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  • Writer's pictureRichard Lai

#64 - Biomedicine Board Review: Deep Vein Thrombosis

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Transcript of Episode

Dr. Richard Lai DPT LAc [00:00:00]:

Hey, everyone. Welcome back to study acupuncture with me. I know that for many of you, it's biomedicine board exam time. So what we're gonna do for this month, we're gonna do a lot of biomed board prep with a lot of short form videos and podcasts that are gonna be easy to digest for you. And, of course, with each episode, I'll have a study guide that goes along with that episode, and you can download that study guide for free at my website, So So in this episode, we're gonna talk about deep vein thrombosis, and we're also gonna talk about the anatomical reasons why a DVT where a deep vein thrombosis can be really dangerous for a person, meaning life threatening. So let's begin by first defining what a DVT even is. So a DVT is a blood clot.

Dr. Richard Lai DPT LAc [00:00:45]:

It is a blood clot that's normally located in one of the deep veins of the body. Usually, it's a vein in one of our legs. And recently, actually, someone on YouTube commented asking about acupressure points that can reduce clots in a blood vessel. Now although this is a really good question. It actually brought up a really good point and a really good opportunity. It's actually the perfect opportunity for us as acupuncturists to learn how to address this question from our patients. Because as acupuncturists, when we're seeing our patients and we're going through the 4 pillars of examination, we're gonna find ourselves at many different crossroads. And at each of these crossroads, we should be confirming whether the symptom that's presenting itself to us is okay, meaning it's typical for that person's condition, or if it's a yellow flag, meaning it's a possible abnormal finding, and we need to evaluate it more.

Dr. Richard Lai DPT LAc [00:01:36]:

Or it could be a red flag, meaning we need to address it immediately by referring them either to emergency or urgent services or back to their physician ASAP. And so when it comes to a DVT, how do we know if it's a typical presentation? How do we know if it's a yellow flag or if it's a red flag? Well, first, we have to know our patient's medical history. So when we do our evaluation, we should do a really thorough evaluation, a thorough chart review. We should review their medications. We should review their surgical history, their past medical history. Three, we should review everything that's clinically relevant about the patient. And whenever I have students, my favorite part is to hone their ability to perform a chart review. And one part of the chart review is the medication list.

Dr. Richard Lai DPT LAc [00:02:19]:

And you can actually really paint a picture of the patient just based on the medications that they're taking. And when you're looking at the list of medications, it should make you ask questions. So for example, if you see on the medication list that the patient has heparin or warfarin or even aspirin. The clinical wheels in your head should be turning, and you would know that this patient is gonna present with some cardiovascular issues because these medications that I just listed, they're known as anticoagulants. And we know that with anticoagulants, there are medications that help to prevent clots. And when you do get a cut on your arm or your finger, that wound is gonna coagulate to stop the bleeding. That would be something normal. That would be a normal presentation.

Dr. Richard Lai DPT LAc [00:03:05]:

Now if someone is on anticoagulants, their ability to clot could be impaired. So their bleeding could be prolonged. They could be more prone to bruising. They might require longer wound healing times. This is all in the name of decreasing the risk of a blood clot forming where it's not supposed to, which is exactly what a DVT is. It's a blood clot or a thrombosis, which is forming in the deep veins of our body, usually in the lower part of our body in our legs. Now the issue is if that blood clot goes somewhere or travels somewhere that it's not supposed to because it could do a lot of harm to the patient. In the most worrisome places are the heart and lungs.

Dr. Richard Lai DPT LAc [00:03:45]:

So that being said, let's take a look at the anatomy of the heart and see what we mean by that. So here, we have a wonderful image of the heart. The heart has 4 chambers. There's the right and left atrium. There's the right and left ventricle. And it's easiest to start talking about the heart from the right atrium. Now the right atrium, it receives blood from our body. This is the blood that comes back to the heart and it's all used up.

Dr. Richard Lai DPT LAc [00:04:12]:

It's deoxygenated. So that blood goes to our right atrium. It goes there from the lower part of the body through the inferior vena cava and then from the upper part of the body through the superior vena cava. Now with patients who have a blood clot, one intervention that some physicians use is they place what's known as an IVC filter. Now an IBC filter, it stands for inferior vena cava filter. Now what that filter does is that when it's placed in the inferior vena cava, it can catch any blood clots that are coming from the lower half of our body. And that filter basically catches it before it brings that bad clot self to the heart or to the lungs where it can really wreak havoc. So that's what an IVC filter is.

Dr. Richard Lai DPT LAc [00:04:58]:

Now, if we go back to the anatomy of the heart, the right atrium, again, it receives blood. It receives deoxygenated blood from the body. It receives it via the superior vena cava and the inferior vena cava. And because DVTs, they're usually found in the veins of the legs, that's why an IVC, an inferior vena cava filter is usually used. Now, if the patient elects not to have this type of filter placed, they can be put on some medications known as anticoagulants, the ones that we talked about before. So now where does the deoxygenated blood go after the right atrium? Trium? Well, from the right atrium, the blood is pushed into the right ventricle. And to get there, it passes through a doorway valve known as the tricuspid valve. So you can think about the right atrium and the right ventricle as 2 rooms, and there's a doorway that swings towards the ventricle.

