DVT and PE Flashcards
Most common preventable cause of death among hospitalized patient (Harrison pp 1631)
Pulmonary Embolism
Compromises Virchow’s triad (Harrison pp 1631)
Endothelial injury
Hypercoagulability
Inflammation
Microparticles contain proinflammatory mediators that bind neutrophils and forms web like extracellular matrix (Harrison pp 1631)
Neutrophil extracellular traps
Two most common autosomal dominant genetic mutations (Harrison pp 1631)
Factor Leiden V
Prothrombin gene mutation
Most common acquired cause of thrombophilia (Harrison pp 1631)
Antiphospholipid antibody syndrome
Predisposing factors for DVT (Harrison pp 1631)
Cancer COPD CKD Obesity Cigarette smoking Systemic Arterial hypertension Blood transfusion Long haul air travel Oral contraceptives Pregnancy
Most common gas exchange abnormalities in Pulmonary Embolism (Harrison pp 1631)
Arterial hypoxemia
Increased alveolar arterial O2 tension gradients
What other pathophysiologic abnormalities found in PE? (Harrison pp 1631)
AID Alveolar hyperventilations Increased pulmonary vascular resistance Impaired gas exchange Increased airway resistance Decreased pulmonary compliance
Affect half of the pulmonary vasculature
Hallmark: dyspnea, syncope, hypotension and cyanosis (Harrison pp 1632)
Massive PE
RV dysfunction despite Normal systemic arterial pressure (Harrison pp 1632)
Submassive PE
Upper DVT is precipated by the following: (Harrison pp 1632)
Pacemaker
Internal cardiac defibrillator
Indwelling central venous
Palpable cord with DVT (Harrison pp 1632)
Superficial venous thrombosis
Most common symptom of PE (Harrison pp 1632)
Unexplained breathlessness
Most common symptom of DVT (Harrison pp 1632)
Crampy
Charley Horse
What is the sensitivity of D-dimer? (Harrison pp 1632)
DVT > 80%
PE > 95%
What conditions are associated with elevated D-dimer? (Harrison pp 1632)
Myocardial Infarction Sepsis Pneumonia Cancer Post operative states 2nd to 3rd trimester of pregnancy
Clinical variables associated with DVT (Harrison pp 1632)
Active Cancer
Paralysis, paresis and recent cast
Bedridden for 3 days, Underwent MAJOR surgery < 12 weeks
Tenderness along distribution of deep vein
Entire leg swelling
Unilateral calf swelling ≥ 3 cm
Pitting edema
Collateral superficial non varicose veins
Clinical variables associated with PE (Harrison pp 1632)
Signs and symptoms of DVT Alternate diagnosis less likely HR > 100/min Immobilization > 3 days Surgery within 4 weeks Prior PE or DVT Hemoptysis Cancer
Most frequently cited ECG with PE (Harrison pp 1633)
Sinus tachycardia
12 lead ECG findings relatively specific but insensitive of PE (Harrison pp 1633)
S1Q3T3
What is the primary criterion for DVT in venous ultrasonography? (Harrison 1633)
NO Wink
Loss of vein compressibility
What chest findings seen in Pulmonary embolism? (Harrison pp 1633)
Western’s mark - focal oligemia
Hampton’s hump - wedge shape
Palla’s sign - inc R pulmonary artery
What is the primary/principal imaging test for PE? (Harrison pp 1633)
Chest CT Scan
Best known indirect sign of PE on TEE (Harrison pp 1634)
Mc Connell’s sign: Hypokinesis of the RV free wall or hyperkinetic motion of the RV apex.
Stocking for DVT should be prescribed with ____ mmHg (Harrison pp 1634)
30-40 mmHg for 2 years
What is the treatment of choice for normotension with RV hypokinesis? (Harrison pp 1634)
Individualized therapy (primary or secondary)
What is the management for pulmonary thromboembolism with hypotension? (Harrison pp 1634)
Primary therapy
- Anticoagulation plus thromboembolysis
- Embolectomy catheter/ surgery
How should unfractionated heparin be given? (Harrison pp 1635)
80 u/kg via bolus then 18 u/kg/hr
Anti Xa pentasaccharides (Harrison pp 1635)
Fondaparinux
The most serious adverse effect of anticoagulation (Harrison pp 1635)
Hemorrhages
What is the duration of anticoagulant for DVT of upper extremities? (Harrison pp 1635)
3 months
What is the duration of anticoagulant for proximal DVT or PE? (Harrison pp 1635)
3-6 months
What is the duration of anticoagulant with CANCER and VTE? (Harrison pp 1635)
Indefinitely
What are the 2 principal indications for insertion of IVC filter? (Harrison pp 1636)
Active bleeding the precludes anticoagulation
Recurrent venous/ thrombosis despite intensive anticoagulation
Most common IVC filter described as marked bilateral swelling (Harrison 1636)
Caval thrombosis
What is the 1st line inotropic agents for treatment of PE related shock? (Harrison pp 1636)
Dopamine and Dobutamine
Only food and drug administration approved indications for PE fibrolysis (Harrison pp 1636)
Massive PE
Most common form of in hospital prophylaxis (Harrison pp 1636)
Low dose of UFH or LMWH
