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Cardiovascular System > Deep vein thrombosis and plumonary embolism > Flashcards

Deep vein thrombosis and plumonary embolism Flashcards

1
Q

What is a ‘clot’ made up of?

A
  • Fibrin
  • Platelets
  • Red blood cells
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2
Q

How is a clot formed?

A

Damage to endothelium etc > Tissue factor > X reacts with Prothrombin to produce Thrombin > Thrombin reacts with Fibrinogen to produce Fibrin which reacts with factor XIII to produce cross-linked fibrin

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3
Q

Mechanisms in Arterial vs Venous thrombosis

A

Arterial
- Usually rupture of atherosclerotic plaque

Venous
- Combination of Virchow’s triad, especially stasis and hypercoagulability

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4
Q

Location of origin in Arterial vs Venous thrombosis

A

Arterial
- Arteries, left heart chambers

Venous
- Venous valves and venous sinusoids of muscles

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5
Q

Results in Arterial vs Venous thrombosis

A

Arterial
- Ischaemia and infarction

Venous
- Back pressure

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6
Q

Disease in Arterial vs Venous thrombosis

A

Arterial

  • Acute coronary syndrome
  • Ischaemic stroke
  • Limb claudication/ischaemia

Venous

  • Deep vein thrombosis
  • Pulmonary embolism
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7
Q

Composition in Arterial vs Venous thrombosis

A

Arterial

  • “white thrombus”
  • Platelets and fibrin

Venous

  • “red thrombus”
  • Red blood cells and fibrin
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8
Q

Features of Virchow’s Triad

A
  • Stasis
  • Hypercoagulability
  • Endothelial damage
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9
Q

What is an embolism?

A

Intravascular material that migrates from its original location to a distal vessel
E.g. blood clot, fat, air, tumour

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10
Q

What is a thromboembolism?

A

Movement of blood clot along a vessel

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11
Q

Examples of venous thromboembolism (VTE)

A
  • Limb deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)
  • Visceral venous thrombosis
  • Intracranial venous thrombosis
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12
Q

Epidemiology of venous thromboembolism

A
  • DVT: 1 in 1000 patients
  • PE: 1 in 3000-5000 patients
  • Leading cause of direct maternal death in UK
  • Case fatality rate: 1 to 5% - untreated PE: 30%
  • PE in 20% of autopsies
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13
Q

Risk factors for VTE

A
  • Major abdominal/pelvic surgery
  • Hip/knee replacement
  • Late pregnancy
  • Fracture
  • Malignancy
  • Congenital heart disease
  • Hypertension
  • COPD
  • Obesity
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14
Q

Symptoms and signs of DVT

A
  • Unilateral limb swelling
  • Persistent discomfort
  • Calf tenderness
  • Warmth
  • Redness-erythema
  • Prominent collateral veins
  • Unilateral pitting oedema

May be clinically silent!!

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15
Q

What is a potential long-term consequence of DVT?

A

Post Thrombotic Syndrome

  • Damage to venous valves
  • Incidence of 20-60% within 2 years of DVT
  • Swelling
  • Discomfort
  • Pigmentation
  • Ulceration in severe form
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16
Q

Diagnosis of DVT

A
  • Clinical assessment and pretest probability score (Wells score)
  • Blood test: D-dimer if low pre-test probability score
  • Imaging: compression ultrasound if positive D-dimer or high pre-test probability score
17
Q

Learn wells score for DVT

A

kinda know about it

18
Q

What is a D-Dimer?

A
  • Breakdown product of cross-linked fibrin: produced during fibrinolysis
  • High sensitivity for VTE
  • Low specificity for VTE: trauma, malignancy, sepsis, bleeding, cancer, recent surgery
19
Q

How is a D-Dimer formed?

A

Plasmin combines with Fibrin producing fibrin degradation products (FDPs), including D-dimer

20
Q

Symptoms and signs of pulmonary embolism

A
  • Pleuritic chest pain
  • Breathlessness (dyspnoea)
  • Blood in sputum (haemoptysis)
  • Rapid heart rate (tachycardia)
  • Pleural rub on auscultation: usually due to pulmonary infarction
21
Q

Symptoms and signs of massive pulmonary embolism

A
  • Severe dyspnoea of sudden onset
  • Collapse
  • Blue lips and tongur (cyanosis)
  • Tachycardia
  • Low blood pressure
  • Raised jugular venous pressure
  • May cause sudden death!!
22
Q

Diagnosis methods of pulmonary embolism

A
  • Clinical assessment and pretest probability score (Wells score or Geneva score)
  • Blood test: D-dimer if low pre test probability score
  • Imaging: If D-dimer positive or high pre test probability score: Isotope ventilation/perfusion scan, CT pulmonary angiogram
23
Q

Look over Wells score for PE

A

Do it

24
Q

What is a potential long-term consequence of pulmonary embolism?

A
  • Pulmonary arterial hypertension

- Most recover fully

25
Q

What is the aims of treatment of VTE?

A
  • Prevent clot extension
  • Prevent clot embolisation
  • Prevent recurrent clot
26
Q

What are the treatment options for VTE?

A

Anticoagulation is the main treatment

  • Parental options: unfractionated heparin, low molecular weight heparin
  • Enteral options: warfarin, direct oral anticoagulants (DOACs)

Thrombolysis is reserved for massive PE: e.g. Alteplase

27
Q

Prevention methods of VTE in hospital

A
  • Early mobilisation
  • ‘Anti-embolism stockings’ - help with the flow of blood
  • Other mechanical methods of thromboprophylaxis
  • Pharmacological thromboprophylaxis
28
Q

Summary learning outcomes

A
  • VTE is common and deadly
  • Aim to prevent VTE in patients at significant risk
  • Need to be aware of suggestive symptoms and signs
  • Apply diagnostic and treatment pathway
29
Q

How do you develop a pulmonary infarction after a PE?

A

Pulmonary infarction = rare due to dual vascular supply to lungs with anastomoses
- Blockage to a branch of the pulmonary artery = increase in pressure within pulmonary vasculature

  • Force within bronchial artery may be insufficient to overcome this
  • ‘Leakage’ of blood into alveolar space occurs, and leads to infarction

Cardiovascular System (36 decks)

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