Deep Vein Thrombosis + PE Flashcards

1
Q

What causes a DVT to form?

A

Stasis in the deep veins and/or hypercoagubility

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2
Q

What are the risk factors for DVT/VTE?

A

Aging - Tissue Trauma - Immobility - Obesity - Smoking - Pregnancy - Exogenous Oestrogen (e.g. the pill) - Inherited Thrombophilia - Some systemic diseases like cancer

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3
Q

What are the symptoms of a DVT?

A

Persistent discomfort & calf tenderness
Warmth
Erythema (redness)
Unilateral Limb Swelling

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4
Q

How do we investigate a suspected DVT?

A

With a clinical probability assessment such as the wells score
Also a D Dimer as it would rule out thrombus
Compression Ultrasound will confirm, locate and assess severity of a DVT

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5
Q

How is a DVT treated?

A

Compression Stockings to encourage flow and anti-coagulant LMWH.
Thrombolysis & thrombectomy are also possible but considered too high risk in most cases

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6
Q

Where do VTEs most often lodge?

A

In the pulmonary arteries making them Pulmonary Emboli

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7
Q

What are the symptoms of a normal PE?

A

Pleuritic chest Pain
Dyspnoea
Haemoptysis
Tachycardia
And a pleural rub on auscultation

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8
Q

What other symptoms come with a massive PE?

A

Collapse
cyanosis
Sudden Death
Low BP
raised JVP
Altered heart sounds

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9
Q

How do we investigate a suspected PE?

A
  • Clinical probability assessment (wells score)
  • D dimer to rule out PE
  • FBC and clotting status to rule out some important secondary causes for the VTE
  • CT Pulmonary Angiogram - The first line in imaging
  • Isotope VQ scan to locate PE
  • ECG
  • Arterial Blood Gasses
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10
Q

How do we treat a PE?

A

Short Term LMWH (5 days)
Oral Anticoagulant - Warfarin (3 months)
Thrombolysis for a massive PE
Thrombectomy is possible but not used much these days
Vena Caval Filter - Traps emboli before entering heart, controversial af

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11
Q

When would we keep the LMWH and not use warfarin in a PE case?

A

If the patient is pregnant
As Warfarin is teratogenic in the 1st trimester

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12
Q

How do we actively prevent VTEs in some hospital patients?

A

Early mobilisation
Regular Movement
Anti-embolism compression stockings
Daily LMWH injections

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13
Q

What makes up a Venous thrombus?

A

Fibrin and RBCs. Hence its called a ‘red thrombus’

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14
Q

What makes up an arterial thrombus?

A

Fibrin and platelets. Hence they’re called ‘white thrombi’

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15
Q

What typically causes venous thrombi?

A

Hypercoagubility - Pregnancy or Trauma
And Stasis - Travel or bed-bound.

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16
Q

What is the most common form of inherited thrombophilia?

A

Factor V Leiden.
It affects 5% of caucasians, increasing risk of VTE of 5 times.

17
Q

What is caused by a long-term DVT?

A

Post-Phlebitic Syndrome:
- Inflammation, valvular incompetance & oedema due to a DVT.
Swelling - Discomfort - brown/red discolouration - Ulceration - Varicose Veins

18
Q

What are the parts of the wells score for a clinical probability assessment?

A

+1:
Active Cancer - Tender Veins - Whole leg swelling - Bed>3 days/Surgery within 4 weeks - Calf Swelling>3cm - Pitting oedema - Collateral Veins - Paralysis/plaster

-2:
Other Diagnosis Likely

19
Q

How do anti-embolism stocking work? (graduated Compression stockings)

A

Apply a greater pressure at the ankle than the calf and even less at thigh pushing blood through the veins. acieves a venous blood velocity 140% of the baseline

20
Q

What do we use graduated compression stockings for?

A

Preventing VTE
Chronic Venous Insufficiency
Varicose Veins
Oedema
Lymphoedema
Preventing post-phlebitic syndrome

21
Q

What is a possible complication of long term PE?

A

Pulmonary Hypertension