polyp, it could also be the result of a number of other causes.
• Abdominal pain. Occasionally, large colon polyps can partially obstruct the intestinal lumen, making it difficult for stool to move, leading to cramping abdominal pain, nausea, vomiting, and severe constipation.

When to see a doctor

See your doctor if you notice any of the following symptoms:

– Stomach pain

– Blood in the stool

– Changes in bowel function that lasts longer than a week

You should be checked regularly for polyps if:

– Your age is 50 years and older;

– You have risk factors such as a family history of colon cancer – in some cases of high cancer risk, regular screening (prophylaxis) should be started much earlier than 50 years old.

Danger of colon polyps

There is still no clear understanding of the causes of colon cancer. Colorectal cancer is known to arise from altered cells in the colon. Normally, healthy cells grow and divide in an orderly manner, but sometimes this process gets out of control. Cells continue the process of dividing even when there is no need for it. In the colon and rectum, this uncontrolled cell growth can lead to precancerous diseases (colon polyps).Subsequently, over a period of time – covering up to several years – some of the polyps can transform into malignant neoplasms.

Polypoid and non-polypoid neoplasms are classified as precancerous tumors of the large intestine.

Colon cancer most often develops from polyps of the large intestine, which are shaped like a fungus. In some cases, precancerous growths may be flat or sunken into the intestinal wall (non-polypoid growths).Non-polypoid neoplasms are more difficult to detect, but less common. Removing colon and rectal polyps and non-polypoid neoplasms before they become cancerous can prevent colon cancer.

Diagnostics of colon polyps

Colonoscopy is performed to examine the mucous membrane of the large intestine. During colonoscopy, a thin, flexible tube equipped with a video camera is inserted through the anus into the large intestine.The image from the video camera is transmitted to the monitor screen and examined by the doctor. If the doctor finds any suspicious area on the colon lining, he will take a small piece of tissue for histological examination. If the doctor finds a polyp or polyps during a colonoscopy, he can immediately remove them. In most cases, colonoscopy is performed under light general anesthesia, which allows the patient to feel comfortable.

Virtual colonoscopy (computed tomography of the large intestine).If you are unable to undergo a colonoscopy, your doctor may recommend a virtual colonoscopy as a preliminary diagnostic method. Computed tomography of the large intestine is widely used during screening preventive examinations (check up).

Treatment of colon polyps

Method of treatment of polyps of the colon and rectum – removal. Polyps are removed during colonoscopy. After colonoscopy, the removed tissue site is sent for histological examination.

After removal of polyps, you should avoid taking aspirin, medications containing aspirin and non-steroidal anti-inflammatory analgesics such as ibuprofen, naproxen, indomethacin and others for two weeks after the procedure to reduce the risk of bleeding. You can take paracetamol if needed.

If you are taking warfarin, Plavix, Tiklid, or similar anticoagulants, your doctor will advise you when you can resume taking them.

You may notice blood in your stools within one to two days after the polyp is removed. Tell your doctor right away if you experience heavy bleeding, discharge of blood clots, or abdominal pain.

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“Do not play roulette to your health”

About 30% of women of childbearing age, during a routine examination by a gynecologist, learn that they have an ovarian cyst.Many do not take this seriously, thinking that the cyst “will pass by itself”, and for years they live with this problem, sometimes bringing the matter to the growth of the cyst, its rupture and even infertility, or in advanced cases – oncology. Today, we are talking with Albina Lebedeva, a gynecologist at the Vladimir Women’s Clinic No. 1, about how important it is to detect an ovarian cyst on time.

– Albina Yurievna, are cysts so dangerous or not?

