12 Questions
What is the preferred test for visualizing clots in the pulmonary artery?
CT pulmonary angiogram
Which test is typically used for a high probability of pulmonary embolism?
VQ scan
What indicates a low-risk pulmonary embolism based on further classification?
Normal blood pressure
What is the treatment option for stable patients with pulmonary embolism?
Anticoagulation
Which diagnostic test may show signs of right heart strain in a suspected pulmonary embolism case?
ECG
What is the treatment option for hemodynamically unstable patients with massive pulmonary embolism?
Thrombolytics
What is the primary characteristic of deep vein thrombosis (DVT)?
Formation of blood clots in the veins
In Virchow's Triad, what contributes to clot formation in DVT?
Stasis of blood flow, hypercoagulability, and endothelial injury
Which of the following factors can lead to stasis, contributing to the formation of DVT?
Post-op states
Which condition is NOT a known cause of hypercoagulability in DVT?
Chronic kidney disease
What is the consequence of a clot breaking off from DVT and blocking a pulmonary artery?
Pulmonary embolism (PE)
What is used to assess the likelihood of DVT or PE based on risk factors, symptoms, and history?
Wells Criteria
Study Notes
- Deep vein thrombosis (DVT) is characterized by the formation of blood clots (thrombus) in the veins, commonly affecting the legs.
- Proximal DVT occurs above the bifurcation, while distal DVT occurs below, with different veins like iliac, femoral, popliteal, tibial, and peroneal being involved.
- Virchow's Triad explains that stasis of blood flow, hypercoagulability, and endothelial injury contribute to clot formation in DVT.
- Factors leading to stasis include post-op states, paralysis, and prolonged travel, while endothelial injury can be caused by smoking and venous catheters.
- Hypercoagulability can be due to conditions like malignancy (pancreatic or lung), pregnancy, oral contraceptives, genetic mutations (Factor V Leiden), nephrotic syndrome, or antiphospholipid syndrome.
- Complications of DVT include phlegmasia cerulea dolens (congested bluish limb), phlegmasia alba dolens (pale limb due to arterial compression), post-thrombotic syndrome, and pulmonary embolism (PE).
- PE occurs when a clot breaks off from DVT and blocks a pulmonary artery, leading to symptoms like pleuritic chest pain, dyspnea, and hemoptysis.
- PE can cause respiratory failure due to VQ mismatch resulting in hypoxemia, and obstructive shock from reduced right ventricular output leading to hypotension and shock.
- Wells Criteria and PERC score are used to assess the likelihood of DVT or PE based on risk factors, symptoms, and history.
- Diagnostic tests for PE include chest x-ray (often normal), ECG (may show signs of right heart strain), D-dimer blood test, and imaging like CT pulmonary angiogram or VQ scan.
- Treatment for DVT depends on the location and severity, ranging from anticoagulation for distal DVT to thrombectomy or catheter-directed thrombolysis for massive proximal DVT.- To diagnose a pulmonary embolism (PE), different tests are used based on the patient's probability: CTPA or VQ scan for high probability, D-dimer with CTPA or VQ scan for moderate probability, and PERC score with D-dimer for low probability.
- CTPA is the preferred test in most cases to visualize clots in the pulmonary artery, while a VQ scan may show perfusion defects.
- If a PE is confirmed, further classification is needed: low-risk PE if echocardiogram shows no right ventricle (RV) dilation, and submassive/massive PE if RV dilation or dysfunction is present.
- The presence of low blood pressure indicates a massive PE burden, while normal blood pressure suggests a submassive PE.
- Treatment for PE varies based on hemodynamic stability: anticoagulation (Warfarin, Heparin, Xarelto, Apixaban) for stable patients, IVC filter if anticoagulation is contraindicated, and thrombolytics or embolectomy for hemodynamically unstable patients with massive PE.
- Prevention of venous thromboembolism involves pharmacological prophylaxis with LMWH or subcutaneous Heparin for immobile hospitalized patients, or mechanical compression devices if anticoagulants are unsafe.
This quiz covers the characteristics, risk factors, complications, diagnostic tests, and treatment options for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), including details on Virchow's Triad, Wells Criteria, diagnostic tests like CTPA and VQ scan, and different classifications of PE. Learn about the prevention and management strategies for venous thromboembolism.
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