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Cardio Exam 2: DVT
Cardio exam 2 : dVT
36
Anatomy
Graduate
10/10/2011

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Term
Virchow's Triad:
Definition
- venous stasis
- intimal injury
- hypercoaguability

Have to have these 3 to get a clot
Term
With DVT, the thrombus usually forms on the __ __.
Definition
valve cusps
Term
Short term course of DVT:
Definition
- risk of DVT> acute thrombophlebitis> resolution and recanalization 6-12 weeks
Term
Long term history of DVT, __ __ __ may occur. In severe cases __ __ __ and __ __ __ may occur which are __ threatening.
Definition
- post phlebitic syndrom
- phlegmasia cerulea dolens
- phlegmasia cerulea albens
- limb threatening
Term
Phlegmasia cerulea dolens is aka __ __ or __ __. It is leg threatAening b/c the pressure in the __ side is increasing so you also get __ occlusion.
Definition
- milk leg or white leg
- arterial
- arterial occlusion
Term
Risk factors for DVT:
Definition
- obesity
- sedentary lifestyle
- smoking and COPD
- BCPs/HRT
- Malignancy
- trauma
- Orthopaedic surgery
- Abdominopelvic surgery
- Operative time greater than 2 hours
- HITTS
- Hypercoagulable states
Term
Hypercoagulable states:
Definition
- Polycythemia, blood is thick, lots of RBCs
- Antiphospholipid antibodies
- Protein C and S deficiency
- Myeloma
- Antithrombin III deficiency
- Dysfibrinoginemia
- Plasmingen disorders
Term
DVT patient presentation:
Definition
- unilateral edema
- pain
- distended veins
- calor
- discoloration (red/purple)
- calf tenderness (Homan's sign)
Term
Only 20% of pts with DVT have __ __.
Definition
Homan's sign
Term
DDx of DVT:
Definition
- cellulitis
- lymphedema
Term
DVT diagnostic studies:
Definition
- duplex venous u/s with color flow doppler- BEST CHOICE
- Impedance plethysmography
- Venography
- Ventilation/perfusion scan (V/Q scan)
- Pulmonary angiogram
- Contrasted CT- most precise best for PE
Term
A ventilation perfusion scan (V/Q scan) is a __ test. ___ can give false positives for DVT.
Definition
- nuclear
- pneumonia
Term
Treatment goals of DVT:
Definition
- prevent propagation of clot and PE
- Acute- severe cases: hospitalization, bedrest, anticoagulation
Term
HEPARIN DOES NOT DISSOLVE A CLOT, IT ONLY PREVENT NEW CLOTS FROM FORMING. KNOW THIS.
Definition
Term
Acute - superficial or infrageniculate cases
can consider outpt. therapy with low molecular weight heparin therapy
Still require immobilization and intermediate term anticoagulation (minimum 6 wk.)
Definition
Term
minimum anticoagulant therapy length for DVT;
Definition
6 weeks
Term
Chronic DVT tmt:
Definition
- anticoagulations: warfarin
- leg elevation
- avoid prolonged sitting/standing
Term
Do NOT use __ __ with chronic DVT b/c clots can break off and go north.
Definition
compression stockings
Term
Anticoagulation:
Definition
- Heparin
- LMWH
- Coumadin (Warfarin)
- Alternative: Hirudin
Term
Heparin dosing:
Definition
- Bolus
- Continuous drip
- Half life
- Monitoring
- Antidote
Term
HITTS is __ __ __ while on heparin. It is aka __ __ __.
Definition
- unexpected arterial thrombosis
- white clot syndrome

HIT IS IMMUNE MEDIATED, IF DROPS BELOW 100,000 OR 50% BELOW WHAT THEIR PLATELETS WERE WHEN THEY STARTED.
Term
Heparin Induced Thrombocytopenia is an __ __ __ __ to the ___ __ __ __ complex. The onset is usually __ to __ __ after initiating heparin, but can be earlier or later. It can be with or without __ complications. The dx is __. Any type of heparin or route of administration can lead to HIT.
Definition
- immune-mediated allergic reaction
- heparin-platelet factor 4 complex
- 5 to 14 days
- with or without thrombotic complications
- clinical
Term
HITT:
Definition
Thrombosis
0.4%–2.2%

