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29 Cards in this Set
- Front
- Back
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Virchows triad
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Stasis
Endothelial injury Hypercoagulable state |
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Which vein thrombosis leads to greater risk of embolization - proximal or distal
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PROXIMA - if propagates to thigh greater risk of embolization
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Risk factor for DVT
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Surgery/trauma
Bed bound/immobilization BCP/Pregnancy CHF Smoking Obesity Coagulopathy |
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Patient presents with leg pain, leg swelling, calf/thigh tenderness and venous distention - diagnosis>
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DVT
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This diagnostic modality is used to look for vein compressibility - accurate for proximal DVT, need to do serially to detect calf --> thigh
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ULTRASOUND
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What is the caution for venography
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CAN CAUSE PHLEBITIS
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Which surgery carries 50-75% of chance of DVT
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Hip/Knee
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Pathophysiology of PE
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Increased pulmonary resistance (serotonin, obstruction)
Increased airway resistance (bronchoconstriction) Decreased pulmonary compliance (lung edema, hemorrhage, loss of surfactant) RV dysfunction --> LV dysfunction --> hypotension |
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Symptoms of pulmonary thromboembolus
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Dyspnea
Tachypnea Tachycardia Chest pain Cough Syncope Hemoptysis |
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Differential diagnosis of PE
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MI
Pericarditis CHF Pneumonia COPD/ASthma Pneumothorax |
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Signs of PE on echo
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Tricuspid regurgitation
RV dilation PA dilation |
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Prophylaxis of DVT/PE
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Anticoagulation - low dose heparin SQ, LMWH (enoxaparin), mechanical compression devices (or both), IVC filter - recurrent DVT/PE at risk for anticoagulation
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Because risk is so high in post op hip/knee surgery - DO NOT use _ for prophylaxis
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Low dose SQ heparin
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Treatment of DVT PE:
- Doesnt dissolve clot, IV at least 5 days |
Unfractionated heparin
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Treatment of DVT/PE:
Less bleeding for outpatient Rx |
LMWH
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Treatment of DVT/PE
PO 3-6 months unless recurrent or inherited disorder |
Coumadin therapy
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50% of people with PVD have _
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CAD
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Treatment of PVD:
Increases RBC flexibility Decreases blood viscosity |
Pentoxyfilline
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Vasodilator
Platelet inhibitor - treatmnet of PVD |
Cilostazol
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Reduce adverse CV events in patients with PVD
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Aspirin and Clopidogrel
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Patient with PVD has rest pain, disabling symptoms ischemic ulcerations and gangrere - what is the definitive Rx
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REVASCULARIZATION
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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
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SPINAL STENOSIS - causes pseudoclaudication (neurogenic claudication)
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5 P's of acute arterial occlusion
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Pain
Pallor Pulselessness Paralysis Paresthesias |
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Patient presents with superficial phlebitis, claudication and Raynauds. History reveals strong smoking pattern - diagnosis
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Buergers disease - thromboangitis obliterans
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Cold induced vasospasm in finger and toes - color changes white --> blue --> purple
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Raynauds phenomenon
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Raynauds phenomenon with no cause
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Raynauds disease
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Treatment for Raynauds phenomenon
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Ca channel blockers
Alpha blockers |
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If abdominal aneurysm is > 5 cm - there is a _ risk of rupture
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30%
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For thoracic aneurysm surgery is needed if its more than _ cm in diameter
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6
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