Text of 1 DVT/ PE Dr Faiza. A. Qari. 2 3 4 DVT Mortality/Morbidity: Death from DVT is attributed to massive...
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1 DVT/ PE Dr Faiza. A. Qari
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4 DVT Mortality/Morbidity: Death from DVT is attributed to
massive pulmonary embolism Sex: The male-to-female ratio is 1.2:1
Age: older than 40 years.
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5 History Many patients are asymptomatic. Edema, principally
unilateral, is the most specific symptom. Leg pain occurs in 50%.
Tenderness. Clinical signs and symptoms of pulmonary embolism. The
pain and tenderness associated with DVT does not usually correlate
with the size, location, or extent of the thrombus. Warmth or
erythema of skin over the area of thrombosis
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6 Physical Signs Physical: No single physical finding or
combination of symptoms and signs is sufficiently accurate to
establish the diagnosis of DVT. Tenderness, to the calf muscles or
over the course of the deep veins in the thigh. Venous distension
and prominence of the subcutaneous veins. Fever: usually low
grade.
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7 Physical signs Phlegmasia cerulea dolens variable
discoloration of the lower extremity., reddish purple from venous
engorgement and obstruction.. Phlegmasia alba dolens Painful white
inflammation was originally used to describe massive ileofemoral
venous thrombosis and associated arterial spasm. The affected
extremity is often pale with poor or even absent distal pulses
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9 DD of DVT Achilles tendonitis Asymmetric peripheral edema
secondary to CHF, liver disease, renal failure, or nephrotic
syndrome Cellulitis, lymphangitis Ruptured Baker cyst Varicose
veins
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10 Causes of DVT General Age Immobilization longer than 3 days
Pregnancy and the postpartum period Major surgery in previous 4
weeks Long plane or car trips (>4 h) in previous 4 weeks Medical
Cancer Previous DVT Stroke Acute myocardial infarction (AMI)
Congestive heart failure (CHF) Sepsis Nephrotic syndrome Ulcerative
colitis
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11 Causes Trauma Multiple trauma CNS/spinal cord injury Burns
Lower extremity fractures Vasculitis Systemic lupus erythematosus
(SLE) and the lupus anticoagulant Behet syndrome Homocystinuria
Drugs/medications IV drug abuse Oral contraceptives Estrogens
Heparin-induced thrombocytopenia
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12 Causes Hematologic Polycythemia rubra vera Thrombocytosis
Inherited disorders of coagulation/fibrinolysis Antithrombin III
deficiency Protein C deficiency Protein S deficiency Factor V
Leyden Dysfibrinogenemias and disorders of plasminogen
activation
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13 Lab Works Duplex ultrasonography. Contrast venography. 100 %
diagnostic D dimer
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18 Pulmonary Embolism Massive PE is one of the most common
causes of unexpected death. Although PE often is fatal, prompt
diagnosis and treatment can reduce the mortality rate dramatically.
Patients who survive an acute PE are at high risk for recurrent PE
and for the development of pulmonary hypertension and chronic cor
pulmonale.
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21 PE Race: is high in all racial groups. Sex: PE is common in
all trimesters of pregnancy and the puerperium, and the incidence
of PE is increased in women receiving oral contraceptive or hormone
replacement therapy Age: Although the frequency of PE increases
with age, Unfortunately, the diagnosis of PE is especially likely
to be missed in older patients.
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22 History PE is so common and so lethal that the diagnosis
should be sought actively in every patient who presents with any
chest symptoms that cannot be proven to have another cause. chest
pain, chest wall tenderness,, syncope, hemoptysis, shortness of
breath, painful respiration, new onset of wheezing, any new cardiac
arrhythmia, or any other unexplained symptom referable to the
thorax. The classic triad of signs and symptoms of PE (hemoptysis,
dyspnea, chest pain).
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23 History Many patients with PE are initially completely
asymptomatic, and most of those who do have symptoms have an
atypical presentation. Pleuritic or respirophasic chest pain is a
particularly worrisome symptom.
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24 Physical Clinical findings of pulmonary embolism These
findings are the primary manifestation in about 10% of patients
with DVT. In patients with angiographically proven pulmonary
embolism, DVT is found in 45- 70%.
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25 Physical Examination Massive PE causes hypotension due to
acute cor pulmonale,. New wheezing may be appreciated. The
spontaneous onset of chest wall tenderness without a good history
of trauma is always worrisome.
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26 Physical signs Physical signs has been reported as follows:
tachypnea (respiratory rate >16/min) rales accentuated second
heart sound tachycardia (heart rate >100/min) fever (temperature
>37.8 C) diaphoresis an S3 or S4 gallop clinical signs and
symptoms suggesting thrombophlebitis lower extremity edema cardiac
murmur cyanosis
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27 Lab works ABG --- Decease PaO2, P Co2. ECG---- sinus
tachychardia, S1,Q3,T3, RBBB, AF. Chest X ray Normal, pleural
effusion, consolidation, abrupt vessel cutoff. V/Q scan ---
mismatch scan. Spiral CT scan Pulmonary arteriogram in case of low
probability
