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02. Cardiovascular System > Deep Vein Thrombosis & Pulmonary Embolism - Presentation, Investigation & Therapy > Flashcards

Deep Vein Thrombosis & Pulmonary Embolism - Presentation, Investigation & Therapy Flashcards

1
Q

What is thrombosis?

A

The formation of a thrombus

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2
Q

What is the formation of a thrombus called?

A

Thrombosis

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3
Q

What is a thrombus?

A

Blood clot that forms in a vessel and remains there

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4
Q

What is a blood clot that forms in a vessel and remains there called?

A

Thrombus

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5
Q

Where can a thrombus be present?

A

Artery

Vein

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6
Q

What is a clot made up of?

A

Fibrin

Platelets

Red blood cells

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7
Q

What catalyses the reaction of fibrinogen to fibrin?

A

Thrombin

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8
Q

What catalyses the reaction of thrombin to prothrombin?

A

Tissue factor V

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9
Q

How does the mechanism of arterial thrombus differ from venous?

A

Arterial is usually due to rupture of atherosclerotic plaque

Venous is usually a combination of Virchow’s triad (especially stasis and hypercoagulability)

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10
Q

What do arterial thrombus result in?

A

Ischaemia and infarction

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11
Q

What do venous thrombus result in?

A

Back pressure

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12
Q

What diseases can arterial thrombus lead to?

A

Acute coronary syndrome

Ischaemic stroke

Limb claudication/ischaemia

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13
Q

What diseases can venous thrombus lead to?

A

Deep vein thrombosis

Pulmonary embolism

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14
Q

What is the composition of an arterial thrombus?

A

White thrombus (platelets and fibrin)

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15
Q

What is the combination of a venous thrombus?

A

Red thrombus (red blood cellsa and fibrin)

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16
Q

What is Virchow’s triad?

A

The factors that leads to thrombosis

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17
Q

What are some risk factors for the stasis aspect of Virchow’s triad?

A

Immobility

Long haul travel

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18
Q

What are some risk factors for the vessel damage aspect of Virchow’s triad?

A

Endothelial dynsfunction (hypertension, smoking)

Endothelial damage (trauma, surgery)

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19
Q

What are some risk factors for the hypercoagulability aspect of Virchow’s triad?

A

Pregnancy

Cancer

Sepsis

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20
Q

What is an embolism?

A

Intravascular material that migrates from its original location to a distal vessel

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21
Q

What is intravascular material that migrates from its original location to a distal vessel called?

A

Embolism

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22
Q

What are examples of different embolus?

A

Blood clot

Fat

Air

Tumour

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23
Q

What is a thromboembolism?

A

Movement of a blood clot along a vessel

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24
Q

What is movement of a blood clot along a vessel called?

A

Thromboembolism

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25
Q

What does VTE stand for?

A

Venous thromboembolism

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26
Q

What are some examples of venous thromboembolism?

A

Limp deep vein thromboembolism

Pulmonary embolism

Visceral venous thrombosis

Intracranial venous thrombosis

27
Q

What does PE stand for?

A

Pulmonary embolism

28
Q

What does DVT stand for?

A

Deep vein thrombosis

29
Q

What is the prevalence of DVT?

A

1/1000

30
Q

What is the prevalence of pulmonary embolism?

A

1/3000

31
Q

What is the leading cause of direct maternal death in the UK?

A

Venous thromboembolism

32
Q

What is the fatality rate of untreated pulmonary embolism?

A

30%

33
Q

What are some risk factors for venous thromboembolism?

A

Surgery

Fracture

Hypertension

Cardiac failure

Obesity

34
Q

What are some symptoms and signs for deep vein thrombosis?

A

Unilateral limb swelling

Persisting discomfort

Calf tenderness

Warmth

Redness

Prominent collateral veins

Unilateral pitting oedema

May be clinically silent

35
Q

What are some potential long term consequences of deep vein thrombosis?

A

Post thrombotic syndrome (damage to venous valves)

36
Q

What is the incidence of post thrombotic syndrome?

