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Venous Thrombosis And Pulmonary Embolism Flashcards

(69 cards)

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1
Q

Thrombosis

A

Pathological clot formation within a blood vessel

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2
Q

Embolism

A

Part of a clot breaks off and travels through circulation until obstructed by vessels of smaller diameter

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3
Q

What colour are venous thrombi

A

Red

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4
Q

What colour are arterial thrombi

A

White - platelets and fibrin, few RBCs

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5
Q

Are venous or arterial thrombi more common

A

Venous

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6
Q

Deep vein thrombosis

A

Thrombus formed in deep vein

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7
Q

Where does a distal deep vein thrombosis form

A

Calf veins

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8
Q

Where does a proximal deep vein thrombosis form

A

Popliteal vein or above

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9
Q

What I’d the most common DVP site

A

Popliteal vein

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10
Q

Pulmonary embolism

A

Dislodged thrombus migrating to pulmonary vasculature

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11
Q

Embolus

A

Dislodged thrombus

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12
Q

How does leg muscle contraction aid venous return from legs

A

Muscle contraction squeezes vein opening proximal valve and pushing blood to heart

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13
Q

What happens if leg muscles don’t contract for a prolonged period

A

Valves remain closed and blood between them becomes stagnant, causing clotting above and below valved

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14
Q

What can dislodge a clot after a period of extended immobility

A

Muscle contraction

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15
Q

What is the most common route a clot may take to the brain

A

Through patent foramen ovale

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16
Q

Why do emboli often get stuck in pulmonary arteries

A

Arteries get smaller as they branch, before this arteries as getting bigger as the clot moves centrally

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17
Q

Saddle embolism

A

Large pulmonary embolus gets stuck in bifurcation of pulmonary trunk

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18
Q

Factors in Virchow’s triad

A

Endothelial injury
Stasis or turbulence of blood flow
Blood hypercoagulability

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19
Q

How does flowing blood prevent platelet adhesion to wall and clotting

A

Stimulates endothelium to release anticoagulants inc NO and prostacyclin

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20
Q

Risk factors for decr blood flow in deep veins

A

Immobilisation
Long haul flights
Obesity
Sickle cell disease

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21
Q

What does heparin sulphate and what does it do

A

Sulphide containing polysaccharide on luminal surface of endothelial cells
Form feathery projections into blood vessel lumen to prevent platelet adhesion

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22
Q

What can cause vessel wall damage

A

Chronic inflammatory disease
Smoking
Obesity
Diabetes

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23
Q

How can chronic inflammatory disease increase clot formation

A

Damage endothelial wall and decr amount of attached heparin

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24
Q

What can cause hypercoagulability

A

Antithrombin III deficiency
Protein C deficiency/resistance
Protein S deficiency/resistance

