DVTPE

Question 1

Stasis

Answer 1

Alterations in normal blood flow

Question 2

Stasis Examples

Answer 2

Turbulence in blood flow, blood stasis, heart valve disorders (e.g. Mitral stenosis) and cardiac regurgitation

Question 3

Vessel Injury

Answer 3

Injuries and/or trauma to the endothelium; exacerbated by hypertension

Question 4

Hypercoagulability

Answer 4

Alterations in the blood dynamics that favors blood clotting

Question 5

Hypercoagulability Examples

Answer 5

Age, smoking status, obesity, decreased physical activities, drugs, pregnancy, and cancer

Question 6

Virchow’s Triad

Answer 6

Blood Stasis, Vessel Injury, and Hypercoagulability

Question 7

Venous (red) Clots

Answer 7

1. Low pressure, typically due to blood stasis
2. Venous clot
3. Fibrin mediated
4. Red clot

Question 8

Arterial (white) Clots

Answer 8

1. High pressure, typically due to underlying vessel disease
2. Arterial clots
3. Platelets predominate
4. White clot

Question 9

Venous Thrombosis Types

Answer 9

Deep Vein Thrombosis (DVT)
Pulmonary Embolism (PE)
portal vein thrombosis
renal vein thrombosis
others

Question 10

Venous Thrombosis Mediation

Answer 10

Clotting factor mediated

Question 11

Arterial Thrombosis Types

Answer 11

Ischemic Stroke
Atrial arrhythmia (atrial fibrillation) --> Can develop into IS
Myocardial Infarction
Heart valve abnormalities
others

Question 12

Arterial Thrombosis Mediation

Answer 12

Platelet activation mediated

Question 13

Venous Thromboembolism/ DVT

Answer 13

Formation of a blood clot within a deep vein

Question 14

Venous Thromboembolism/ DVT Signs

Answer 14

Swelling, pain, and redness near affected area

Question 15

Venous Thromboembolism/ DVT Prevalence

Answer 15

Up to 2 million/ year

Associated with hospital stays, immobility, recovery periods, and fracture

Question 16

Venous Thromboembolism/ DVT Risks

Answer 16

Age, obesity, pregnancy medications (estrogen in OCP’s)

Question 17

Venous Clots: Superficial Thrombophlebitis (vericose veins)

Answer 17

Inflammation in vein that are on top of muscle

Pain, clotting occurs locally (clots do not travel away from site)

Question 18

Venous Clots: Deep Vein Thrombosis

Answer 18

Tucked underneath the muscles, more blood flow

Question 19

Pulmonary Emboli: venous clot origin

Answer 19

Blockage of the pulmonary artery or one of its branches when a deep vein clot migrates through the heart

Question 20

PE outcome

Answer 20

Severe cases can lead to pulmonary insufficiency, circulatory collapse, and sudden death (200,000 deaths/ year)

Question 21

DVT Signs and Symptoms

Answer 21

Leg pain, warmth, swelling, redness, tenderness, discoloration, edema
Most often in lower extremities

Question 22

PE Signs and Symptoms

Answer 22

Sudden onset of unexplained dyspnea (labored breathing) and cough, tachypnea (abnormal, rapid breathing), chest pain, anxiety, hemoptysis (coughing up blood), circulatory collapse (hypotension, syncope, coma), death

Question 23

Venothromboembolism (DVT and PE) Treatment

Answer 23

1. Prophylactic following surgery or inactivity: resume some movement of lower extremities, maintain healthy lifestyle, and lose weight
2. Oral anticoagulants (OAC): Warfarin (Coumadin), Dabigatran (Pradaxa), Rivaroxaban (Xarelto), etc.
3. Compression Stockings

Question 24

A Fib and Risk of Stroke

Answer 24

Approximately 15% of all strokes cause by AF
3-5x increased risk of stroke with AF
AF can be asymptomatic and stroke risk still present
Assess risk to determine prophylactic drug therapy (CHADS2 score)

Question 25

CHADS2

Answer 25

``` C - Recent CHF (Score: 1) H - Hypertension (1) A - Age 75 or older (1) D - Diabetes mellitus (1) S2 - History of stroke of TIA (2) ```

Question 26

CHADS2 Stroke Rate %

Answer 26

``` 0 - 1.9% 1 - 2.8% 2 - 4.0% 3 - 5.9% 4 - 8.5% 5 - 12.5% 6 - 18.2% ```

Question 27

Stroke Prevention based on CHADS2

Answer 27

0 - No therapy | 1- Aspirin (81-325 mg QD), Oral Anticoagulation w/ Warfarin (INR 2.5), or new novel anticoagulants (NOAC's)