– Most of the detected ovarian cysts, fortunately for women, are really harmless and resolve on their own within two to three menstrual cycles: 7-8 cysts out of 10 are just such.But it is always better to play it safe and be examined to make sure that the cyst is “the same” and, in any case, get recommendations from a gynecologist. There are cysts that are fraught with serious complications. The safest are functional cysts: follicular and corpus luteum cyst. A follicular cyst is formed in connection with violations of the ovulation processes. It does not carry the risk of cancer. But this does not mean that you should not pay attention to it. If you have pulling pains in the lower abdomen, irregularities in the menstrual cycle, or there is a specific discharge between periods, contact your gynecologist.If the follicular cyst is not more than 6 cm, we carry out conservative therapy, we observe the cyst for three menstrual cycles. But if more than 6 cm, you should think about surgical treatment. A corpus luteum cyst appears at the site of an already ruptured follicle and may contain blood clots. The corpus luteum is a temporary gland that forms after ovulation, produces hormones and provides preparation for pregnancy. The cause of the appearance of a cyst in this case may be a violation of blood circulation in the corpus luteum.Can it dissolve itself? Yes. But it must be watched. Often it does not manifest itself in any way, although there may be pulling pains and disruptions in the cycle. The main danger is that this cyst can be accompanied by hemorrhage into the abdominal cavity. And this is a reason for an emergency operation.

– If there are no symptoms, how can a woman suspect something is wrong?

– Most of the time, there are really no symptoms. That is why we, gynecologists, recommend that women of any age, even in the absence of complaints, undergo scheduled examinations at least once a year.Because, despite the optimistic statistics that most cysts resolve on their own within two to three months, you can be among those who are unlucky. And here, as with any disease: the earlier you start treatment, the higher the chances of maintaining your health. Unfortunately, many women believe that if they do not have a sexual partner or they are no longer going to give birth, then they do not need a gynecologist. For 5-6 years they are not examined, but they come with ready-made pathologies. Or they get urgently with the rupture of the same cysts.Some then say that they mistook the symptoms for signs of ovulation. There are those who disappear after the diagnosis and receiving recommendations, and then go to the hospital with a rupture of the cyst capsule … Only about 40% are regularly examined and follow all recommendations. As a rule, these are women after 35-40 years. But young girls often demonstrate frivolity and denseness. Some come with literally every infection that exists. At the same time, it is quite difficult for them to explain that there are barrier methods of contraception and protection against infections.

– Let’s go back to the types of cysts. Which is worse follicular?

– Endometrioid, dermoid and paraovarian cysts. I must say right away: in our time, they are all curable without complex consequences, if they are identified in time. An endometrioid cyst can appear as a result of the drift of endometrial cells onto the ovary. It manifests itself as cyclical pain in the lower abdomen due to microperforation of the cyst, acute pain is possible. It is fraught with reproductive system disorders. Often, we identify such cysts in women who have long ignored the symptoms and have already arrived when they began to plan a pregnancy and found that they had problems with it.In the early stages, the endometrioid cyst is treated with hormonal drugs. In a more difficult case, the cyst and foci of endometriosis are removed by surgery, most often by laparoscopy. After the operation, hormone therapy is prescribed. If the process is started, if the cysts are large and are located on both ovaries, there is little chance of completely preserving the ovaries themselves. So I will repeat again: be sure to be examined once a year, then you will hardly ever need surgical treatment of cysts.

– Each of us has heard something about follicular and endometrioid cysts.But what kind of “beast” is a dermoid cyst?

– This is a rather rare occurrence. Its cause is in the violation of intrauterine development. When the woman’s body was still forming in the womb of her mother, there was a failure in the laying of organs and a dermoid cyst was formed. It is dense, with thick walls, filled with mucus, fatty tissue, the remains of hair, nails, bones, etc. Yes, this information usually causes shock to patients. Such a cyst can grow up to 10 centimeters or more. But symptoms appear when it reaches about 5 cm.This soreness of menstruation, pulling pain in the lower abdomen, dull pain in the lower back, pain during intercourse. A dermoid cyst should be removed when detected. It will not disappear, it will not decrease, but it may well develop into cancer.

