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F2 E3 Shea > DVTs and PEs > Flashcards

DVTs and PEs Flashcards

1
Q

Most common EKG abnormality for PE (pulmonary emboli)?

A

Sinus Tachycardia

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2
Q

Over 90% of acute PE cases are due to what?

A

Emboli originating from lower extremity DVTs

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3
Q

What is Virchow’s Triad?

A
  • Vessel wall injury
  • Hyper-coagulability
  • Venous stasis
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4
Q

2 most common hypercoagulable states as risk factors for VTE (venous thromboembolism)

A
  • Factor V Leiden mutation
  • Prothrombin gene mutation
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5
Q

3 things which cause DVT in extremities

A
  • injury
  • stasis
  • prothrombotic status
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6
Q

Common vessel of DVT in leg

A

Femoral Vein (previously superficial femoral vein)

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7
Q

If a DVT and PE occur simultaneously, which one is symptomatic and which is asymptomatic?

A

Symptomatic DVT

Asymptomatic PE

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8
Q

What syndrome occurs if DVT is untreated?

A

Post-thrombophlebitic syndrome

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9
Q

What is a common risk factor that causes UE DVT?

A

Catheter placement

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10
Q

What is a useful scoring system for DVT if there is no quick US available?

A

Wells Criteria

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11
Q
  • What lab test is helpful if NEGATIVE for diagnosing DVT?
  • Sensitivity of 97%
  • Specificity of 45%
A

D-dimer

(endogenous fibrinolysis almost always causes the release of D-dimers from fibrin clot in presence of DVT/PE)

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12
Q

4 causes of elevated D-dimer

A
  • Venous thromboembolic diseaes (DVT / PE)
  • Post operative state
  • Malignancy
  • Normal pregnancy
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13
Q
  • Test of choice for DVT?
  • Test no commonly used?
A
  • Compression US (veins should normally collapse, but will not collapse if DVT is there)
  • Contrast venography
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14
Q

What is our main reason for treating DVT?

(ON EXAM)

A

Prevent PE

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15
Q

3 timing classifications of PE

A
  • Acute - (24 to 48 hrs)
  • Subacute - (days to weeks)
  • Chronic (months to years)
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16
Q

PE associated w/ SBP <90 or drop in SBP of greater than 40 for over 15 minutes

A

Massive PE

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17
Q

PE associated w/ pt not being hypotensive, but has either RV dysfunction or myocardial necrosis

A

Submassive PE

18
Q

Small or low risk PE

A

Non-massive PE

19
Q
  • Main symptom of PE
  • Main sign of PE
A

Sxs: SOB or dyspnea

Signs: Tachypnea

20
Q

Troponin is increased in pts w/ DVT or PE?

A

PE (57% of pts)

21
Q

EKG sign “classic” for PE? BUT, only seen in <10% of pts

22
Q

What is a pathognomic CXR finding for PE? (but is a very rare finding)

A

Hampton’s Hump

(pleura based shallow wedge shaped consolidation in lung periphery)

23
Q

What is this?

Usually occurs in pts w/ pre-existing cardiopulmonary disease.

A

Pulmonary Wedge Sign

24
Q

A V/Q scan to dx PE is positive if there is a 1 or greater “____”

A

Mismatch (ventilation, but no perfusion)

25
Q
A

Left pulmonary artery PE on CTA (CT angiogram)

26
Q

What is the gold standard diagnostic test of a PE?

(highly specific/sensitive)

A

Angiogram

(but is not used frequently due to new generation CTs)

27
Q

What is not a routine diagnostic test for PE, but is widely used to identify right heart hemodynamic changes that indirectly suggest PE & for prognostication?

A

Echocardiography

(commonly used to see RV failure)

28
Q

What is the initial tx of VTE? (most commonly used)

A

IV Unfractionated Heparin

(inhibits clotting cascade by inactivating thrombin)

29
Q

Antidote for Heparin / Reversal

30
Q

What med is given for outpatient tx of DVT / Stable PE?

A

Low Molecular Weight Heparin

31
Q

What med for long term tx of VTE?

Is pregnancy category X

A

Warfarin

(acts on liver to block vitamin K dependent synthesis coagulant proteins)

32
Q

During the first few days the patient is on Warfarin pt is ______, so Heparin is a bridge when starting Warfarin.

A

Hypercoagulable

33
Q

What med for DVT, PE, and non-valvular A-fib?

A

NOACs / DOACs

(factor Xa or direct thrombin inhibitor)

Antidote: PCC

34
Q

Which drug?

  • Activate plasminogen to form plasmin, resulting in the accelerated lysis of thrombi
  • Used for unstable pts w/ PE
A

Thrombolytics

(Streptokinase, Urokinase)

35
Q

What tx will prevent DVT from propagating to lungs?

A

IVC filter

(absolute contraindication to anticoagulation)

36
Q

3 Prophylactic Measures

A
  • SCD (Sequential compression devices)
  • TED hose (thromboembolic deterrent)
  • Low dose SQ Heparin
37
Q

Can a clinically stable pt w/ DVT or PE be tx outpatient?

A

Yes, give Lovenox or NOACs

38
Q

Who is responsible for monitoring pts anticoagulation?

A
  • PCP
  • Cardiologist
39
Q

Pretest Probability scores for PE based on Wells Criteria

  • High
  • Moderate
  • Low
A
  • High: >6
  • Moderate: 2-6
  • Low: <2
40
Q

Pretest Probability scores for PE based on Wells Criteria

  • High
  • Moderate
  • Low
A
  • High: 3 or greater
  • Moderate: 1-2
  • Low: 0

F2 E3 Shea (16 decks)

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