DVT

Question 1

vte

Answer 1

venous thromboembolic disease

Question 2

dvt

Answer 2

deep vein thrombosis - a thrombus formed in the deep venous circulation but can be anywhere
>clots form via venous valve pockets and other sites of presumed stasis

Question 3

pe

Answer 3

a clot that has embossed and lodged in the pulmonary circulation
>clot travels through the right side of the heart to block vessels in the lungs

Question 4

left side of the heart = arterial circulation

Answer 4

right side = venous circulation ie pulmonary arteries

Question 5

DVT - proximal !

Answer 5

distal = dvt of calves
proximal = dvt of popliteal vein or femoral vein (closer to the heart)

Question 6

quality of life

Answer 6

have significant worse perceptions of their health

> lower levels of physical functioning

Question 7

what is post thrombotic syndrome

Answer 7

30% people have it after proximal DVT

Question 8

virchow’s triad

Answer 8

endothelial injury -
venous disorders 
venous valvular damage
trauma or surgery
indwelling catheters
hypercoaguable state -
malignancy 
pregnancy and permpartum period
oestrogen therapy
inflammatory bowel disease
sepsis
thrombophilia
circulatory stasis -
LV dysfunction 
etc

Question 9

risk factors for vte

Answer 9

> surgery , trauma , acute medical illness , acute heart failure

> ageing

> smoking ! travel , combined oral contraception , hormone replacement , protein C/S deficiency
factor V leiden mutation , pregnancy , active malignancy , surgeries , prothrombin gene mutation

Question 10

how does vte present

Answer 10

dvt - painful and swollen limb with redness and heat
tenderness along vein subacute development - no other obvious cause
pe -

Question 11

pre test probability

Answer 11

how likely is it that the patient will have what you’re looking for
>there are scoring systems
>mod/high scoring then dvt likely so go straight to scan (ie no d-dimer)

Question 12

d-dimer blood test and vte

Answer 12

d-dimer is fibrin that has broken down
>high negative prediction values >98% for VTE
>low positive predictive value for vte
>valuable first line screening test for suspected VTE with low wells score
>25%-50% patients require no further investigations

Question 13

severity assessment - pe

Answer 13

pesi score + patient characteristics
because PEs can cause rh strain and pressure there can be risk of deterioration and death
severity assessment guides initial management

Question 14

dvt - severity assessment

Answer 14

clinical assessment of severity - almost all patients are managed as out patients

Question 15

management of dvt

Answer 15

oral anti coagulation ie thrombolysis

sometimes thrombolysis

Question 16

management of pe

Answer 16

thrombolysis the oral anticoagulants if high risk

low / med risk = oral anticoagulants

Question 17

what is thrombolysis

Answer 17

fibrinolysis ie aggressive clot destruction

Question 18

which anticoagulants

Answer 18

DOA = apodaban or rivaroxaban (these are the main ones - first line)
vit. K antagonist = warfarin
LMWH injections = still used in patients with active cancer and PE

Question 19

duration of treatment

Answer 19

provoked vte with reversible factor = 3-6 months
“ with irreversible factor = 3-6 months or life long depending on patients
unprovoked vte =

Question 20

post thrombotic syndrome

Answer 20

occurs in nearly 1/3 of patients within 5 years after dvt 
-PTS is characterised by :
pain 
oedema 
hyperpigmentation 
eczema 
varicose collateral veins 
venous ulceration

Question 21

CTEPH

Answer 21

serious complication of pe
5% get it after pe
initially asymptomatic and following progressive dyspnea and hyperaemia
RHF can frequently occur
progressive condition
… not the lungs but sort of cor pulmonale