Venous thrombo embolic disease Flashcards
Thrombus ( blood clot)
a blood clot which forms within a vein
deep vein thrombosis
a blood clot forms within the deep veins of the leg or pelvis
pulmonary embolism
thrombus dislodges and travels to pulmonary arteries via right side of the heart and ends up occluding a small pulmonary artery of the lungs
Venous thromboembolism
includes both a DVT and PE
Virchows triad - causes of clotting
- local trauma to the vessel wall
- Hyper coagubility
- Stasis of blood flow
Risk factors of clotting
- cancer/malignancy
- Obesity
- Post partum pregnancy
- Journey of more than 4 hours/ prolonged bed rest
- Hyper coagubility
Complications of dvt
- pulmonary embolism
- chronic leg swelling
Symptoms of pulmonary embolism
- shortness of breath (dyspnea)
- Leg swelling
- Pleuritic chest pain
BIGGER THE PE, MORE CVS SYMPTOMS
SEVERE PE: - systemic hypotension and dvt
- progressive right heart failure - high pressure placed on the heart as a result of clot
Symptoms of right side heart failure
• Elevated JVP
• Elevated troponin - cardiac msucle damage
• Elevated brain naturetic peptide which is a marker for right side heart failure
CT
- pulmonary artery width is greater than aorta
- right ventricle pushes to the left
Non thrombotic pulmonary embolism
- fat embolism/amniotic fluid embolism not blood
paradoxial embolism
- clot has gone from DVT then via petent foramen ovale to theleft atrium, then into cerebral circulation
Presents as a stroke
Well’s score
- each clinical feature of dvt has points
- PE likely with more than 4 points
IF WELLS SCORE SAYS PE IS LIKELY
- CT pulmonary angiogram
* Proximal leg vein ultrasound
IF WELLS SCORE SAYS PE IS UNLIKELY
• D dimer test - d dimer is a breakdown product for a clot, not significant except to indicate some level of clotting activity
Negative test used to exclude PE
D DIMER IS POSTIVE - do CT ect
D DIMER IS NEGATIVE - PE/DVT can be excluded
