Category II - Pulmonary Thromboembolism Flashcards
It is the most common cause of preventable death among hospitalized patients.
Pulmonary thromboembolism
Two most common autosomal dominant genetic mutations, producing prothrombotic states.
Factor V Laden
Prothrombin gene mutation
Most common cause of acquired thrombophilia
APAS
Give risk factors to DVT/PTE
Cancer Systemic arterial HTN COPD Long-haul air travel Air pollution Obesity Cigarette smoking Eating large amounts of red meat OCPs Pregnancy Postmenopausal HRT Surgery Trauma
Most common gas exchange abnormalites in DVT/PTE
Hypoxemia
Increased alveolar-arterial O2 tension gradient
The usual cause of death of patients with PTE
Progressive right heart failure
A 75/F patient with breast cancer came in for sudden onset of DOB, no chest pain noted. ECG revealed sinus tachycardia, CRBBB, BP 60/40. She was then diagnosed to have PTE. How will you treat the px?
Give primary therapy - Anticoagulation plus thrombolysis OR embolectomy (catheter/surgical)
Normotension with normal RV - secondary prevention (anticoagulation alone or IVC filter)
Normotension plus RV hypokinesis - individualize therapy
In massive PE, how many percent of the pulmonary vasculature is already involved?
At least 50%
Massive PE: dyspnea, syncope, hypotension, cyanosis
Submassive PE: RV dysfunction with normal BP
It is called the “great masquerader”
Pulmonary embolism
Mot common symptom of pulmonary embolism
Breathlessness
Most common symptom of DVT
Cramp or “charley horse” in the lower calf that persists and intensifies over several days
This diagnostic test for DVT/PE is useful to rule out DVT/PE but has low specificity because it may also elevate in other diseases (AMI, pneumonia, sepsis, cancer, post-surgical, 2nd/3rd trimester of pregnancy)
D dimer
The most frequently cited ECG abnormality in PE?
Sinus tachycardia
Also seen: S in lead I, Q wave in lead III, inverted T wave in lead III
An xray finding in which a peripheral wedge shaped density is seen above the diaphragm.
A. Westermark’s sign
B. Hampton’s hump
C. Palla’s sign
B. Hampton’s hump
Westermark’s sign: focal oligemia
Palla’s sign: enlarged right descending pulmonary artery
The primary criterion in the ultrasonographic finding in DVT?
Loss of vein compressibility or “wink” finding
This diagnostic test replaced CT scan with IV contrast as the principal imaging test used to diagnose PE?
Pulmonary angiography
Give diagnostic findings that would denote an increase in mortality from PE
RV hypokinesis
Enlarged RV
Increased troponin
*Will benefit from PRIMARY THERAPY - anticoagulation with thrombolysis or embolectomy
Approved as monotherapy for acute VTE without parenteral “bridging”
NOACs
Rivaroxaban: Factor Xa inhibitor
Apixaban: factor Xa inhibitor
Dabigatran: direct thrombin inhibitor (anti factor IIa)
Duration of anticoagulation for DVT of upper extremity or calf provoked by trauma.
3 months
Duration of anticoagulation for DVT of upper extremity or calf provoked by trauma, surgery, estrogen exposure, indwelling catheter/device
Provoked proximal leg DVT or PE: 3-6 months
Cancer and VTE: use LMWH indefinitely until “cancer-free”
Moderate or high levels of antiphospholipid antibodies: indefinite
Common complication of IVC filter?
Caval thrombosis
If with MAJOR bleeding due to warfarin, what will you give?
Cryoprecipitate or FFP or rFVIIa
Warfarin with minor bleeding: oral vitamin K
First line inotropic agents for treatment of PE-related shock
Dopamine and Dobutamine
