37 y/o with left lower leg swelling and pain, left-sided chest pain, and SOB
Patient will present as → a 78-year-old female complaining of generalized pain and edema in her left leg. She denies chest pain, shortness of breath, and hemoptysis. She takes 2.5 mg warfarin daily for atrial fibrillation and her INR is 2.6. On physical examination the patient experience calf pain with dorsiflexion of the left foot. The patient has a positive D-dimer and a lower extremity ultrasound reveals the presence of a deep venous thrombosis in the left popliteal vein.
Caused by a clot formation in the veins. Virchow's triad determines risk factors for clot formation.
- Stasis: post-surgical, immobility, venous insufficiency.
- Hypercoagulable states: Factor V Leiden, cancer, OCP + smoking, pregnancy.
- Trauma: surgery, cellulitis.
Will present with edema of one extremity, and a positive Homan's sign (extend leg and push the foot towards the head with pain in the calf)
*Women over age 35 who smoke are at increased risk for the development of venous thrombosis and women older than 35 years who smoke should avoid oral contraceptive pills. Progestin-Only hormonal methods are a reasonable alternative in this population.
Venous duplex ultrasound is first line imaging test
- D-dimer - a negative D-dimer will rule out DVT in low-risk patients
- Venography is considered GOLD STANDARD
Treat with IV heparin and switch to Warfarin
- Recurrent DVT requires lifetime anticoagulation
Varicose veins are the result of pressure overload on incompetent veins and not due to the use of oral contraceptives.
The defined risks of atherosclerosis includes smoking, but does not include the use of oral contraceptives.
There is no relationship between the use of oral contraceptives and the development of peripheral edema.
Venogram has been replaced by noninvasive tests due to discomfort, cost, technical difficulties, and complications, such as phlebitis.
Thrombophlebitis is a venous problem, not an arterial one. Any unnecessary invasive procedure is potentially harmful.
Impedance plethysmography is equivalent to ultrasound in detecting thrombi of the femoral and popliteal veins, but it may miss early, nonocclusive thrombi.