A

20-60% within 2 years of deep vein thrombosis

37
Q

What are the symptoms of post thrombotic syndrome (damage to venous valves)?

A

Swelling

Discomfort

Pigmentation

Ulceration in severe form

38
Q

What is used to diagnose deep vein thrombosis?

A

Clinical assessment and pre-test probability score (Well’s score)

Blood tests (D-dimer if low pre-test probability score)

Imaging (compression ultrasound if positive D-dimer or high pre-test probability score)

39
Q

What scoring system is used to diagnose deep vein thrombosis?

A

Well score

40
Q

What well score is a high probability of DVT?

A

More than or 3

41
Q

What wells score is a moderate probability of deep vein thrombosis?

A

1 or 2

42
Q

What wells score is a low probability of deep vein thrombosis?

A

Less than or 0

43
Q

What is D-dimer?

A

Breakdown product of cross-linked fibrin (produced during fibrinolysis)

44
Q

What is fibrinolysis?

A

Breakdown of fibrin in blood clots

45
Q

What is breakdown of fibrin in blood clots called?

A

Fibrinolysis

46
Q

What are some symptoms and signs of pulmonary embolism?

A

Pleuritic chest pain

Dyspnoea

Haemoptysis

Tachycardia

Pleural rub on auscultation

47
Q

What are symptoms and signs of massive pulmonary embolism?

A

Severe dyspnoea of sudden onset

Collapse

Cyanosis

Tachycardia

Low blood pressure

Raised jugular venous pressure

Sudden death

48
Q

What is used for the diagnosis of pulmonary embolism?

A

Clinical assessment and pre-test probability (Wells score)

Blood test (D-dimer if low pre test probability)

Imaging, perfusion scan or CT pulmonary angiogram (if D-dimer positive or high pre-test probability score)

49
Q

What imaging is used to diagnose pulmonary embolism?

A

Perfusion scan

CT pulmonary angiogram

50
Q

What Wells score is a high probability for pulmonary embolism?

A

More than or equal to 6.5

51
Q

What Wells score is a moderate probability for pulmonary embolism?

A

4.5-6

52
Q

What Wells score is a low probability for pulmonary embolism?

A

Less than or equal to 4

53
Q

What are potential long term consequences of pulmonary embolism?

A

Most recover fully

Pulmonary arterial hypertension

54
Q

What are the aims of treatment for venous thromboemolism?

A

Prevent clot extension

Prevent clot embolism

Prevent recurrent clot

55
Q

What are the treatment options for venous thromboembolism?

A

Anticoagulatation (main treatment)

Thrombolysis (reserved for massive pulmonary embolism)

56
Q

What are examples of anticoagulants?

A

Unfractionated heparin

Low molecular weight heparin

Warfarin

Direct oral anticoagulants (DOACs)

57
Q

What is an example of a thrombolysis?

A

Alteplase

58
Q

How is venous thromboembolism prevented in hospital?

A

Early mobilisation

Anti-embolism stockings

Other mechanical methods of thromboprophylaxis

Pharmacological thromboprohylaxis

59
Q

What can develop after a pulmonary embolism?

A

Pulmonary infarction

60
Q

What is the process of pulmonary embolism leading to pulmonary infarction?

A

1) Blockage to a branch of the pulmonary artery causes increase in pressure within pulmonary vasculature
2) Force within bronchial artery must be sufficient to overcome this
3) Leakage of blood into alveolar space occurs and leads to infarction

61
Q

Why is pulmonary infarction?

A

Dual vascular supply to the lungs with anastomoses

62
Q

What is the dual vascular supply to the lungs composed of?

A

Pulmonary vascular system

Bronchial vascular system

63
Q

What vascular system supplies the majority of O2 to the lung parenchyma?

A

Bronchial vascular system

64
Q

Where do the pulmonary and bronchial vascular systems anastomoses?

A

Pre and post capillary

02. Cardiovascular System (72 decks)

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