PE & DVT

Question 1

Symptoms of a PE

Answer 1

dyspnoea (most common symptom)
pleuritic chest pain
cough
fatigue

-small PE may not give symptoms

Question 2

Other key diagnostic factors for PE

Answer 2

Hypoxaemia 
Signs of a DVT (usually in one leg)
Other risk factors - active cancer, recent surgery/hospitalisation, pregnancy/6 weeks post-partum
Positive wells score
Failure to meet PERC criteria

Question 3

Definitive diagnostic investigation for PE is

Answer 3

CT pulmonary angiography

Question 4

Besides CT pulmonary angiography, another important diagnostic test for PE is

Answer 4

Elevated D-dimer level in blood (but can be elevated for other reasons)

Question 5

What does heamodynamic instability mean?

Answer 5

Perfusion failure shown by the clinical feature of circulatory shock or advanced heart failure

Question 6

How can a large PE be treated?

Answer 6

thrombolytic enzymes

surgical removal via pulmonary thrombectomy

Question 7

Long term treatment to prevent another PE

Answer 7

anti-coagulants - heparin, warfarin

Question 8

What is Virchows triad?

Answer 8

Factors which lead to DVT;

1. slowed blood flow/stasis (caused by turbulant flow, inactivity of skeletal muscle pump, pregnancy - baby compressing veins)
2. hypercoagulation (altered amount of clotting factors - can be caused by damage to vessels during surgery, contraceptive pill)
3. damage to blood vessels - infection, toxins (eg. tobacco), chronic inflammation

Question 9

How would a thrombus from a DVT bypass the lungs and get into the left ventricle?
Where could it go from here?

Answer 9

via an atrial septal defect

the brain - embolic stroke

Question 10

How would you investigate a DVT

Answer 10

Wells score: =/>2 then DVT likely -> image; if <2 then DVT unlikely do D-dimer test

D-dimer test: elevated then image, normal (in combo with wells score <2) the DVT ruled out

Imaging: proximal duplex ultrasound or whole leg ultrasound - looking for inability to fully compress vein lumen with ultrasound transducer, slow blood flow