Flashcards in Venus Thrombosis & Pulmonary Thrombo-Embolism Deck (23)
Where do venous thrombi mostly arise?
In the deep veins of the legs
What are the risk factors for venous thrombosis?
Slowing of blood and hyper coagulability - (endothelial dysfunction is not as relevant)
What causes slowing of blood?
Imobility, thickened blood, right heart failure, dehydration
What causes endothelial dysfunction?
direct trauma, surgical trauma, injury from catheters
What causes hypercoagulability?
post operative, post MI, malignancy, chemotherapy, oestrogen, anti-phosphilipid antibody syndrome, nephrotic syndrome, obesity, cigarette smoking, inflammatory disease, genetic abnormalities
What genetic abnormalities lead to hyper coagulability?
mutation in factor V leading to inability of APC to bind, prothrombin mutation leading to increased amount of prothrombin in circulation
What is thrombophilia?
A group of inherited or acquired disorders that increase a person’s risk of developing arterial or venous thrombosis
What are the symptoms of DVT?
leg is warm. swollen, pain, discomfort - but symptoms are often not present at all
Where are DVT most common?
In the calf
Where are DVT most clinically significant?
Proximal veins - pelvic and deep femoral veins most likely to cause a pulmonary embolism
What are the symptoms of a large pulmonary thrombo-embolism?
sudden collapse and death or acute cor pulmonale with SOB, hypotension, cyanosis
What are the symptoms of a medium thrombo-embolism?
SOB, cough, acute cor pulmonale
What are the symptoms of a small pulmonary thrombo-embolism?
may be clinically silent or may lead to chronic pulmonary hypertension or chronic cor pulmonale
What are the complications of a medium or small pulmonary thrombo-embolism?
Pulmonary infarct - usually only occurs if there are underlying cardiovascular problems or underlying hypoxemia
What are the features of a pulmonary infarct?
Wedge shaped coagulative necrosis that is haemorrhagic with a fibrinous exudate
What are the symptoms of a pulmonary infarct?
haemoptysis, pleuritic chest pain and pleural friction rub
What is the fate of pulmonary emboli?
dissolution and or organisation and or recanalisation
What is a saddle embolus?
An embolus across the pulmonary trunk and right and left pulmonary arteries
What is the treatment for pulmonary embolism?
What is the aim of treatment of pulmonary embolism?
To prevent expansion of thrombus in the leg and limit the possibility of a subsequent embolism
What are the long term outcomes of DVT?
fibrinolysis, organisation, recanalisation of the thrombus, varicose veins, chronic venous insufficiency, oedema, venous stasis, tissue pigmentation, dermatitis, chronic ulceration
How is DVT prevented?
Anticoagulant drugs, mobilisation, exercise, compression stockings