Superior vena cava syndrome history and symptoms

The hallmark of superior vena cava syndrome is elevated jugular venous pressure. A positive history of cancer and intra-vascular devices are suggestive of superior vena cava syndrome. The most common symptoms of superior vena cava syndrome include upper body swelling, dyspnea, and cough.

• Obtaining the history is the most important aspect of making a diagnosis of superior vena cava syndrome. It provides insight into cause, possible recurrence, and associated comorbid conditions. Complete history will help determine the correct therapy and helps in determining the prognosis. Specific histories about the symptoms (duration, onset, and progression), associated symptoms, and drug usage have to be obtained.^[1]

• Specific areas of focus when obtaining the history, are outlined below:
  • History of cancer
  • History of infections
  • Recent surgeries or interventions (eg. intravascular devices)
  • Associated symptoms (lethargy, fever, confusion)
  • Previous response to glucocorticoids

Superior vena cava syndrome patients gradually develop symptoms as the malignancies increase in size. Symptoms occur when obstruction of venous blood flow back to the heart is compromised. Symptoms may begin suddenly or gradually, and may worsen with postural changes. Symptoms are quite varied among benign and malignant superior vena cava syndrome. They can range from sub-clinical presentation to death. Superior vena cava syndrome is an oncological emergency which if untreated never resolves on its own. ^[2]

The most common symptoms include the following:^[3]

• Dyspnea
• Cough
• Swelling of the face, neck, trunk, and arms

Less common symptoms include the following:^[3]

• Hoarseness
• Chest pain
• Problems swallowing and/or talking
• Coughing up blood
• Headache
• Lightheadedness
• Decreased alertness
• Dizziness
• Fainting
• Sensation of head or ear “fullness”
• Vision changes

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