16. VTE Flashcards
Definition of VTE
One-disease concept wherein part of a thrombus from the deep veins of the legs embolizes in the pulmonary circulation.
VTE includes: DVT & PE
Risk Factors
(Basic, molecular, clinical)
Patho mga to
Basic Risk Factor: Virchow’s Triad of Thrombosis 1. Stasis 2. Hypercoagulability 3. Endothelial injury
CLinical: acute MI, Stroke, Malignancy, Pregnancy
Molecular: Deficiencies in protein C, S and AT3
Virchow’s Triad
S.H.E.D.
Stasis, Hypercoaguability, Endothelial damage
M/c manifestation symptom and sign if PE
Dyspnea - m/c symptom
Tachypnea - m/c sign
tachycardia, low-grade fever, neck vein distention, accentuated pulmonic component of S2
Massive PE —> (+) syncope (+) hypotension (kasi nabblock nayung pulmonary circ) (+) central cyanosis cos impaired gas exchange
Located near the pleura —> (+) pleuritic chest pain, cough or hemoptysis
DVT s/Sx
Homan’s sign: pain behind knee on dorsiflexion
Unilateral leg swelling, warmth, pain, redness
Well’s Criteria - most clinically tested deicison rule based on history taking and PE of pulmonary embolism
Well’s Criteria for PE
Components: Signs and Symptoms of DVT (3.0) PE (3.0) Heart rate >100* Immobilization or surgery 4 weeks before* Previous DBT Hemoptysis* Active Cancer*
> 4 – PE is likely
<4 – PE is unlikely
Diagnostics for PE
CBC, ABG
CXR
Hampton’s Sign: A peripheral wedge shaped infiltrate which signifies a PE
with infarction
Westermark’s Sign: Localized decrease in pulmonary vascular markings (focal oligemia)
Palla’s Sign: Increase in pulmonary artery size, can be seen in CXR & Chest CT
D-dimer assay - a negative test may rule
out PE in patients with a low to moderate pretest probability and a non-diagnostic VQ scan
Hampton’s Sign
A peripheral wedge shaped infiltrate which signifies a PE
with infarction
Westermark’s Sign
Localized decrease in pulmonary vascular markings
Palla’s Sign
Increase in pulmonary artery size
