Deep Vein Thombosis and Pulm Embolism Flashcards
Two types of DVT?
Proximal DVT (popliteal, femoral, iliac) or distal DVT (calf)
Two most common places for DVT?
Posterior tibial vein and peroneal vein
What is the most common form of DVT in pregnant womean?
Left lower extremity due to fetal compression of left iliac vein
3 components of Virchow Triad?
Hypercoagulability, vessel injury, circulatory stasis
Why are pregnant women at an increased risk of having a DVT or PE?
Increased coagulation factors
What are inherited risk factors for DVT?
Factor V Leiden (most common), prothombin gene mutation, protein C/S deficiency, antithrombin deficiency, dysfibrinogenemia
What are acquired risk factors for DVT?
Recent surgery (hip/knee), immobilization, malignancy, oral contraceptives, HRT, pregnancy, obesity, inflammation (AutoImmune)
Clinical presentation of DVT?
Leg pain, tenderness and warmth, swelling, discoloration, palpable chord
What is Phlegmasia cerulean dolens?
Clinical sign of severe DVT. Massive obstruction and cyanosis
Calf circumference that measures ______ increases probability of DVT?
Greater than 3cm
What is the preferred method of diagnosis of DVT? When should it be ordered?
Compression venous duplex ultrasound. Should be ordered same day
What is the GOLD standard for diagnosis of DVT? What are some complications?
Ascending contrast venography. Uncomfortable, can induce DVT, only used if noninvasive test uncertainty
What other test can be ordered if DVT suspected?
D-dimer, hypercoagulable state screening (CBC, TP, aTTP, protein C/S, antithrombin, factor V Leiden)
These individuals should raise suspicion of hypercoagulable state?
Younger individuals with DVT
All patients with _____ will require anticoagulation and 90% of ________ result from ________.
proximal DVT, PE, proximal DVT
These individuals can be monitored every 2 weeks with ultrasound?
Distal DVT and high risk of bleeding
________ score of >13% will require no antocoag.
HTN, abnormal liver or renal function, stroke, bleeding, labile INR, Eldery (>65), drugs or alc
Individuals with recurrent DVT are treated for how long?
indefinitely or if they have multiple risk factors
Individuals with first episode of DVT are treat for how long?
3 months (sx, high risk bleeding) OR 6 months if persisent risk factors not resolved (cancer, immobile)
PE can arise from?
DVT, air, fat, tumor cells
Pathophysiology of PE?
Emboli gets lodged in the arteries of lungs This leads to reduction of pulm circulation and infarcted areas. Tachypnea and hypoxia can result. Vasoconstriction and increased pulm resistance occur. This can cause atelectasis. If more than 50% pulm circ. occluded, right sided heart failure can occur.
Clinical presentation of PE?
DYSPNEA (can be sudden & severe), CHEST PAIN, COUGH, hemoptysis, tachypnea, tachycardia, syncope, JVD, gallop can occur, cyanosis
Typical physical examination findings of PE?
Rarely demonstrate specific findings
Diagnostic testing for PE?
CBC, ESR, ABG (resp. alk & hypocapnia. Can progress to resp. acid & hypercapnia if shock), BNP, Troponins, Ddimer, check PT/aPTT
ECG findings for PE?
S1Q3T3 sign of acute cor pulmonale
Common CXR findings of PE?
Hampton’s hump, Westermark sign (blunting of pulm arteries) these are rare, atelectasia, pleural effusion
What is the diagnostic test of choice for PE?
Multidetector CT pulmonary angiography
In this disease, patients have autoantibodies that activate thombotic processes?
Antiphospholipid antibody syndrome (APS)
Treatment for PE?
Anticoagulation therapy. Start LMWH (1mg/kg SC q12h) or unfractionated heparin (80U/kg bolus IV then 18U/kg/hr IV). Start coumadin 5mg qd.
