DVT

Question 1

DVT and PE

Answer 1

1/3 of pts with DVT have PE regardless if they have PE symptoms

Question 2

DVT and the heart

Answer 2

Large clots lead to RV dilation and myocardial damage, release of troponin and B-type natriuretic peptide
If these things are found risk of RV failure is increased

Question 3

PE presentation

Answer 3

Unexplained dyspnea
Pleurtic chest pain
Chest pain in thorax between clavicles and costal margin which increases with cough or breathing
3-4% syncope
1-2% new onset seizure

Question 4

Foramen ovale PE

Answer 4

20% of people have patent foramen ovale, during PE with R sided pressure increase the clots can pass from R atria to L and produce stroke like symptoms (paradoxical embolism syndrome)

Question 5

Physical exams for PE

Answer 5

Tachycardia, tachpnea, low SP02, mild fever (10%)

Vitals don’t mean much for PE though

Question 6

Clinical features of DVT

Answer 6

> 2cm between legs 10cm distal to tibial tubercle doubles likelihood of DVT
Hand/finger swelling, tenderness redness in affected extremity

Question 7

12 PE

Answer 7

If RV systolic pressure exceeds 40mmHg T-wave inversion in V1-V4, incomplete RBBB, classic (but uncommon) S1 Q3 T3

Question 8

RBBB

Answer 8

Wide QRS
Side slurred S wave laterally I, aVL, V5-V6
RSR in V1-V3 because of delayed RBB depol
No axis deviation just from RBBB
Incomplete is same findings without wide QRS (110-120ms)

Question 9

D-dimer PE

Answer 9

Best blood test to exclude VTE (venous thrombo embolism)
Fibrin breakdown liberates D-dimer through action of plasmin
Sensitivity 96% specificity 55%
D-dimer has 8 hour half life, can be elevated for 3+ days after VTE

Question 10

CT for PE

Answer 10

Specificity and sensitivty about 90%

Can also differentiate pneumonia

Question 11

PE TX

Answer 11

Heparin or better yet LMW heparin. Rivaroxaban is used. Stop the clot from getting worse let the body lyse it

Question 12

Massive PE

Answer 12

<90 SBP or <100 if HTN or 40% SBP drop
Submassive is normotensive with other cardiac findings
These two may get fibrinolysis