PE and DVT Flashcards
virchows triad
stasis, hypercoagulability, vessel damage
what causes change in stasis
immobility
what causes vessel damage (dysfunction or damage)
hypertension, smoking, high cholesterol, indwelling venous catheters, trauma, surgery
what causes hypercoagulability
pregnancy, cancer, sepsis (all acquired). some inherited too
signs and symptoms of
painful, unilateral swelling, discomfort, infarction, calf tenderness, warmth, redness, prominent collateral veins, pitting oedema. can be clinically silent
embolisms can be
blood, tumour, air, fat. thromboembolism is blood
risk factors of DVT
surgery, late pregnancy, C section, cancer, lower limb fracture or varicose veins, reduced mobility, CVS issues, oestrogens eg contraceptive, COPD, obesity, thrombotic disorders,
prevention of `VTE on hospital
easy mobilisation, anti embolism stockings, pharmacological thromboprophylaxis
diagnosis of DVT
clinical assessment and Wells score
investigations for DVT
blood test- D dimer if low pre test probability score, compression ultrasound if positive d dimer. sometimes can get missed so if symptoms persist go back to GP
what is a D dimer
breakdown product of cross linked fibrin produced during fibrinolysis. highly sensitive for VTE but low specificity
symptoms and signs of PE
pleuritic chest pain, breathlessness, haemoptysis, rapid heart rate, pleural rub on auscultation usually due to pulmonary infarction
symtoms and signs of massive PE
severe dyspnoea, collapse, tachycardia, cyanosis, low BP, raised JVP, may cause sudden death
diagnosis of PE
clinical assessment and wells score or Geneva score but wells better, blood test and the imaging if D dimer positive or high pre test probability score - isotope ventilation perfusion scan and CT pulmonary angiogram
well score
two levels, its a test. if negative and blood test negative then it it is not DVT or PE
questions to ask in patients with VTE
was there a clear cause eg surgery or hospitalisation, any symptoms or signs to suggest underlying malignancy?, consider risk of recurrence- clinical risk, cancer patients, DASH score/ HERDoo2 etc
treatment of PE
anticoagulation eg 10A anticoagulants eg rivaroxiban or low molecular weight heparins (not of renal failure) or unfractionated heparin or warfarin, provoked- treat for 3 months then stop. unprovoked and his risk of recurrence- lifelong treatment
surgical treatment for PE
vascular surgical interventions with massive DVTs. thrombolysis reserved for massive PE eg alteplase
aims of treatment of VTE
prevent clot extension, prevent clot embolisation, prevent recurrent clot
potential long term consequence of DVT
post thrombotic syndrome- damage to venous valves, incidence of 20-60% within 2 years of DVT, just manage by bandaging and pain management, most recover fully, can get pulmonary hypertension but rare
