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Cardiovascular > Venous Disease > Flashcards

Venous Disease Flashcards

1
Q

What are the 3 elements of Virchow’s triad?

A

Stasis

Hypercoagulability

Endothelial damage

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2
Q

What is a deep vein thrombosis?

A

Blood clot/thrombus within the deep veins

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3
Q

What can cause a DVT?

A

Surgery

Varicose veins

Reduced motility

Genetics

  • Inherited thrombophilia
  • Factor 5 Leiden

Pregnancy

Drugs

Malignancy

Dehydration

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4
Q

What drugs can cause a DVT?

A

COCP

Tamoxifen

Raloxifene

Hormone replacement therapy

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5
Q

How does a DVT present?

A

Persisting discomfort

Unilateral limb swelling

Calf tenderness

Erythema

Warmth

Prominent collateral veins

Unilateral pitting oedema

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6
Q

What investigations are used in DVT diagnosis?

A

D-Dimer

Doppler US

  • If wells score is over 2, US within 4 hours

Venography

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7
Q

What is a D-Dimer test?

A

Test for fibrin degradation product produced during fibrinolysis

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8
Q

What is the management of a DVT?

A

Anticoagulation

Thrombectomy

Thrombolysis

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9
Q

Describe management of DVT if patient has begun DOAC, d dimer is positive but US is negative?

A

Stop anticoagulation and repeat scan in 1 week

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10
Q

How can DVTs be prevented?

A

Early mobilisation

Anti-embolisation stockings

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11
Q

Give complications of DVT

A

Post Thrombotic Syndrome/damage to venous valves

Valvular Incompetence/venous insufficiency

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12
Q

How does valvular incompetence/venous insufficiency present?

A

Swelling

Discomfort

Brown/red discolouration

Ulceration

Dry skin

Varicose veins

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13
Q

What are varicose veins?

A

Torturous/twisted dilated superficial veins that occur secondary to incompetent venous valves, allowing blood to flow back, away from the heart

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14
Q

Name some risk factors for varicose veins

A

F>M

Age

Obesity

Pregnancy

Trauma

Previous DVT

Prolonged standing

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15
Q

How do varicose veins present?

A

Present for cosmetic reasons

Pruritis

Nocturnal cramps/aching

Hyperpigmentation/Darkening of skin

Ulceration

Bleeding

Swelling

Lipodermatosclerosis/hard tight skin

Superficial thrombophlebitis

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16
Q

What is the management of varicose veins?

A

Conservative

  • Leg elevation
  • Weight loss
  • Regular exercise
  • Graduated compression stockings

Endothermal ablation

Foam sclerotherapy

  • Irritant foam causes inflammatory response and closure of vein

Surgery

  • Ligation
  • Stripping
17
Q

Give complications of varicose veins

A

Acute haemorrhage

Superficial Thromboemblitis

18
Q

Give indications to refer varicose veins to secondary care

A

Significant/troublesome lower limb symptoms, such as pain or swelling

Previous bleeding from varicose veins

Skin changes secondary to chronic venous insufficiency

Superficial thrombophlebitis

Active or healed venous leg ulcer

19
Q

What is superficial thrombophlebitis?

A

Describes the inflammation associated with thrombosis of one of the superficial veins, usually the long saphenous vein of the leg

This process is usually non-infective in nature but secondary bacterial infection may rarely occur resulting in septic thrombophlebitis

20
Q

What conditions are associated with superficial thrombophlebitis?

A

DVT

  • 20% of patients will also have an underlying DVT at presentation

Varicose veins

21
Q

How is superficial thrombophlebitis managed?

A

NSAIDS

  • Topical for limited/mild disease and oral for more severe

Compression stockings

LMWH

  • Mainly for DVT prophylaxis
22
Q

Describe venous ulcers

A

Painless

Shallow

Large

Medial calf

Irregular granulomatosis base

23
Q

Describe arterial ulcers

A

Painful

Deep

Small

Pressure areas such as heels, base of big toe

Well defined punched out lesions

Reduced pulses

24
Q

Describe neuropathic ulcers

A

Punched out

Soles, heels, toes

Painless

Small

Deep

Sensory loss

Debridement

25
Q

Describe the management of venous ulcers

A

Rule out arterial with ABPI

Compression bandaging, usually four layer

Oral pentoxifylline, a peripheral vasodilator that improves healing rate

26
Q

Give features of paradoxical embolus

A

Thromboembolism travelling from IVC to left heart circulation

DVT features followed by acute limb ischaemia

Cardiovascular (12 decks)

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