DVT/PE Flashcards
Deep vein thrombosis definition
Where a thrombus forms within the deep leg veins
Iliac veins or great saphenous vein
Pulmonary embolism definition
occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung.
They most often start in the legs (DVT) and travel up
Aetiology PE
The clot formation is associated with virchows triad
This overcoming the anticoagulant activity of the body can lead to thrombus formation
Clinical features PE
Sudden onset of unexplained dyspnoea (MC)
– often the only symptom in pulmonary embolism
Pleuritic chest pain and haemoptysis
– only present when infarction has occurred
Many PE occur silently.
There are 3 types:
– small/medium pulmonary embolism:
—- embolus has impacted in a terminal pulmonary vessel.
—- pleuritic chest pain and breathlessness
—- haemoptysis occurs in 30%, often more than 3 days after the initial event
– massive pulmonary embolism:
—- much rarer, where there is a sudden collapse because of an acute obstruction of the right ventricular outflow tract
—- severe chest pain and becomes shocked, pale and sweaty
—- syncope may result if the cardiac output has been dramatically reduced
—- raised JVP
– multiple recurrent pulmonary embolism:
—- leads to increased breathlessness
—- accompanied by weakness, syncope on exertion and occasionally angina
Investigations
Chest x-ray
ECG
Blood tests- elevated ESR
Plasma D-dimer
Treatment
Acute management:
– pt should receive high-flow oxygen (60-100%), unless they have significant chronic lung disease.
Fibrinolytic therapy- such as streptokinase.
Massive pulmonary embolism has IV fluids and even intrepid agents to improve the pumping of the right heart
Prevention of further emboli:
– pt anti coagulated with vitamin K antagonists for a period of 3-6 months.
– pts with cancer or pregnant women should be treated with long-term low-molecular-weight heparin.
