Deep Vein Thrombosis: Invasive Treatment & Natriuretic Peptide Tests
Indications for Invasive Treatment of Deep Vein Thrombosis
Indications:
- Phlegmasia
- Symptoms of IVC thrombosis
- Acute iliofemoral DVT
Methods:
- Insert IV line into a vein
- Anesthesia is injected
- A small incision is made
- Guided X-ray, insert catheter via skin
- Contrast media injected
- X-ray is taken to find clot location
- Clot-dissolving drugs are given
- Catheter removed, pressure to stop bleeding
- Dressing is put on
Post-op:
- Daily examination of calves
- Anticoagulants
- Stay hydrated
- Bed rest
- Foot elevation
B-type Natriuretic Peptide (BNP) and NT-proBNP: Evaluation and Interpretation of Lab Test Results
BNP is released from the cardiac ventricles in response to volume expansion and wall stress.
- Diuretic, natriuretic, and hypotensive effects
- Inhibit RAAS system and renal sympathetic activity
| BNP | NT-proBNP | Interpretation |
|---|---|---|
| < 100 pg/mL | < 300 pg/mL | HF unlikely |
| 100 – 500 pg/mL | 300 – 450 pg/mL (< 50 yrs) or 300 – 900 pg/mL (> 50 yrs) | HF possible |
| > 500 pg/mL | > 450 pg/mL (< 50 yrs) or > 900 pg/mL (> 50 yrs) | HF likely |
NT-proBNP is the precursor of BNP with longer half-life and higher accuracy.
Most Common Pathogens of Infectious Pericarditis, Their Diagnostic Possibilities
Causes:
- Virus: Coxsackievirus, Echovirus, Adenovirus, EBV, CMV, Influenza, Rubella, HIV, Hepatitis B
- Bacteria: Staphylococci, Streptococci, Pneumococci
| Virus | Bacteria | Fungi | Protozoa |
|---|---|---|---|
| Coxsackievirus | Staphylococci | Aspergillus | Entamoeba |
| Echovirus | Staphylococcus aureus | Candida spp. | Toxoplasma gondii |
| Influenza (A+B) | Haemophilus influenzae | Blastomyces | |
| Hepatitis B | Salmonella | Coccidioides | |
| Pseudomonas | Cryptococci | ||
| Brucella | Histoplasma |
Diagnosis:
- Dyspnea
- Fever
- Dry Cough
- Sweating
- Pericardial rub
- CT scan
- MRI
- X-ray (Large Arteries)
- Electrocardiogram
Diagnostic Criteria of Infective Endocarditis
| Major Criteria | Minor Criteria |
|---|---|
| Typical microorganisms consistent with IE from 2 separate blood cultures | |
| Single positive blood culture for C. burnetii or IgG antibody titer > 1:800 | |
| Echo positive | |
| New valvular regurgitation | |
| 1. Predisposition: Heart condition, Intravenous drug use | |
| 2. Fever > 38°C | |
| 3. Vascular phenomena: Arterial emboli, Septic pulmonary infarct, Mycotic aneurysm | |
| 4. Immune phenomena: Glomerulonephritis, Osler nodes, Roth spots | |
| 5. Microbiological evidence: Positive blood culture, Serological evidence |
Diagnosis:
- 2 Major
- 1 Major + 3 Minor
- 5 Minor
Confirm IE