Guide To Treating Superior Vena Cava Syndrome

November 26, 2023

A lung cancer patient wakes up uncomfortably, their chest feeling a bit tight. Looking in the mirror, they see their face is puffy and swollen. They get up and begin to go about their day. Later, they notice the swelling has gone down. Perhaps it was an odd reaction to a new medication. But the next morning the swelling and tightness return. They go to their doctor and, after some testing, is diagnosed with superior vena cava syndrome.

This syndrome describes a collection of symptoms that occur when blood flow through the superior vena cava is blocked by exterior pressure or interior blockage. Additional symptoms include shortness of breath, coughing, and swelling in the arms and hands.

Elevating The Head

In the circulatory system, the superior vena cava channels blood from the head and upper body to the right atrium. Restricted flow in this important blood vessel leads to edema in the head and extremities. Initial treatment for this condition can be as simple as elevating the head. By sitting upright or standing the force of gravity can aid in the draining process.

This is the reason patients with superior vena cava syndrome can be slow to recognize the issue. Especially if the constriction of the blood vessel is in an early stage, if they have been upright most of the day, any swelling may disappear by the evening, leading them to believe it was a temporary issue like an allergic reaction.

Supplemental Oxygen

While not treating the underlying cause, supplemental oxygen is often administered to provide relief for some of the respiratory symptoms of superior vena cava syndrome. These include shortness of breath, lightheadedness, chest pain, and coughing. Upon testing, the patient may present with a low blood oxygen level due to their circulatory constriction.

Normally, these symptoms do not pose an immediate threat, but they do add discomfort and stress to the patient. In the long term, low blood oxygen levels can affect the health and functioning of the entire body. Supplemental oxygen delivered via nasal cannula can help regulate blood oxygen levels and bring them back to normal. Patients whose blood flow is not severely constricted frequently respond very well to elevation and oxygen therapy.

Blood Thinners

Blood thinners may be indicated as a treatment for superior vena cava syndrome if the restriction is caused by interior blockage as opposed to exterior pressure. In recent years, as more patients have been undergoing procedures such as the installation of pacemakers and intravenous catheters, clotting has increased as a factor in this condition. Fortunately, clotting is a very treatable source of the syndrome.

Depending on the nature and size of the clot, a course of blood thinners may be the primary treatment or may simply be an initial treatment in preparation for the placement of a stent or, in some cases, bypass surgery. It is also possible that the intravenous device that created the issue may need to be removed. In addition, thrombolytic drugs may be used as a medical means to resolve the clot.

Cancer Treatment

An incredibly common cause of superior vena cava syndrome is a tumor growing in the lung or lymph nodes near the vein. The superior vena cava has fairly thin walls and low interior pressure. As the tumor grows, it begins to press on the blood vessel from the outside, constricting the blood flow within. In this case, the main course of action is to treat the symptoms of superior vena cava syndrome while the proper cancer treatment is used to address the malignancy.

If the tumor responds to a treatment such as chemotherapy or radiation and begins to shrink, there will naturally be less pressure on the blood vessel. The easing of symptoms may be a sign the treatment is effective. Unfortunately, the prognosis for cancer patients with superior vena cava syndrome is not good, as the syndrome may indicate a tumor of significant size.

Watch And Wait

In minor cases of superior vena cava syndrome, it is not unusual for the initial treatment to be symptom relief combined with a watch and wait attitude. Although it is the side effect of some severe conditions, superior vena cava syndrome is rarely life-threatening in and of itself. Some patients find significant relief in a short time with the simple interventions of elevation and oxygen.

For those with an underlying malignancy, basic treatment of symptoms may be palliative while they wait to see whether cancer treatments are effective. The outlook for patients with superior vena cava syndrome is very much dependent on the underlying cause. Some simple, non-invasive interventions can provide comfort and relief.

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