Deep vein thrombosis and pulmonary thromboembolism – presentation, investigation & therapy Flashcards
What is the definition f a thromboembolism
Movement of clot along a vessel
What are the three factors in virchows triad that result in thrombosis
Stasis - static blood flow
hyper-coagulability - abnormality of blood coagulation
Vessel damage
What are examples of things resettling in stasis
bed rest
traveling
What are examples of things causing hyper-coagulability
Pregnancy
Trauma
What is the main cause for vessel damage
atherosclerosis
What is the main cause of venous thrombus from virtuous triad
Principally due to stasis and hypercoagulability
What is red thrombus composed of
fibrin and red blood cells
What does venous thrombosis result in
back pressure
what is is white clot composed of
Platelets and fibrin
What does arterial thrombus result in
Ischaemia
Infarction
What is the main cause of arterial thrombus from virtues triad
Vessel damage - atherosclerosis
Is red thrombus venous or arterial
Red thrombus = venous
What are examples of venous thromboembolism
Limb deep vein thrombosis (DVT)
Pulmonary embolism
visceral venous thrombosis (nerves)
intracranial venous thrombosis (skull)
What is the signs and symptoms of DVT
Unilateral limb swelling
Persisting discomfort
Calf tenderness
Warmth
Redness- erythema
May be clinically silent - asymptomatic
What is the long term consequences of DVT if not treated
Swelling
Discomfort
Pigmentation
Ulceration in severe form
What is the signs and symptoms of pulmonary embolism
Pleuritic chest pain
Breathlessness- dyspnoea
Blood in sputum- haemoptysis
Rapid heart rate- tachycardia
Pleural rub on auscultation
What is the signs of a massive pulmonary embolism
Severe dyspnoea of sudden onset
collapse
Blue lips and tongue- cyanosis
Tachycardia
Low blood pressure
Raised jugular venous
pressure
What is the potential result of a massive pulmonary embolism
Sudden death
How do you diagnose for a DVT
Use Wells score in clinical assessment for pre test probability
Blood test: D dimer
Imaging
What blood test in performed for DVT and pulmonary embolism
When would a blood test be performed
D - dimer
Performed if low test probability score
What imaging technique is performed and when would it be performed in diagnosing DVT
Compression ultrasound if positive D-dimer or high pre-test probability score
How do you diagnose for a pulmonary embolism
Clinical assessment using Wells or Geneva score
Blood test
Imaging
What imaging technique is used for diagnosing a pulmonary embolism
when would imaging be used in diagnosis
Isotope ventilation/perfusion scan
CT pulmonary angiogram
Used if D-dimer positive or high pre test probability score
What is the long term consequences of pulmonary embolism
Pulmonary hypertension
What is the aims in the treatment of Venous thromboembolism
Prevent clot extension
Prevent clot embolisation
Prevent recurrent clot
What is the main treatment option in Venous thromboembolism
anticoagulation
What is examples of anticoagulation medication in Venous thromboembolism treatment
unfractionated heparin
low molecular weight heparin
Warfarin
Direct Oral Anticoagulants (DOACs)
What is the best treatment for a massive PE
Thrombolysis
What is methods to prevent Venous thromboembolism occurring hospitals
Early mobilisation
‘Anti-embolism stockings’
Other mechanical methods of thromboprophylaxis
Pharmacological thromboprophylaxis