As for the paraovarian cyst, it is formed from the tissues of the epididymis, too, as a result of disruptions in embryonic development. It does not turn into cancer, but it is often the cause of infertility. It must be removed, because it can grow up to 20 cm (under the influence of inflammation, hormonal disorders, stress, etc.)which will lead to constant pain, problems with defecation and urination, because large cysts press on the nearest organs. It can twist along with the fallopian tube. And here an emergency operation is required.

– So you are a supporter of cyst removal if therapy does not help?

– Certainly. I am also a proponent of prevention. Every woman needs to be attentive to her body. If in doubt, consult a doctor. Treat with it existing hormonal disorders, inflammation and genital infections.Be sure to protect yourself if your partner is not alone. In case of accidental communication – without delay to pass tests for sexually transmitted infections. Normalize the work of the thyroid gland. Eat right. No smoking or alcohol abuse. Understand that if you have irregular periods, this is a clear sign of hormonal imbalance, which, by the way, can lead not only to cysts. Sitting and waiting for everything to work out by itself is stupid. Maybe it will get better. But do you really want to play roulette for your health? Even worse than sitting and waiting is self-medication on the advice of pharmacists, girlfriends and the Internet.Only a specialist, after conducting a diagnosis, will understand what exactly is happening to you and will prescribe an adequate therapy.

– Is sex dangerous if you have a large cyst?

– No doubt about it. In the presence of a cyst, contact should be very gentle. Ideally, no contacts or loads at all, as long as there is a cyst. Often, rupture occurs during intercourse, during sports or thermal procedures. There is nothing pleasant about a ruptured cyst, whatever it may be. Therefore, if the cyst grows, it must be removed.Fortunately, now, with timely diagnosis, in most cases, laparoscopy can be dispensed with, after which there are practically no complications and there are no cosmetic defects. This is important for women.

– How is a cyst diagnosed and its causes identified?

– Diagnosed by examination and – then – examination of ultrasound of the pelvic organs. In some cases, CT, MRI of the pelvic organs is required. Analysis for tumor markers in the detection of any cyst, except for the follicular, is required.As for the reasons, ideally, it is necessary for the patient to be tested for hormones. Unfortunately, this is quite an expensive pleasure that not everyone can afford. But by the type of physique, the condition of the skin, hair, it is possible to determine which hormone the patient needs. Simplified: if her voice becomes coarse and excessive body hair is present, this is a clear sign of hyperandrogenism. Cysts that appear due to hormonal disruption in the thyroid gland, we, as a rule, treat in tandem with endocrinologists.

– How long does it take to recover after scheduled laparoscopy?

– On average about 1-2 weeks.But from the hospital, patients are allowed to go home, as a rule, within 5-7 days after the operation. The stomach will sip a little, but you will already begin to walk and enjoy life. However, an important point: some types of cysts may appear again if the causes of their occurrence after the first laparoscopy are not eliminated. So get checked regularly and be sure to follow the recommendations of your doctors.

Varicocele – a latent threat to men’s health

It is embarrassing to ask about some things, and often there is no one to ask.This is especially true for health problems in men. It seems that something bothers them, but not much and not so often – and then the stronger sex prefers to endure instead of going to a doctor’s consultation or diagnosis. And they get to the clinic even when it is impossible to endure, that is, at an advanced stage of the disease. To prevent this from happening, we asked the same uncomfortable questions to the doctors of the URO-PRO International Medical Center, which has been operating in Sochi for over 10 years.

UNIDENTIFIED ENEMY

– They say that many serious problems, such as impotence and infertility, often have one cause – varicocele.What kind of ailment is this?

– To put it simply, this is a varicose veins of the spermatic cord. We often see varicose veins on the legs of women, because there they are in sight. The veins of the spermatic cord are hidden by clothing and are less visible through the skin, therefore they are often not detected by the patient himself. Even a doctor may not detect them in the early stages if he does not use a complex of diagnostic methods.

– What are the problems associated with this condition?

– The vast majority of operations on these veins are performed in connection with infertility.About half of the men operated on become fathers. There are two more officially approved indications – a decrease in the size of the seminal gland on the side of the enlarged veins, as well as pain in this place.