Thrombocytopenia
2%–3%

Antibody formation
7.8%–51%
Term
HITT pathophysiology:
Definition
- PF-4 binds the surface of platelet following activation> complexes of heparin and PF-4 form> IgG binds heparin/PF-4 complexes> IgG/heparin/PF-4 complexes activates via the Fc receptor> Fc stimulation leads to generation of procoagulant rich particles
Term
Clinical Dx of HIT:
Definition
Timing of thrombocytopenia
Typically 5 to 14 days after initiation of heparin, except in patients with recent heparin exposure
Earlier onset of thrombocytopenia with heparin
re-exposure
Onset may be delayed
Degree of thrombocytopenia
Decrease from baseline of 30% to 50%
Very low platelet counts (<15,000/mcL) rare
Other causes of thrombocytopenia excluded
Presence of thrombosis or other characteristic sequelae
If HIT is suspected, discontinue heparin IMMEDIATELY: Do not wait for results of lab tests
Initiate alternative anticoagulant
Term
Contraindications to Anticoagulation:
Definition
- active hemorrhage
- recent head trauma/spinal surgery
- recent stroke (CVA)
- pregnancy (relative)
- CNS tumor
- AAA
- AVM
- uncontrolled HTN
- bleeding disorder
Term
Conditions in which you should think twice about adminstering anticoagulation, but you still can if benefit outweighs risk:
Definition
- liver disease
- fall risk
- recent surgery
- mural thrombus
- diabetic retinopathy
Term
Interventional DVT treatment:
Definition
- Inferior vena cava interruption
- Thrombolysis
- Thrombectomy
Term
Post Phlebitic Syndrome is __ __ __ in which there is __ __ __ leading to __ __. Manifestations include __ __, __ __ __, __ __, and __.
Definition
- chronic venous stasis
- valve cusp contraction leading to venous reflux
- exercise intolerance
- venous stasis ulceration
- venous gangrene
- phlegmasia
Term
DVT prophylaxis:
Definition
- ambulatory to surgery
- SCD's prior to anessthesia induction
- Pre-op heparin in high risk pts
- Ambulate early post-op
- Atraumatic surgical technique
- Post-op LMWH and SCDs
Term
Thrombectomys have a high incidence of __ __ and __ __ __. An __ __ should be done at the same time to change the flow.
Definition
- recurrent thrombosis
- post phlebitic syndrome
- AV fistula
Term
Venous bypass has a high incidence of __ and may allow time for ___. This is usually for __ __ patients or for __ ___ __ __.
Definition
- failure
- collateralization
- severely symptomatic patients
- limb threatening venous congestion
Term
Thrombolysis is a __ __ __, but you must correct the underlying cause. This usually requires __ __ __. It can be done in conjuction with an __ __. It offers __ __ of symptoms and __ incidence of post phlebitic syndrome.
Definition
- catheter directed infusion
- long term anticoagulation
- AV fistula
- immediate relief
- less
Term
Angioplasty and stenting have __ __ failure rates and are usually for __ __ __. This may allow time for __ __.
Definition
- high early failure rate
- severely compromised limbs
- collateral development
Term
3 types of vena caval interruptions:
Definition
- caval filters
- caval clips
- caval ligation

These don’t prevent clots or DVT, just prevent PE from big clots.
Term
Post Phlebitic Syndrome:
Definition
- venous valve injury
- incompetant perforating veins
- pain
- throbbing
- edema
- venous stasis
- dermatitis
- venous ulceration
- phlegmasia
- venous gangrene
chronic venous stasis
- valve cusp contraction leading to venous reflux
- exercise intolerance
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