Venous Thromboembolic Dz (PE/DVT) Flashcards
What is virchow’s triad?
endothelial damage, venous stasis, hypercoagulable state
Why suspect thrombophilia? Which labs for initial work-up?
- previous VTE, famhx, hx of multiple miscarriages, no recent trauma/malig/estrogens/pregnancy
- CBC, CMP, PT, PTT (set aside blood for ATIII, Protein C/S)
- Later: Factor V Leiden, hyperhomocysteinemia, anti-phospholipid Ab
What is a person’s risk if first episode with no RF or fmhx?
low- no investigations
What is person’s risk if >50yo, idiopathic first episode, no fmhx?
moderate-
- resistance to activated protein C
- Prothrombin mutation
- Lupus anticoag
- ELISA for antiphospholipid Ab
- Homocysteine level
What is risk if idiopathic before age 50 or recent thrombosis or fmhx of VTE?
high
(everything for moderate + ATIII)
protein C/S
What are signs of UE DVT?
-SVC syndrome, blurred vision, dyspnea (causes include trauma from sports or med instruments), thoracic outlet syndrome- Adson test and Wright test
What are signs of DVT in general?
- tenderness, erythema, warmth, edema, low grade fever, +Homan, +Moses
What tests are used in dx DVT?
D-dimer, duplex US, contrast venography is gold standard
for UE and pelvic=MRI
How do you treat DVT in general?
SQ LMWH- loveox
IV or SQ UFH
SQ fondaparinux
*Start warfain at same time
What is goal PTT with heparin? What is goal INR with coumadin?
- 5-2.3
2. 0-3.0
How do you reverse OD of heparin? coumadin?
- protamine
- takes time and requires FFP if urgent
What are some special cases for tx of DVT?
- UE in young: tPA infusion, mechanical fragmentation via cath
- IVC filter if no anticoag or recurrent or bleeding risk
What is prophylaxis for DVT for high risk? Low risk? When is LMWH preferred?
- SQ heparin or LMWH for (CHF, resp illness, immobilization, hx VTE, major sx (for 1 mo after sx))
- IPCs or SCDs
- orthopedic cases
What type of cardiac complications happen with PE?
- RV pressure inc–>dilation, hypokinesis, tricuspid regurg
- Compress RCA–>subendocardial ischemia
What are the sxs of PE?
dyspnea and pleuritic CP, tachycardia, low O2 sat
anginal if ischemic, hemoptyis if pulm infarct, syncope if cor pulmonale
How do you dx PE?
- V/Q scan
- Spiral CT w/ contrast
- echo
- pulmonary angiography
How do you tx PE?
- admit to hospital
- antigoag w/ heparin and warfarin (for 3-6 months, longer in cancer)
- tPA if hypotensive/shock/RVE
if tPA contraindicated in massive PE, consider sx or percutaneous removal - EKOS
What is cor pulmonale?
RHF d/t idiopathic PHTN–> dec CO, arrhythmias
What are other types of emoblic phenomena?
septic, myxoma, parasites, amniotic fluid, fat, air
Cause of septic emoblism?
infective endocarditis, usually strep viridans- cause vegetations on valves that break off- takes 2 weeks to 6 months or more
Symptoms of septic embolism? How to tx?
- back pain, fever, heart murmur, pleuritic CP, hemoptysis, sore throat, swelling of jaw, bacteremia
- CXR round cavitating infiltratrates
- IV PCN 24 million units/day + metronidazole 500 mg q 6 hrs
What is an atrial myxoma?
- primary cardiac tumor, familial
- dx on echo
- tx is sx
What is an amniotic fluid embolism?
fluid is foreign= clotting => massive obstruction of microvasculature=> shock=> DIC (tx is supportive)
-mortality is 80% maternal
How does a fat embolism occur?
usually after bone fracture (12-36 hrs)
-mental aberrations, delerium, coma, dyspnea, tachypnea, tachycardia, anemia, thrombocytopenia
