Thromboembolic Venous Disease

Question 1

What accounts for the majority of embolic events?

Answer 1

Deep veins of the LE above the knee, pelvic and abdominal venous structures

Question 2

What is Virchow’s triad?

Answer 2

Vascular injury
Venous stasis
Hypercoaguable state

Question 3

Discuss Ventilation/Perfusion Mismatch

Answer 3

1. Some areas of the lung is not receiving blood flow leading to Impaired gas exchange.
2. Pulmonary edema results from decreased surfactant production by Type 2 pneumocytes

Question 4

How can pressure overload in the RV and PA lead to thromboembolism?

Answer 4

1. RV pressure overload causes bulging of septum and decreased amount of preload available to LV
2. PA pressure overload causes pulmonary hypertension and decreases lung ability to oxygenate
3. <33% occlusion needed in pts with comorbid conditions to cause RV strain

Question 5

Symptoms of Thromboembolism

Answer 5

Hemoptysis
Pleuritic Chest pain
Dyspnea

Question 6

What test has a perfect negative predictive value for thromboembolic disease?

Answer 6

D-Dimer(Fibrin split product)

Question 7

How is thromboembolic disease diagnosed and treated?

Answer 7

Spiral ct; Heparin