– Are there any other manifestations besides male infertility and pain?

– Yes. Varicose veins are not an independent disease, but only one of the manifestations of pelvic varicose veins, which gives rise to other problems. They are much less often taken into account and remain unrecognized, dooming men to prolonged suffering.

– What are these problems?

– Largest J.J. Keller 2012, which included 120 thousand men in Taiwan, found that with varicocele, the risk of losing potency was five times greater. In 2017, Egyptian scientists Ji B. and Jin X.B. an analysis of previously conducted worldwide studies on this disease was made. He showed a connection between varicocele and a decrease in the production of the male hormone testosterone and confirmed its connection with a violation of potency.

– But male infertility and decreased potency are often associated with prostatitis, isn’t it?

– And it was here that a big surprise awaited the scientists.Back in 1991, the Russian scientist Yevsey Borisovich Mazo et al. Revealed the presence of symptoms of prostatitis in patients with varicocele, and in 2012, ZI Chanakanov, discovered the onset of prostatitis in varicocele already in adolescence.

– What is the evidence that varicocele was the cause of these diseases?

– The disappearance of these diseases after treatment is irrefutable proof. Russian scientists Mazo and Kapto found the disappearance of the manifestations of prostatitis in 65-81% of patients operated on for varicocele.In the already mentioned study by J.J. Keller in the operated patients, the risk of potency loss was halved. The Egyptian researcher W. Zohdy et al. In 2010 recorded an increase in testosterone levels by 15% after treatment, and in 2015 a team of Egyptian and Arab scientists led by A.F. Ahmed achieved cessation of early ejaculation in 40% of men treated for varicocele.

– It turns out that varicocele is a problem of young age: infertility, prostatitis, early ejaculation, weakening of potency.

– For older men, it is no less relevant. Firstly, in men with this pathology, the risk of loss of potency arises precisely in adulthood and old age, when the margin of safety of the reproductive system decreases. Secondly, a distinct influence of pelvic varicose veins on the development of such age-related diseases as adenoma and prostate cancer was revealed. A group of Israeli scientists led by Y. Gat in 2008-2009, having operated on elderly men with varicocele, received a decrease in the volume of an enlarged prostate by one and a half times, and the number of night trips to the toilet from four to one.Slowing the progression of prostate cancer has also been achieved.

PAYMENT FOR DIRECT WALKING

– What is the reason for developing varicocele?

– We, like all mammals, have the main artery along the spine that carries blood from the heart – the aorta and the main vein – the lower hollow, returning it back. Arteries that carry blood to the internal organs depart from the aorta, and veins that return blood from these organs flow into the vena cava. In animals, the body is located horizontally, so the arteries and veins of the organs are located perpendicular to the aorta and vena cava and do not interfere with each other.In humans, the body is in an upright position, the internal organs tend downward under their weight, and after them their vessels also move. In this case, the artery feeding the intestines presses the left renal vein to the aorta and the pressure in this vein rises. And the vein of the left testicle flows into the left renal vein. The outflow of blood from the seminal gland is at first difficult, then, as it progresses, it stops, then it can be reversed. Therefore, the veins of the testicle dilate. The reverse flow of blood has to be redirected further, into the venous plexus of the prostate gland, and then, along the chain, into the veins of the right testicle.Another variant of pelvic blood stasis is associated with compression of the pelvic veins that carry blood from the left leg. At the same time, through the vein of the scrotum, blood also overflows the veins of the spermatic cord. In addition, the flow of blood through the veins also has to overcome the force of gravity, since the heart is higher.

– How does the overflow of veins with blood harm the body?

