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12 Cards in this Set
- Front
- Back
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Definition |
Thrombus formation in distal veins that embolises to pulmonary vasculature |
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Epidemiology |
c. 30k per year and reasonably even between men/women and age groups |
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Aetiology (Virchow's triad) |
- Vessel wall damage: (rauma, previous DVT, surgery, venous harvest) - Venous stasis: age >40 years, immobility, anaesthesia, paralysis, spinal cord injury, MI, prior CVA, varicose veins, CHF, and COPD - Hypercoagulability: cancer, high-oestrogen states and inherited thrombophilia
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Inherited thrombophilia |
Factor V Leiden mutation, prothrombin gene mutation, protein C and S deficiency, antithrombin III deficiency, and antiphospholipid antibody syndrome |
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Pathophysiology |
Fibrin and entrapped erythrocytes (red clots). Thrombus dislodges and becomes trapped in the pulmonary vasculature. Increases pulmonary vascular resistance. Pressure builds and backlogs reducing cardiac output causing hypotension and shock |
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Risk factors |
Obesity, prolonged bed rest, pregnancy/postpartum period, inherited thrombophilias, active malignancy, recent trauma/fracture, and history of previous thrombosis. |
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Signs and symptoms |
Symptoms: Chest pain, dyspnoea, tachypnoea Signs: Little that's common tachycardia |
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Investigations |
ECG: AF, RBBB and S1(large)Q3T3 (inv) CXR: Fleishner sign: big pulmonary artery, Hampton hump: peripheral wedge of airspace opacity and Westermark’s Sign: reduced regional blood volume) CTPA scan: Gold standard + maybe polo mint sign D Dimer: breakdown of clots. Sensitive not spec. |
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DDx |
Angina, MI, Pneumonia, exacerbation of asthma/COPD, anxiety, pericarditis and tamponade |
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Management |
Modified Wells criteria or Geneva score - < 4 PE unlikely. Treatment: oxygen and fluid as required Anticoagulation: treatment with anticoagulants while awaiting diagnosis - UFH (stopped once INR achieved) WARFARIN: 3/6/12/lifelong. INR 2-3 |
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WARFARIN |
Anticoagulant. Inhibits vitamin K reductase >>> reduction in coagulation proteins |
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SOTALOL |
Class II + III anti-arrhythmic Class II - Beta blocker Class III potassium channel blocker. Inhibits inward movement of potassium ions >>> prolongs repolarisation, increases QT interval and reduces automasticity |
