DVT and VE (VTE) Flashcards
How does the location of embolus differ between DVT and PE
DVT = Deep leg vein PE = Pulmonary artery circulation
Which lower calf veins are affected by DVT
Anterior and Posterial Tibial veins
Which upper calf veins are affected by DVT
Superficial femoral
What are the 3 components of Virchow’s Triad
Hypercoagulability
Venous stasis
Endothelial Injury
What are some factors affecting hypercoagulability
Pregnancy
Obesity
Sepsis
Malignnacy
What is venous stasis
Aggregation of clotting factors affecting laminar flow
What factors affect venous stasis
Immobility (flights and surgery)
What can cause endothelial injury
Smoking
Trauma
Surgery
What does the endothelium secrete and what happens if it is damaged
Can no longer secrete Anticoagulant chemicals
What complication can arise from PE
Cor Pulmonale
How does Cor Pulmonale occur as a result of PE
Increase PVR
Increase RV strain
RVH
RV fails (Increased Pulmonary pressure)
What kind of Chest pain does PE present with
Pleuritic chest pain
What are the Presentations of PE
Sudden Pleuritic chest pain Dyspnoea (+-Haemoptysis) DVT evidence Tachycardia w/Hypotension Raised JVP and Ankle oedema Wells >4
What are the presentations of DVT
Unilateral swollen calf
Warm veins with oedema
Complete leg occlusion = Phlegmasia cerulean dolens
Wells >1
What is phlegamsia Cerulean dolens
Complete leg vein occlusion by DVT
How does the Wells Score for diagnosis change between PE and DVT
PE >4
DVT >1
How can PE be diagnosed
D Dimer and CT Pulmonary Angiography ECG (S1 Q3 T3) = Cor Pulmonale -T Inversion of anterior/inferior leads -New RBBB CXRAY = Normal
How can DVT be diagnosed
D Dimer and Duplex Ultrasound
Wells Score
How is a patient manage if they have a wells score less than 1 for DVT
D Dimer
-If raised do Duplex Ultrasound
How is a patient managed if they have a Well’s score 1+
Duplex Ultrasound
What is the gold standard investigation fro DVT
Duplex ultrasund
What is the gold standard investigation for PE
D Dimer and CTPA
How is a patient managed if they have a PE Wells score greater than 4
CTPA (Gold)
How is a PE Patient managed if they have a Wells Score less than 4
D dimer
-If raised do CTPA
What does the D Dimer test for
Measures Clot Burden
-Protein released if blood clot fibrolyses
Why is D Dimer not diagnostic
It is raised in many conditions (Not specific)
But it is Sensitive
How is non massive PE treated
DOAC (Anticoagulation)
1st = Apixaban/Rivoroxaban
If CI w/ renal impairment give LMWH
How is a massive PE treated
Clot buster Alteplase (Thrombolytics)
How is a DVT treated (Like non massive PE)
DOAC Anticoagulation
1st = Apixaban/Rivoroxaban
CI w/Renal impairment give LMWH
How can a DVT patient be non medically managed
Compression stocking
Mobilisation
What is the Differential for DVT
Cellulitis (Skin infection by S Aureus and S Pyogenes)
-Tender inflamed calf w/ Leukocytosis (DVT will have D Dimer and normal inflammation levels)
