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Cardiology > Venous Thromboembolic disease > Flashcards

Venous Thromboembolic disease Flashcards

1
Q

What is a DVT?

A

A clot that forms around the valves of the deep veins which blocks venous return to the heart

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2
Q

What is an arterial clot?

A

high flow of blood leads to the clot being rich in platelets

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3
Q

What is a venous clot?

A

Pooling of static blood occurs which then forms a fibrin rich clot

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4
Q

What are the two types of DVT?

A

Distal and proximal DVT

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5
Q

What are most diagnosed DVTs?

A

proximal as we dont scan below the knee.

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6
Q

What is the mortality rate for a PE alone?

A

17.5% at 3 months

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7
Q

What is the mortality rate for a DVT alone?

A

0.5-5% at 3 months

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8
Q

What are the three components of Virchows triad?

A
  • hypercoagubilty of blood
  • turbulent blood flow
  • endothelial injury
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9
Q

What are some exposing risk factors for VTE?

A

surgery, trauma, acute medical conditions, central venous catheterisation

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10
Q

What are some predisposing risk factors for VTE?

A
  • history of VTE
  • chronic heart failure
  • Age
  • obesity
  • immobility
  • pregnancy
  • hormone therapy
  • genetic
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11
Q

What can provoked VTE be characterised into?

A

reversible or irreversable

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12
Q

What is an example of a reversible provoked VTE factor?

A

surgery

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13
Q

What is an example of an irreversible provoked VTE?

A

cancer

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14
Q

What is an example of an unprovoked VTE?

A

no identifiable cause, idiopathic

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15
Q

What is the likelihood of a reversible provoked VTE of recurring?

A

low

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16
Q

What are some known consequences of VTE?

A
  • fatal PE
  • risk of recurrent VTE
  • Post thrombotic syndrome
  • Chronic thromboembolic pulmonary hypertension
  • reduced quality of life
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17
Q

What is post thrombotic syndrome?

A

A collection of symptoms occurring in nearly 1/3 of patients within 5 years after idiopathic DVT

18
Q

What are the characteristics of PTS?

A
  • pain
  • oedema
  • hyperpigmentation
  • eczema
  • varicose collateral veins
  • venous ulceration
19
Q

What is Chronic thromboembolic pulmonary hypertension?

A

CTPH is a relatively rare, but serious, complication of PE.2
In CTPH, the original embolic material is replaced over time with fibrous tissue that is incorporated into the intima and media of the pulmonary arteries. This material may occlude the pulmonary artery, leading to pulmonary artery resistance and, ultimately, right heartfailure.2

20
Q

What is the presentation of CTEPH like?

A

initially asymptomatic and followed by progressive dyspnoea and hypoxaemia

21
Q

What is the cure?

A

Operation to remove the clot which will cure the hypertension
-meds are also available

22
Q

How do you investigate VTE?

A
  • probability testing (asses the likelihood by assessing risk factors as well as symptoms)
  • D dimer
  • ultrasound
23
Q

What do the D dimer results indicate?

A
  • negative D dimer test as well as low probability in testing will mean no PE
  • positive D dimer does not indicate that a PE is present
24
Q

How is the ultrasound carried out?

A
  • Look at the groin and popliteal veins.

- If they can compress the vein then the pressure isn’t high and so there is no clotting above this point.

25
Q

What are the two types of probability tests used in assessing VTEs?

A
  • Wells score

- revised Geneva score

26
Q

How are the probability tests used?

A
  • If the probability comes out low then check d dimer and if that’s negative then dont need ultrasound
  • If the probability is high then need ultrasound regardless of D dimer
27
Q

What other two imaging techniques can be used?

A
  • CXR (doesn’t usually show a PE)

- V/Q scan (good in peripheral PEs) (can have inconclusive results)

28
Q

What drugs are used to treat DVT and PE?

A
  • Anticoagulants
  • Thrombolysis
  • Analgesia
29
Q

What are the mechanical interventions for DVT and PE?

A
  • graduated compression stockings

- IVC filters

30
Q

What are the screenings done for DVT and PE?

A

-screen for cancer and thrombophilia

31
Q

How long should you treat provoked VTE?

A

3 months

32
Q

How long should you treat unprovoked VTE?

A

At least 3 months but you need to assess consequences of long term use of drugs

33
Q

What are the main anticoagulants you should use?

A

-rivaroxaban
-apaxiban
(dabigatran and Edoxaban are not often used)

34
Q

What are the major haemorrhage rates like in the use of apaxaban?

A

It has the same rate of major bleeding as placebo so is a safer drug than warfarin

35
Q

What are special cases to be considered when using drug treatment?

A

-All men who have had an episode of a PE that are unprovoked or irreversible factors should continue with anticoagulants
-Drug users (may have damaged vessels so high haemorrhage risk)
-cancer patients (use fragmin instead)
-

36
Q

When should you give thrombolysis?

A

iliofemoral DVT

37
Q

When should you use thrombolysis in relation to PEs?

A
  • In PE patients with haemodynamic instability

- In PE patients who aren’t improving with treatment

38
Q

What are compression stockings used for?

A
  • to prevent post thrombotic syndrome
  • need to be worn as soon as possible after diagnosis
  • worn for at least 2 years post thrombosis
  • only on affected leg
39
Q

What are IVC filters?

A
  • A mechanical plate that sits in the inferior vena cava and catches clots from thrombi. They prevent death by PE
  • Used alongside anticoagulant therapy
40
Q

What are the issues with IVC filter?

A

They can stick into the aorta and cause fistulas
They can also cause thrombis
Try to avoid use

Cardiology (32 decks)

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