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Cardiovascular emergencies 

Cardiovascular emergencies
Chapter:
Cardiovascular emergencies
Author(s):

Spence Roy A.J.

, and Johnston Patrick G.

DOI:
10.1093/med/9780199215638.003.0002
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date: 15 October 2019

Superior vena cava obstruction 92

Venous thromboembolism 98

Pericardial effusion and tamponade 110

Cardiac masses 114

Cardiomyopathy 120

Eroded artery 124

Superior vena cava obstruction (SVCO) is a commonly encountered problem in certain subgroups of cancer patients.

The SVC is formed by the fusion of the left and right brachiocephalic veins. It extends caudally for 5–8 cm and drains into the right atrium. The azygos vein also arches over the right main bronchus to fuse posteriorly with the SVC. The SVC is contained within a confined anatomical space with the mediastinal parietal pleura laterally and the mediastinal lymph nodes medially. As the vein is thin-walled and only filled at relatively low pressure, any significant compression within this space can result in obstruction to blood flow. External compression (by tumour, lymphadenopathy or some other process) is often complicated by internal thrombosis within the blood vessel. The severity of the resulting syndrome depends on the rapidity of onset and the level of the obstruction. Secondary thrombosis often results in a more rapid onset and more severe symptoms. A more gradual onset allows the establishment of collateral blood flow and limits the severity. If the obstruction is above the level of the azygos vein, this system can readily dilate and shunt blood, thus limiting the severity of symptoms....

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