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25
What is the most common DVT/PE risk in younger people
Factor V Leiden mutation - causes resistance to activated protein C
26
Thromboembolism risk factors
Pregnancy Prolonged immobilisation Previous VTE Contraceptive pill Long haul travel Cancer Heart failure Obesity Surgery HRT Thrombophilia Severe burns Age
27
How does pregnancy increase thromboembolism risk
Coagulant factor production increases in liver
28
DVT signs and symptoms
Pain Erythema Tenderness Warmth Superficial venous dilation May be asymptomatic
29
DVT differential diagnoses
Musculo-tendinois injury Superficial thrombophlebitis Cellulitis Compression of iliac veins Congestive cardiac failure Lymphoedema Lymphangitis
30
What is used to estimate probability of DVT and PE in a patient
Wells’ scores
31
What are the 2 risk categories for DVT and PE
Likely - wells score 2+ Unlikely - wells score 1 or less
32
DVT clinical features - Wells score
Active cancer Paralysis, paresis, or recent plaster immobilisation of lower extremities Recently bedridden for 3+ days or major surgery within 12wks needing anaesthesia Localised tenderness along distribution of the deep venous system Entire leg swollen Calf swelling 3cm larger than asymptomatic side Pitting oedema confirmed to symptomatic leg Collateral superficial veins Previously undocumented DVT
33
When is a proximal leg vein ultrasound scan offered to a patient
Wells score 2 points or more
34
What test should be done if a proximal leg vein ultrasound scan is negative in a patient with a wells score over 2
D dimer test
35
D dimer
Fibrin degradation product
36
When is d dimer released into the blood
Thrombus degraded by fibrinolysis Inflammation Cancer Pregnancy
37
Pulmonary embolism symptoms
Dyspnea Pleuritic chest pain Cough Sub sternal chest pain Haemoptysis Fever (but <39*c) Syncope Unilateral leg pain Chest wall tenderness
38
When is pleuritic pain worst
Inspiration
39
Haemoptysis
Coughing up blood
40
Syncope
Fainting
41
Pulmonary embolism signs
Tachypnoea Rales Decreasing breath sounds Accentuated second heart sound Tachycardia Fever Diaphoresis SIgns and symptoms suggesting thrombophlebitis Lower extremity oedema Cardiac murmur Central cyanosis
42
Why is pulmonary embolism difficult to diagnose
Patients may have mild or no signs and symptoms
43
Pulmonary embolism differential diagnoses
Pneumothorax Pneumonia Myocardial infarction Pericarditis Pleurisy Musculo skeletal chest pain
44
Pulmonary embolism investigations
Blood gases Chest x ray - exclude other diagnoses ECG - rule out CVD
45
Classic PE ECG
deep S wave lead I Q wave lead iii Inverted t wave lead iii
46
What 2 level PE wells score suggests PE is likely
More than 4 points
47
What 2 level PE wells score suggests PE is unlikely
4 or less points
48
PE clinical features on 2 level wells score
Clinical signs and symptoms of DVT Alternative diagnosis less likely than PE heart rate >100 bpm Immobilisation more than 3 days or surgery in prev 4wks Previous DVT/PE Haemoptysis Malignancy
49
PE imaging
Pulmonary angiography Ventilation perfusion lung scintigraphy CT pulmonary angiography
50
PE causes of death
Acute right ventricular overload Respiratory failure Pulmonary infarction
51
PE treatment
Immediate subcutaneous low molecular weight heparin Oral anticoagulant
52
How does heparin prevent clot formation
Binds to and Activates antithrombin -> activated complex inactivates factor Xa -> prevents conversion of prothrombin to thrombin
53
How does heparin decrease PE mortality
Stops thrombus propagation in pulmonary arteries Stops thrombus propagation at emboli source Reduces frequency of further pulmonary embolism
54
Heparin complications
Increased risk of bleeding Heparin induced thrombocytopenia
55
High risk PE patients
Haemodynamic support Respiratory support Exogenous fibrinolytics Percutaneous catheter directed thrombectomy Surgical pulmonary embolectomy
56
How long are patients put on oral anticoagulants for PE
Identifiable temporary risk factor - 3 months Active cancer - 6 months No identifiable risk factor - indefinitely
57
Why are direct oral anti coagulants DOACs increasingly being prescribed instead of warfarin
Lower risk of bleeding
58
How does warfarin reduce plasma levels of factors II, VII, IX, and x
Vitamin K+ antagonist
59
Why must treatment be started with heparin instead of just giving warfarin
Warfarin has a delayed onset of actiom
60
Why can warfarin not be given in pregnancy
Tetarogenic Can cause material bleeding
61
Why must warfarin dose be changed if patient put on antibiotics
Antibiotics kill vitamin k producing bacteria in gut, leading to decr coagulation and bleeding
62
Dabigatran
Orally active direct thrombin inhibitor
63
Rivaroxaban and apixaban
Orally active factor Xa inhibitors
64
What are rivaroxaban and apixaban used to treat
DVT PE reduce risk of recurrent DVT and PE Prophylaxis of DVT Prevent blood clots in atrial fibrillation
65
When can rivaroxaban and apixaban not be used
Significant liver disease End stage kidney disease
66
How can venous thromboembolism be treated during pregnancy
Low molecular weight heparin
67
How can venous thromboembolism be treated while breastfeeding
Low molecular weight heparin Warfarin
68
How are patients with active cancer and associated thrombosis treated
Low molecular weight heparin more effective than warfarin DOACs Treatment reviewed after 3-6 mo
69
How are patients who can’t take anti coagulants treated for venous thromboembolism
Umbrella filter

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