– For fun, children sometimes tie their finger or hand with some kind of string or elastic band. Adults wear a pressure measuring device on their arm.In both cases, the outflow of blood through the veins is difficult, the limb turns blue and swells, unpleasant sensations appear in it, and microcirculation is disturbed. Stagnation of venous blood in the veins of the pelvis acts in the same direction, not so clearly, but constantly. The blood supply to the organs is disrupted, therefore the testes reduce the production of sperm and testosterone, potency decreases, the prostate gland ceases to resist microbes. In addition, blood from the testes begins to enter the veins of the prostate gland, containing a large amount of testosterone, for which the prostate is not designed.This provokes adenoma and prostate cancer. Practical example. Recently, in an 18 year old patient referred by a dermatologist with hair loss and high levels of the responsible dihydrotestosterone, I found significant varicocele. Also, a violation of the quality of sperm was revealed, which made it possible to address the problem in a timely manner.

AT THE SIGHT OF A SPECIAL DOCTOR

– Apparently, this disease occurs infrequently, since it is not heard.

– It’s just that it’s underdiagnosed.In adolescents, it occurs in 15%, according to a large-scale study by Tarusin. Further, its prevalence increases and in percentage terms is numerically consistent with age, according to U. Levinger et al. At the age of eighty, it already occurs in 75% of men. In people lifting weights, it occurs even more often, due to straining.

– Why is it little diagnosed?

– Firstly, they are not always looking for it, since information is not widely known about all of its consequences.Its manifestations are often mistaken for independent diseases – prostatitis, hypogonadism, erectile dysfunction, early ejaculation, pelvic pain syndrome, adenoma and prostate cancer. Secondly, even with a targeted search, the percentage of detecting the initial stages depends both on the doctor’s skill and on the number and quality of diagnostic methods used, ranging from simple physiological tests to thermography, magnetic resonance imaging and computed tomography. Therefore, it makes sense to contact those medical centers and those doctors who specifically deal with this pathology.

GOLD STANDARD

– Can varicocele go away on its own, or is treatment necessary anyway?

– The very fact that this condition increases with age indicates the progressive nature of the disease, despite individual reports of the opposite direction. There is evidence of a ten percent deterioration in the quality of semen without treatment annually. First, the valves that prevent the return flow of blood in the veins are irreversibly lost as it progresses.Secondly, testicular tissues that produce sperm are extremely sensitive to oxygen starvation and their number is decreasing due to gradual death. Thirdly, with varicocele, immunity to one’s own spermatozoa often develops, which is almost impossible to correct. Therefore, the birth of children in men with varicocele or spermogram indicators within the normal range do not guarantee the preservation of well-being in the future. The disease can be compared to a fire, which is better to extinguish immediately – and it is easier to cope with, and the damage is less.

– How to treat varicocele?

– Today there are more than one hundred surgical methods. The most famous Ivanissevich’s operation is still used, since it does not require special equipment, but it turns a person off from physical activity for a long time, turns out to be ineffective in half of the cases and often gives complications that are corrected only surgically, and even then not always. Modern X-ray endovascular embolization methods are expensive, involve X-ray irradiation, but are also ineffective, since they do not block the scrotal vein through which blood flows from the lower extremities.

– Are there reliable and safe methods?

– Yes. The Marmara operation is recognized as the gold standard, as its efficiency and safety reaches 98%. During the operation, all potential sources of venous congestion of the scrotum are blocked. At the same time, the abdominal cavity is not opened, which allows you to resume physical and sexual activity in a short time. True, it is better to carry out such an operation with special equipment – an operating microscope to see even the smallest veins.Therefore, not all medical institutions can provide such a service at the proper level.

– Who should be checked for varicocele and when?

– Usually, when examining adolescents of pre-conscription age, the organs of the scrotum are checked, although without the use of equipment, therefore, pronounced stages of varicose veins should be detected at this stage. However, it may be advisable to additionally check in more depth when entering adulthood. It is mandatory to diagnose varicocele if the partner has not been pregnant for more than six months or if the quality of the sperm is impaired.I would also like to note that a spermogram should be done in large laboratories, using modern criteria. If the indicators are close to the lower limit of the norm, this is already a reason to be wary, since the lower limit of the norm is found only in 5% of men with children.