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Cardiovascular Week 4 2016/17 > 6: DVT and pulmonary embolism > Flashcards

6: DVT and pulmonary embolism Flashcards

1
Q

DVT and PE are collectively known as ___ ___ disease.

A

venous thromboembolic

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2
Q

In DVT, thrombi form in venous __ pockets.

A

valve

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3
Q

What is a DVT?

A

Formation of a thrombus within the lumen of the vessels which make up the deep venous system

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4
Q

Where are distal DVTs found?

A

In the calves (anywhere below the popliteal vein)

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5
Q

Where are proximal DVTs found?

A

At or above the popliteal vein

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6
Q

Venous thromboembolic diseases like DV and PE are strongly associated with ___.

A

cancer

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7
Q

The biggest risk factor for thromboembolic disease is __ __.

A

major surgery

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8
Q

Which genetic condition increases your thrombophilia?

A

Factor V Leiden

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9
Q

Thromboembolic disease can be divided into those which are ___ and un___.

A

provoked , unprovoked

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10
Q

If you have had a thrombus, you (are / aren’t) likely to have another one.

A

are

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11
Q

Which GI condition increases the likelihood of developing DVT/PE?

A

Crohn’s disease

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12
Q

What is the clinical presentation of PE?

A

Breathlessness

Pleuritic chest pain

Haemoptysis

Collapse

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13
Q

What is the clinical presentation of DVT?

A

Red, hot, swollen calf/calves

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14
Q

What is post thrombotic syndrome?

A

A pain/dysfunction syndrome affecting mainly the legs

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15
Q

Why do people get post thrombotic syndrome after DVT treatment?

A

Valve has been removed - pressure in deep venous system increases and damages further valves

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16
Q

What is the clinical presentation of post thrombotic syndrome?

A

Pain

Oedema

Hyperpigmentation

Eczema

Varicose veins

Ulcers

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17
Q

What is a chronic complication of PE?

A

Chronic thromboembolic pulmonary hypertension

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18
Q

What is a consequence of chronic thromboembolic pulmonary hypertension (CTEPH)?

A

Right heart failure

19
Q

What is the initial presentation of CTEPH, a complication of PE?

A

Progressive breathlessness, hypoxaemia and death

20
Q

What can be used instead of massive tests to estimate someone’s probability of DVT?

A

Pre-test probability scores

21
Q

What test is used to exclude DVT?

A

D-dimers (good rule out test, rubbish rule in test)

High = no DVT

Low = maybe DVT

22
Q

What investigation involves compressing veins to rule out DVT?

A

Ultrasound

If pressure upstream is high (due to blockage) then vein won’t compress very well

23
Q

D-dimers are produced upon breakdown of __.

This gives an indication of the extent of ___.

A

fibrin

fibrinolysis (clot breakdown)

24
Q

look over d-dimers again

A
25
Q

Which two scores can be used to estimate the likelihood of PE?

A

Wells score

Geneva score

26
Q

What is the gold standard investigation for diagnosing PE?

A

CT pulmonary angiogram

27
Q

In PE, chest x-rays are usually ___.

What may you see on a chest x-ray indicating PE?

A

normal

Wedge-shaped infarctions

28
Q

Which type of scan may you want to do to check for PE in a pregnant woman, where you want to limit radiation dosage to her and the foetus?

A

V/Q scan (usually perfusion only)

29
Q

Which pharmacological interventions are used to treat DVT & PE?

A

ANTICOAGULATION (WARFARIN / RIVAROXABAN)

THROMBOLYSIS

ANALGESIA

30
Q

Name two mechanical interventions which can be used to treat DVT & PE.

A

Compression stockings

IVC filters

31
Q

Does an IVC filter block out all clots?

A

No

32
Q

Which conditions would DVT/PE patients be screened for?

A

Cancer (only if red flag symptoms are met e.g blood in stool, unexplained weight loss)

Thrombophilia

33
Q

look at nice guidelines for dvt/pe treatment

A
34
Q

What is an advantage of warfarin over new drugs (e.g rivaroxiban)?

A

Warfarin anticoagulation can be reversed with Vitamin K

35
Q

What is an advantage of new anticoagulant drugs e.g rivaroxiban?

A

Act predictably

Large therapeutic windows

Few interactions

36
Q

What is a disadvantage of new anticoagulant drugs (e.g rivaroxiban)?

A

Irreversible (i.e no antidote if you overdo it) but not much of a problem

37
Q

What are the two main NOACs used in DVT/PE?

A

Apixaban

Rivaroxaban

(Also dabigatran and edoxaban but these are rarely used.)

38
Q

What do rivaroxaban and apixaban inhibit?

A

Factor Xa

(forms thrombin from prothrombin)

39
Q

Rivaroxaban is (safer / more dangerous) than warfarin.

A

safer

40
Q

In treatment of DVT/PE, the risk of ___ has to be balanced with the risk of death by ___.

A

haemorrhage

the embolic disease itself

41
Q

In people with cancer-associated clotting, __ is the first line treatment.

A

fragmin

42
Q

phlegmasia

A
43
Q
A

Cardiovascular Week 4 2016/17 (7 decks)

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