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29 Cards in this Set

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Virchows triad
Stasis

Endothelial injury

Hypercoagulable state
Which vein thrombosis leads to greater risk of embolization - proximal or distal
PROXIMA - if propagates to thigh greater risk of embolization
Risk factor for DVT
Surgery/trauma

Bed bound/immobilization

BCP/Pregnancy

CHF

Smoking

Obesity

Coagulopathy
Patient presents with leg pain, leg swelling, calf/thigh tenderness and venous distention - diagnosis>
DVT
This diagnostic modality is used to look for vein compressibility - accurate for proximal DVT, need to do serially to detect calf --> thigh
ULTRASOUND
What is the caution for venography
CAN CAUSE PHLEBITIS
Which surgery carries 50-75% of chance of DVT
Hip/Knee
Pathophysiology of PE
Increased pulmonary resistance (serotonin, obstruction)

Increased airway resistance (bronchoconstriction)

Decreased pulmonary compliance (lung edema, hemorrhage, loss of surfactant)

RV dysfunction --> LV dysfunction --> hypotension
Symptoms of pulmonary thromboembolus
Dyspnea

Tachypnea

Tachycardia

Chest pain

Cough

Syncope

Hemoptysis
Differential diagnosis of PE
MI

Pericarditis

CHF

Pneumonia

COPD/ASthma

Pneumothorax
Signs of PE on echo
Tricuspid regurgitation

RV dilation

PA dilation
Prophylaxis of DVT/PE
Anticoagulation - low dose heparin SQ, LMWH (enoxaparin), mechanical compression devices (or both), IVC filter - recurrent DVT/PE at risk for anticoagulation
Because risk is so high in post op hip/knee surgery - DO NOT use _ for prophylaxis
Low dose SQ heparin
Treatment of DVT PE:

- Doesnt dissolve clot, IV at least 5 days
Unfractionated heparin
Treatment of DVT/PE:

Less bleeding for outpatient Rx
LMWH
Treatment of DVT/PE

PO

3-6 months unless recurrent or inherited disorder
Coumadin therapy
50% of people with PVD have _
CAD
Treatment of PVD:

Increases RBC flexibility
Decreases blood viscosity
Pentoxyfilline
Vasodilator
Platelet inhibitor - treatmnet of PVD
Cilostazol
Reduce adverse CV events in patients with PVD
Aspirin and Clopidogrel
Patient with PVD has rest pain, disabling symptoms ischemic ulcerations and gangrere - what is the definitive Rx
REVASCULARIZATION
55 year old male complains of pain in both legs on ambulation and standing - pain is RELIEVED BY SITTING OR BENDING AT THE WAIST. PE shows good pulses - diagnosis
SPINAL STENOSIS - causes pseudoclaudication (neurogenic claudication)
5 P's of acute arterial occlusion
Pain

Pallor

Pulselessness


Paralysis

Paresthesias
Patient presents with superficial phlebitis, claudication and Raynauds. History reveals strong smoking pattern - diagnosis
Buergers disease - thromboangitis obliterans
Cold induced vasospasm in finger and toes - color changes white --> blue --> purple
Raynauds phenomenon
Raynauds phenomenon with no cause
Raynauds disease
Treatment for Raynauds phenomenon
Ca channel blockers

Alpha blockers
If abdominal aneurysm is > 5 cm - there is a _ risk of rupture
30%
For thoracic aneurysm surgery is needed if its more than _ cm in diameter
6