Signs, Symptoms & RFs

• What is the presentation of PE?

  Tachypnoea

  Tachycardia

  Cyanosis

  Loud second heart sound

  Haemoptysis

  Pleuritic chest pain

  Systemically hypotensive (due to vasodilation)
• What are the 2 types of hypercoagulability?

  Primary - congenital deficiencies or Leiden factor V mutation

  Secondary - due to increased conc of fibrinogen & prothrombin
• How does endothelial injury increase the risk of thrombosis?

  Endothelial injury -> promotes platelet adhesion & aggregation -> production of pro-coagulant factors
• How does abnormal blood flow increase the risk of thrombosis?

  Prevents blood diluting activated clotting factors

  Causes;

  • Stasis -> allows platelets to encounter endothelium (loss of laminar flow) & slows the washout of activated clotting factors
  • Turbulence -> physical trauma to endothelial cells or dysfunction, countercurrents & local pockets of stasis
• What are the risk factors of DVT?

  Age (over 60)

  Obesity (BMI> 30)

  Smoking

  Past history of DVT

  COC

  Cancer treatment

  Prolonged immobilisation
• What are the risk factors of PE?

  Age (over 60)

  Obesity (BMI >30)

  Smoking

  Pregnancy

  Severe trauma (fat emboli)

  Prolonged immobilisation

  Previous DVT/PE
• What are the signs & symptoms of DVT?

  Pain & swelling in 1 leg

  Leg red & warm to touch

  Tenderness along course of deep veins & dilation of superficial veins

  +ve Homan's sign
• What is Homan's sign?

  With knee fully extended, dorsiflex the foot & squeeze calf with the other hand

  +ve sign = deep calf pain & tenderness