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219 Haemoptysis 2: Pulmonary Embolism > Thromboembolic Disease > Flashcards

Thromboembolic Disease Flashcards

1
Q

What are the physical signs of DVT? (4 marks)

A

Local pain and tenderness

Fever

Swelling

Homan’s sign: pain on dorsiflexion of foot

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2
Q

What does Virchow’s triad consist of? And what does it represent a predisposition for?

A
  1. Venous stasis
  2. Injury to vessel wall
  3. Blood contents (coagulability)

Predisposing factors for thrombosis

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3
Q

What is used more commonly to image DVT? Doppler US or CT scan?

A

Doppler US

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4
Q

What is the management of DVT?

A

Enoxaparin (clexane) until diagnosis made

Doppler US the next day

Continue clexane until INR = 2.5 (or another oral anticoagulant)

Warfarin for 3/12 if clear cause, or 6/12 if no clear cause

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5
Q

Define an embolism

A

Something that has travelled in the bloodstream, lodged in a vessel and clogged it

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6
Q

Where is a large clot likely to cause severe/fatal haemodynamic compromise?

A

Bifurcation of PAs

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7
Q

How is a small clot likely to manifest?

A

Small clot → Distal clot → infarction → pleuritic pain

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8
Q

Define paradoxical embolism and where do symptoms manifest?

A

A clot that has travelled through a septal defect into the Left side of the heart → systemic manifestation

Stroke, kidney infarction, acute limb infarction

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9
Q

What are the differences and common signs in Acute and Subacute Massive PE

A

Both:

Tachypnoea, Hypoxaemia, Hypotension, Pleuritic Pain

Acute:

Recent surgery/immobility, Catastrophic CO drop, Cyanosis

Subacute:

SOB due to progressive obstruction

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10
Q

What are the signs for acute minor PE?

A

SOB

Pleuritic pain

Haemoptysis

Fever

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11
Q

What are the signs for Chronic Thromboembolic PE?

A

Repeated small emboli → occlusion

Progressive SOB

Pulmonary hypertension (instead of hypotension in subacute massive PE)

Right heart failure

Pleuritic Pain

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12
Q

What are the cardinal signs of PE?

A

Dyspnoea (SOB)

Tachypnoea (rapid breathing)

Pleuritic Pain

Other: tachycardia, cyanosis, pyrexia, AF, loud/widely split second sound (P2), increased JVP, hypotension, pleural rub, signs of DVT

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13
Q

What is the investigation of choice for PE?

And explain the process

A

CT pulmonary angiogram

Dye injected into arm, the scan is performed as the dye reaches the pulmonary arteries

Can do ventilation and pefusion scan

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14
Q

What would ABGs show for someone with PE?

A

High pH (respiratory alkalosis)

Low pCO2 (due to hyperventilation)

Low pO2

Hyperventilation with hypoxia

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15
Q

How would PE show on a CXR?

A
  1. May be normal
  2. May show linear shadows
  3. Small effusion only (do not get large ones)
  4. Peripheral wedge
  5. Elevated diaphragm
  6. Paucity of vessels (small quantity)
  7. Small cavity - abscess
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16
Q

What are the basic tests and routine further tests done for PE investigation?

A

Basic tests: ABGs, CXR, D-dimer, ECG (ACDE)

Further tests: CTPA/Q scan +/- ECHO

The echo for cardiac overload signs

17
Q

What is the Pesi score?

A

It is a tool used to predict the 30 day outcome of patients with PE

18
Q

What is the immediate management of PE?

A

High flow oxygen + IV fluids + Analgesia

Unfractioned heparin for proven PE

Enoxaparin (clexane) given whilst investigations commence

Thrombolysis (tPA) given if severe haemodynamic compromise (within 12-24hr)

19
Q

What is the long term management of PE?

A

Warfarin (vitamin K antagonist) once diagnosis confirmed - aim for INR 2-3

IVC filter placement (rare)

20
Q

Name two new anticoagulants used for PE treatment, and what is their advantage?

A

Rivaroxaban - Factor 10a inhibitor (anticoags including X, mean they inhibit 10)

Dabigatran - Thrombin inhibitor

No need for INR monitoring

21
Q

How would you treat septic emboli?

A

Prolonged antibiotics

22
Q

What are the clinical manifestations of inherited thrombophilia? (5 marks)

And how does acquired thrombophilia differ?

A

Young, recurrent VTE, unusual site, VTE despite anticoagulants, complications in late pregnancy

Acquired: progressive VTE despite anticoagulants

arterial as well as venous VTEs

23
Q

What is HIT? and what does it predispose?

A

Heparin-induced thrombocytopaenia, causes VTEs

219 Haemoptysis 2: Pulmonary Embolism (2 decks)

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