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Respiratory System > DVT and PE: Venous thromboembolism > Flashcards

DVT and PE: Venous thromboembolism Flashcards

1
Q

What is a thrombus composed of?

A

Fibrin
Platelets
RBC

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2
Q

How do a thrombus form?

A

Damage to endothelium, cancer, infection -> activation of platelets, turning them into sticky platelets and aggregate in endothelium, becoming foundation on which a thrombus can be formed on

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3
Q

What is the cause of white thrombus in arterial system?

A

Usually rupture atherosclerotic plaques in arteries and L side of heart

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4
Q

What conditions can arise form arterial thrombosis?

A

ACS
Ischaemic stroke
Limb claudication / ischaemia

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5
Q

What conditions can arise from venous thrombosis?

A

DVT

Pulmonary embolism

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6
Q

What is the cause of red thrombus formation in the venous system?

A

Virchow’s triad and results in back pressure

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7
Q

What are the 3 factors in Virchow’s triad?

A

Changes to vessel wall (damage)
Changes to blood constituents (hypercoagulability)
Pattern of blood flow (stasis)

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8
Q

What can cause stasis of the blood?

A

Immobility

Long haul flights

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9
Q

What can cause hypercoagulability?

A 
Inherited 
Pregnancy
Cancer
Recent trauma/surgery 
Sepsis
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10
Q

What can cause endothelial dysfunction?

A

Hypertension
Smoking
High cholesterol

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11
Q

What can cause endothelial damage?

A

Catheters
Trauma
Surgery

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12
Q

Define embolism

A

Intravascular material that migrates from its original location to a distal vessel (thrombus, fat, air, tumour)

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13
Q

Define thromboembolism

A

Movement of a thrombus along a vessel

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14
Q

What are 2 examples of venous thromboembolism?

A 
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)

Visceral VT
Intracranial VT

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15
Q

What are the symptoms of DVT?

A

Unilateral limb swelling
Persisting discomfort
Calf tenderness

Warmth
Erythema (redness)
Prominent collateral veins
Pitting oedema

May be clinically silent

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16
Q

What can long-term DVT cause?

A

Post-thrombotic syndrome - damage to venous valves

17
Q

What are the symptoms of post-thrombotic syndrome?

A

Swelling
Discomfort
Pigmentation
Ulceration if severe

18
Q

How is DVT diagnosed?

A

Clinical assessment and pretest possibility score (wells score)
Blood test: D-dimer if low pre-test score
Imaging: Compression ultrasound - if high pretest score or positive D-dimer

19
Q

What is D-Dimer?

A

Breakdown product of cross-linked fibrin

20
Q

What are the symptoms of PE?

A

Pleuritic chest pain
Dyspnoea
Haemoptysis

21
Q

What are the signs of PE?

A

Pleural rub on auscultation (due to pul. infarction)

22
Q

What are the signs of a massive PE?

A 
Acute severe dyspnoea 
Collapse 
Cyanosis 
Tachycardia 
Hypotension 
Elevated JVP 
Sudden death
23
Q

How is PE diagnosed?

A

Clinical assessment and pretest probability (Wells and Geneva score)
Blood test: d-dimer if low test probability
Imaging: V/Q scan or CT pul. angiogram - if D-dimer positive or pretest high

24
Q

What can prolonged PE cause?

A

Most fully recover

Pulmonary arterial hypertension

25
Q

What are the aims of treatment of VTE?

A

Prevent clot extension
Prevent clot embolisation
Prevent recurrent clot

26
Q

What is main treatment of VTE?

A

Anticoagulation
Parental: unfractionated or LMW heparin
Enteral: warfarin, direct oral anticoagulants (DOAC)

27
Q

What treatment is given for massive PE?

A

Thrombolysis (alteplase)

28
Q

What lines of prevention are taken for PE in hospital?

A

Early mobilisation
Anti-embolism stockings
Thromboprophylaxis - mechanical and pharmacological

29
Q

How does pulmonary infarction develop from a PE?

A

Blockage of branch of pulmonary artery = increase pulmonary pressure
Force in branch too weak to dislodge
Leakage of blood into alveolar spaces -> infarction

Respiratory System (29 decks)

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