Dr. Richard Lai DPT LAc [00:05:50]:

That doorway is known as the tricuspid valve. The tricuspid valve is on the right side of our body. Blood goes from the right atrium to the right ventricle. It passes through the tricuspid valve. Now at the right ventricle, that blood is going to be pumped and it's going to go to our lungs. So when the right ventricle contracts, it shoots that blood through what's known as your pulmonary valve to your lungs. Now how it gets to your lungs is through the pulmonary artery. So if a DVT or a blood clot was dislodged from your legs, that blood clot, because it's now moving, its name actually changes.

Dr. Richard Lai DPT LAc [00:06:26]:

So instead of calling it a blood clot, now since it's moving, we call it an embolism. So this embolism is now moving, and it's coming up through the inferior vena cava goes into the right atrium and then into the right ventricle. Now it's going to get shot into the lungs. And when it's in the lungs, what could happen is known as a pulmonary embolism. A pulmonary embolism is when that clot finds its way into the lungs. And what happens is that it clots up one of the blood vessels in the lungs. And so that means that the blood flow into the lungs could diminish, and the patient's gonna present with a bunch of symptoms like pain in the chest, shortness of breath, coughing. Sometimes they could even cough up blood.

Dr. Richard Lai DPT LAc [00:07:08]:

All that can actually lead to death. So a pulmonary embolism is very serious. It's life threatening. So now, because you know the anatomy of the heart and the direction of the flow of blood, you can understand why a DVT, which starts in the lower part of the body, can end up in your lungs. Alright. Now let's finish up the anatomy of the heart. So after the blood goes to the lungs, the lungs get a chance to oxygenate all of that blood. Now that blood is gonna go back to the heart by way of the pulmonary veins.

Dr. Richard Lai DPT LAc [00:07:38]:

Where does it go in the heart? It goes first to the left atrium. Now after the left atrium, that blood is gonna go into our left ventricle. It's gonna pass through a bicuspid valve. That bicuspid valve is also known as a mitral valve. So before, we mentioned the tricuspid valve, which is the valve on the right side of the heart where it separates our right atrium and our right ventricle. And then we have the bicuspid valve, which is on the left side of the heart. The bicuspid valve separates the left atrium and the left ventricle. So a mnemonic to remember that is that the tricuspid valve is on the right and the bicuspid valve is on the left.

Dr. Richard Lai DPT LAc [00:08:16]:

So you try before you bi. Tricuspid on the left and then bicuspid on the right. Okay. So now this rich, oxygenated blood is in our left ventricle. The left ventricle is super strong. When it contracts, it pushes that blood all through our entire body. So pushes that blood through our aortic valve into our aorta, where it not only goes up to our head, but it goes to our arms, our legs, our organs. That rich oxygenated blood just goes everywhere.

Dr. Richard Lai DPT LAc [00:08:44]:

So that's the anatomy of the heart and that's how a DVT can go from your legs to your heart to your lungs. Now the question for us as acupuncturists is how do we know if someone has a DVT? Now we know this through our examination, because we look at our patient's signs and symptoms, and we determine whether each sign and symptom is typical for their presentation or if it's a yellow or a red flag, meaning it warrants more evaluation or it requires urgent or emergent evaluation. So the signs and symptoms of a DVT are number 1, you can have swelling in the ankle or you can have swelling in the lower leg. That's because the clot is in the leg, so so there could be swelling in that leg. Now the patient could also present with cramping type pain. They would say, oh, my calf muscle has been cramping or it is cramping right now. Number 3, the patient could have 1 leg that's more warm than the other leg. Number 4, the patient could have color changes in the leg.

Dr. Richard Lai DPT LAc [00:09:42]:

So for example, one leg could be red, it could be blue, the other leg could be normal color. And then sometimes, honestly, and it's very scary, but there are no symptoms sometimes. So the question then becomes, what do you do if you suspect a patient to have a DVT? So that's when you're treating the patient, your the patient's on your plinth, and you notice 1 leg is more red than the other leg, 1 leg is warmer than the other leg, one leg is more swollen than the other leg. And the patient says, yeah. That leg has been cramping more. That's why I came in. That's why I want you to treat it. Well, then this would be a clinical red lag if there are all of these symptoms.

Dr. Richard Lai DPT LAc [00:10:18]:

And in this instance, you would refer them to their physician or to urgent care services because the only way to diagnose a DVT is through an ultrasound because a DVT is a blood clot. It's blocking a vein. So that means that the area that the vein is, it won't get good blood flow. So that's why there could be more red color there or blue color there. That's also why that area could be cramping. That's also why a patient's leg can look different from one to the other. So they get a local ultrasound, the physician sees that there's a blockage, the patient could be prescribed some medications that could help dissolve the clot or whatever the physician determines depending on the severity of the clot itself. Alright.

Dr. Richard Lai DPT LAc [00:10:59]:

So that brings us to the end of this episode. If you want a study guide related to this episode, go to my website, and I'll send a study guide right to your email. When you sign up for my email list, you also get study guides on a monthly basis. You also get a newsletter from me, and you'll also just get to hear more from me. Alright, everyone. Until next time. God bless, and happy studying.

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