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clin med > Cardio: DVT > Flashcards

Cardio: DVT Flashcards

1
Q

what kind of problem is a DVT?

A

cardiac/pulmonary - venous fibrin clotting (will need anti-coag > anti-plt)

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2
Q

what is vichor’s triad?

A
  1. venous stasis/ turbulent flow
  2. hypercoag state
  3. endothelial damage
    aka abnormalities in Flow (1) , blood composition (2) , vessel wall (3)
    *three things that are often in the history of someone w/ DVT
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3
Q

what are 3 endogenous anti-coags ?

A

protein C & S
TFPI (tissue factor path inhib)
anti-thrombin III

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4
Q

significance of protien C or S deficiency

A

serious genetic condition with excessive clotting b/c you dont have the protein that naturally breaks down clots

  • multiple clotting events in life
  • can happen at young age
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5
Q

tPA vs PAI-1

A

opposites (natural influencers of clots)
tPA: cleaves plasminogen into ACTIVE plasmin which then DISSOLVES CLOT

PAI-1:(PROTHROMBOTIC) pLT activating inhibitor- inhibits plasmin creation (so you can’t dissolve clots) (there will be an inc. level of this in someone w/ HTN)

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6
Q

pts w/ excessive clotting may present with what major venous or arterial problems?

A

vein: DVT/PE
artery: stroke/MI/PVD (prothromic state or stasis (Afib))
…also may have family history of stroke or other CVD

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7
Q

PE: DVT usually presents as…

A
  • often after minor trauma or immobilization
  • unilateral lower extremity
  • inflamm. (blood causes inflamm response), pain, warmth
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8
Q

Dx of DVT - what can you use to localize the clot?

A

doppler US

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9
Q

medication txt for DVT

A

anti-coag

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10
Q

SOB, pleuritic CP, Right-side HF, Virchow’s triad…. all could be indications of …

A

DVT

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11
Q

sudden right sided heart failure and rapid peripheral edema and JVD could be indications of …

A

DVT

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12
Q

what are you weighing when consider whether to image test for DVT?

A

how highly you suspect there to be one

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13
Q

what is the GOLD STANDARD Dx test for DVT?

A

contrast venography … but we dont really use it

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14
Q

what is plasma D-Dimer ?

A

degradation product of fibrinolysis (elevation in plasma will indicate that this is happening)

  • normal? low likelihood of DVT/PE
  • negative? MOST useful b/c you can r/o DVT/PE
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15
Q

*almost all pt’s have _____D-dimer

A

elevated (means you can get many false positives w/ this test)

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16
Q

homan’s sign is usually used to test ___ not ____ (according to Hadley)

A

thrombophlebitis NOT DVT

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17
Q

what do you do to estimate pre-test probability of DVT?

A

wells score.
>2 = 28% likelihood of DVT
<1 = 6% liklihood of DVT

18
Q

when is D-Dimer a “high value test” over venous doppler?

A

when you have LOW PRE-TEST PROBABILITY (from wells score) , negative D-dimer gives you an answer at 1/10 the cost of Venous doppler US

19
Q

what is Duplex doppler scanning? what is it best for?

A

combo of US and pulsed doppler- moving while it takes imaging to see the change (if any) in flow
-best for proximal disease (e.g. femoral and up)

20
Q

what is prevention for DVT for …
1. short/uncomplex surgery
vs
2. long/high-risk surgery or pt w/ risk factors?

A
  1. early ambulation
  2. heparin, (quick onset, easily reversible) (short term)
  3. warfarin/direct thrombin inhibit (for long term)
21
Q

how long is the “longterm” for warfarin for DVT txt/prophylaxis? and what are you monitoring?

A

3 months - checking PT/INR

22
Q

what would you use for MI/stroke prophylaxis is ASA fails?

A

warfarin

23
Q

how long does it take to get therapeutic levels of warfarin ?

A

4-5 days

24
Q

what two situations would someone need lifelong prophylaxis for DVT?

A
  1. recurrent DVT

2. no clear cause of the DVT

25
Q

anti-coag for ____ DVT helps prevent PE. for ____DVT it is less clear

A

proximal

distal (much lower probability of getting a PE from distal)

26
Q

anti-coag for distal DVT? if symptomatic vs asymptomatic?

A

symptomatic: anticoag as you would for proximal
asymptomatic: maybe surveillance, maybe txt w/ anti-plt ASA
* *which prevents “sticking” (clot progression) but not the cascade (clot initiation)

27
Q

pulmonary embolism: pt often has preceding ____ that may be ____

A

DVT, asymptomatic

28
Q

etiology of pulmonary emb.

A

embolization from venous system through right V to lung

29
Q

tachycardia, tachypnea, low O2, low grade fever from inflamm., possible DVT signs… what may this be?

A

PE

30
Q

what is the “gold standard” for Pulm. embolism and what do we actually use more commonly?

A

gold: pulmonary angiography (invasive and expensive)
actually: spiral CT (spins around body)

31
Q

____ of PE arise from ____ in deep venous system

A

> 90% of PE arise from venous thrombi in deep venous system (thigh > calf)

32
Q

3 presentations of PE

A
  1. acute cor pulmonale (massive pulmonary embolism that obstructs >50% pulmonic circulation)
  2. pulmonary infarction
  3. acute unexplained dyspnea
33
Q

what can pulmonary infarction be easily confused with? and what S&S does it present with?

A

pneumonia, pleuritis, MI
S&S: pleuritic (sharp local) CP, dyspnea, tachy, hemoptysis
AKA hard to Dx

34
Q

what 2 things are important for Dx unexplained dyspnea?

A

history and risk factors (b/c S&S are very vague and confusing)

35
Q

Dx test for “unexplained dyspnea”?

A

arterial blood gas (ABG) : classic drop in PO2 and PCO2

* PO2 can be WNL at expense of PCO2 (very low CO2)

36
Q

what is a ventilation/perfusion (VQ) scan? what are you trying to Dx between? what do results indicate?

A

examines air and bloodflow in lungs: shows ventilation:perfusion mismatch (trying to Dx unexplained dyspnea to see if its a PE)

  • normal scan is helpful ( r/o PE)
  • high probability scan is helpful (r/i PE)
  • low probability scan = not helpful
37
Q

what is unexplained dyspnea?

A

sub massive embolism w/out infarction

38
Q

what is MUD (medically unexplained dyspnea)? how are they presenting?

A

pt presents with dyspnea but no cardio-pulmonary explanation for it.
“submassive embolism w/out infarction” - “no infarction but poor perfusion” (hadley)
-usually presenting w/ anxiety and hyperventilation, tachypnea, tachycardia (nervous friggin nelly)

39
Q

suspect a PE? what do you need to give RIGHT AWAY?

A

heparin at least 10,000 unit bolus

40
Q

Txt for stable pts w/ PE ?

A

O2 and close monitoring in ICU
heparin
then warfarin/ other non-vitk anticoag (NOAC) (longterm anti-coag)

41
Q

IVC filter

A

used for high risk PE - small device placed in center of Vena Cava to prevent PE

42
Q

order to tests once you suspect PE…

A

D-dimer - if its elevated –> spiral chest CT –> pos? txt for PE
Txt:
continue anticoag- for non high risk
thrombolysis or IVC filter for high-risk

clin med (88 decks)

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