Deep vein thrombosis & pulmonary thromboembolism Flashcards
what is deep vein thrombosis
it is thrombosis in a vein lying deep below the skin, especially in the legs
when does deep vein thrombosis occur
when a thrombus forms in one or more of the deep veins in your body, usually in your legs
what can deep vein thrombosis cause
leg pain or swelling, but can also occur with no symptoms
what can sometimes occur for no apparent reason
DVT
list things that increase getting DVT
inactivity staying in hospital blood vessel damage medical conditions genetic conditions pregnancy contraceptive pills hormone replacement therapy
state a medical condition that can cause DVT
vasculitis, varicose veins
state conditions that increase your risk of getting DVT
cancer heart disease infectious conditions inflammatory conditions thrombophilia anti-phospholipid syndrome
how can cancer increase your chance of getting DVT
cancer treatments such as chemotherapy and radiotherapy can increase your risk of getting DVT
state a genetic condition that increases your risk of getting DVT
thrombophilia, it is a genetic condition where your blood has an increased tendency to clot
state an immune system disorder that increases your risk of getting DVT
anti-phospholipid syndrome, this disorder causes an increased risk of blood clots
state other causes of DVT
being overweight being obese smoking dehydration being over 60
what is the treatment of DVT
medicines called anticoagulants, these drugs prevent blood clot getting bigger and can prevent an embolism
what are anticoagulants referred to as
blood thinning medicines, however, they do not thin blood, they prevent clots forming so easily
state 2 anticoagulants used to treat DVT
heparin
warfarin
describe heparin treatment of DVT
heparin works immediately to prevent further clotting, it is injected straight into one of your veins generally
what are the 2 forms of heparin available
standard heparin
low molecular weight heparin
what are side effects of heparin
skin rash
bleeding
allergic reactions
weakening of the bones
describe warfarin treatment of DVT
warfarin is taken as a tablet, it prevents further blood clots occurring
what are 2 main complications of deep vein thrombosis
pulmonary embolism
post-thrombotic syndrome
what is the most serious complication of DVT
pulmonary embolism
When does pulmonary embolism occur as a complication of DVT
it happens when a piece of blood clot breaks off and travels through your bloodstream to your lungs, where it blocks one of the blood vessels
what is post-thrombotic syndrome
it is the occurrence of long term symptoms after having a DVT
what percentage of people with history of DVT does post-thrombotic syndrome affect?
20-40%
what do the symptoms of post-thrombotic syndrome include
calf pain
swelling
a rash
ulcers on the calf
what increases your risk of getting post-thrombotic syndrome
if your DVT is in your thigh vein
if you are overweight
if you have more than one DVT in the same leg
what is the initial investigation of choice in nearly all patients with suspected DVT
duplex ultrasound
state 4 investigations of DVT
ultrasound
venography
CT venography
MRI
what is pulmonary thromboembolism
it is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream
what does pulmonary thromboembolism result from
usually thrombus in the leg that travels to the lung
what is the presentation of pulmonary thromboembolism
chest pain pain of the upper back difficulty breathing coughing up of blood a developing DVT
describe the management of pulmonary thromboembolism
injection of anticoagulant medicine in hospital,
anticoagulant tablets then for 3 months
what is the role of anticoagulants
they stop blood clots getting bigger and prevent new clots forming
state investigations of pulmonary thromboembolism
routine laboratory blood tests chest x-rays ECGs ventilation/perfusion scan CT pulmonary angiogram pulmonary angiography ECHO MRI compression ultrasound scan
what is a thrombus
a blood clot formed in situ within the vascular system of the body and impedes blood flow
what is a blood clot
blood that has been converted from a liquid state to a solid state
what is a blood clot also called
a thrombus
where is a blood clot
it is stationary within a vessel or the heart
what is coagulation
the process by which a blood clot forms
what is a clot made up of
fibrin
platelets
red blood cells
what is arterial thrombosis
a blood clot in an artery
what is the result of arterial thrombosis
it can be very serious and can stop blood reaching important organs
what is venous thrombosis
it is a blood clot that forms within a vein
state a common type of venous thrombosis
deep vein thrombosis
what is deep vein thrombosis
it is a blood clot in the deep vein of the leg
what is thrombosis
it is a term for a blood clot occurring inside a blood vessel
what is embolism
obstruction of an artery, typically by a blood clot or an air bubble
what is thromboembolism
obstruction of a blood vessel by a blood clot that has become dislodged from another site in the circulation
state the 2 main examples of venous thromboembolism
limb deep vein thrombosis
pulmonary embolism
what is pulmonary embolism
it is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream
state 2 other examples of venous thromboembolism
visceral venous thrombosis
intracranial venous thrombosis
what are symptoms of deep vein thrombosis
pain, swelling and tenderness in your leg
a heavy ache in the affected area
warm skin in the area of the clot
red skin
what are common tests for DVT
ultrasound
d-dimer testing
venography
what is the most common test for diagnosing DVT
ultrasound, sound waves create images showing the blood flowing through the arteries and veins in the affected leg
what are symptoms and signs of pulmonary embolism
pleuritic chest pain dyspnoea haemoptysis tachycardia pleural rub on auscultation
what are symptoms and signs of massive pulmonary embolism
Severe dyspnoea (sudden onset) Collapse cyanosis Tachycardia Low blood pressure Raised JVP May cause sudden death
state tests for diagnosis of pulmonary embolism
wells score geneva score blood tests d-dimer tests CT pulmonary angiogram isotope ventilation/perfusion scan
what is the outcome of pulmonary embolism
most patient recover fully
development of pulmonary arterial hypertension
what are the aims of treatment of venous thromboembolism
prevent clot extension
prevent clot embolisation
prevent recurrent clot
what is the main treatment of pulmonary embolism
anticoagulation
what are the parental options of anticoagulation treatment of pulmonary embolism
unfractionated heparin
low molecular weight heparin
what are the enteral options of anticoagulation treatment of pulmonary embolism
warfarin
direct oral anticoagulants
what is another treatment for pulmonary embolism that isn’t anticoagulation treatment
thrombolysis
thrombolysis is reserved as treatment for massive pulmonary embolism
alteplase is a thrombolytic drug
describe prevention of venous thromboembolism in hospital
early mobilisation
anti-embolism stockings
mechanical methods of thromboprophylaxis
pharmacological thromboprophylaxis
