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Finals - CardioResp > DVT and PE > Flashcards

DVT and PE Flashcards

1
Q

How can a DVT lead to a PE?

A

Embolises from deep veins, through right side of the heart and into the lungs where it becomes lodged in the pulmonary arteries

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2
Q

In what instance may a DVT lead to a stroke?

A

ASD

Clot can pass through to the left side of the heart into the systemic circulation to brain

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3
Q

List 4 risk factors for DVT/ PE

A
  1. Immobility
  2. Recent surgery
  3. Long haul flights
  4. Pregnancy
  5. COCP and HRT
  6. Malignancy
  7. Polycythaemia
  8. SLE
  9. Thrombophilia
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4
Q

List 2 examples of a Thrombophilia

A
  1. Antiphospholipid syndrome
  2. Antithrombin deficiency
  3. Protein C or S deficiency
  4. Factor V Leiden
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5
Q

VTE prophylaxis in hospital

A

Every patient admitted to hospital should be given LMWH eg. Dalteparin unless contraindicated

Anti-embolic compression stockings are also used unless contraindicated

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6
Q

List 2 contraindications for VTE prophylaxis

A
  1. Active bleeding
  2. Existing anticoagulation with warfarin or a NOAC
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7
Q

When are compression stockings contraindicated?

A

Significant peripheral arterial disease

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8
Q

What is the Wells score?

A

Predicts the risk of a patient with symptoms, actually having a DVT or PE

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9
Q

How does a DVT present?

A
  1. Unilateral warm, swollen calf or thigh
  2. Pain on palpation of deep veins
  3. Distention of superficial veins
  4. Pitting oedema
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10
Q

List 2 differentials for bilateral symptoms of DVT

A

More likely due to chronic venous insufficiency or heart failure

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11
Q

How to we examine/determine leg swelling?

A

Measure the circumference of the calf 10cm below the tibial tuberosity

3cm difference between calves is significant

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12
Q

What are the criteria for the DVT Wells score?

A
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13
Q

Investigations for a suspected DVT?

A
  1. D-dimer
  2. Doppler ultrasound of the leg ☆
  3. Digital subtraction or CT/MR venogram
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14
Q

What is the clinical relevance of D-dimer in diagnosis of DVT or PE?

A

↑Sensitivity, ↓ Specificity

Useful for excluding VTE in low clinical suspicion. ie. if negative VTE is extremely unlikely

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15
Q

List 4 causes of raised D-dimer

A
  1. PE/DVT
  2. Pneumonia
  3. Malignancy
  4. Heart failure
  5. Surgery
  6. Pregnancy
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16
Q

Management of a DVT?

A
  1. Initially: LMWH as soon as DVT suspected eg. enoxaparin and dalteparin
  2. Switch to long term anticoagulation: warfarin, NOAC or LMWH
17
Q

List 3 examples of NOACs

A

apixaban, dabigatran and rivaroxaban

18
Q

What is meant by an Unprovoked DVT

How is it investigated?

A

First instance of VTE without a clear cause

NICE recommend investigating them for possible cancer and testing for antiphospholipid syndrome

19
Q

How does a PE present?

A
  1. SOB
  2. Cough +/- haemoptysis
  3. Pleuritic chest pain
  4. Hypoxia
  5. Tachycardia
  6. Raised RR
  7. Low grade fever
  8. Hypotension
20
Q

What are the criteria for the PE Wells score?

A
21
Q

Investigations for a suspected PE?

A

Perform Wells score and proceed based on:

  • PE Likely: CT pulmonary angiogram
  • PE Unlikely: D-dimer, if positive perform a CTPA
22
Q

What ABG findings are typically seen in a PE

Explain

A

Respiratory alkalosis

High RR causes them to “blow off” extra CO2, blood becomes alkalotic

23
Q

Management of a PE?

A
  1. Supportive: O2, Analgesia, monitoring
  2. Initially: Apixaban or rivaroxaban as soon as PE suspected
  3. Switch to long term anticoagulation: warfarin, NOAC or LMWH
24
Q

How long should anticoagulation be continued for following a DVT or PE?

A
  • 3 months if there is an obvious reversible cause
  • > 3 months if cause is unclear, recurrent VTE or irreversible cause
  • 6 months in active cancer
25
Q

Which anticoagulant is the first line treatment in pregnancy or cancer?

A

LMWH

26
Q

What is an Inferior Vena Cava Filter?

A
  1. Used for recurrent PEs OR
  2. If unsuitable for anticoagulation
27
Q

How is a massive PE with haemodynamic compromise managed?

A

Thrombolysis via

  • IV using a peripheral cannula.
  • catheter-directed thrombolysis (directly into pulmonary arteries )
28
Q

List 3 examples of thrombolytics

A

streptokinase, alteplase and tenecteplase

29
Q

What is Budd-Chiari Syndrome?

A

Thrombosis develops in the hepatic vein, blocking the outflow of blood

Causes an acute hepatitis

30
Q

Triad of Budd-Chiari?

A
  1. Abdominal pain
  2. Hepatomegaly
  3. Ascites
31
Q

Treatment of Budd-Chiari?

A
  1. Anticoagulation (heparin or warfarin)
  2. Investigate underlying cause of hyper-coagulation
  3. Treat hepatitis
32
Q

Treatment of Budd-Chiari?

A
  1. Anticoagulation (heparin or warfarin)
  2. Investigate underlying cause of hyper-coagulation
  3. Treat hepatitis

Finals - CardioResp (18 decks)

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