BLOCK 10: Venous Thromboembolism, Aortic Disease, and Pericardial Disease
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Learning Objectives By Lesson
1-Acute Pulmonary Thromboembolism
  • Define pulmonary thromboembolism (PE)
  • Describe the various types of pulmonary thromboembolism (PE)
  • Define Virchow's triad
  • Describe the patholophysiologic consequences associated with pulmonary thromboembolism (PE)
  • Describe the clinical presenation of acute pulmonary thromboembolism (PE)
  • Describe the initial management approach to patients with acute pulmonary thromboembolism (PE)
  • Describe the role and components of the Wells score in the clinical management of acute pulmonary thromboembolism (PE)
  • Describe factors involved in the decision for empiric anticoagulation therapy for acute pulmonary thromboembolism (PE)
  • Describe how to evaluate the risk of bleeding when considering empiric anticoagulation therapy for acute pulmonary thromboembolism (PE)
  • Describe the definitive therapeutic strategies for acute pulmonary thromboembolism (PE) in hemodynamically stable and unstable patients
  • Describe the duration of anticoagulation for acute pulmonary thromboembolism (PE)
  • Identify the anticoagulation therapy of choice for patients with acute pulmonary thromboembolism (PE) in the context of underlying malignancy, pregnancy, and heparin-induced thrombocytopenia
  • Describe important supportive care considerations in the management of acute pulmonary thromboembolism (PE)
2-Venous Thromboembolism: Background & Evaluation
  • Describe the etiology of venous thromboembolic (VTE) disease
  • Identify provoking and necessary factors for venous thromboembolism (VTE)
  • Describe the diagnostic approach for venous thromboembolism (VTE)
  • Describe the clinical signs and symptoms of deep venous thromboembolism (DVT) and pulmonary thromboembolism (PE)
  • Describe important relationships between deep venous thromboembolism (DVT) and pulmonary thromboembolism (PE)
  • Describe how to define the clinical pre-test probability of deep venous thromboembolism (DVT) and pulmonary thromboembolism (PE)
  • Describe the Wells' scores for the evaluation of acute deep venous thromboembolism (DVT) and acute pulmonary thromboembolism (PE)
  • Describe the role in D-dimer in the evaluation of acute venous thromboembolic (VTE) disease
  • Describe the diagnostic imaging methods for deep venous thromboembolism (DVT) and pulmonary thromboembolism (PE)
3-Venous Thromboembolism: Treatment
  • Review the diagnostic approach for venous thromboembolic (VTE) disease
  • Describe the treatment goals for acute venous thromboembolic (VTE) disease
  • Describe the anticoagulation options and duration of treatment for acute venous thromboembolic (VTE) disease
  • Describe the role of anticoagulation treatment in isolated distal deep venous thromboembolism and subsegmental pulmonary embolism
  • Identify recurrent venous thromboembolism and major bleed risk factors
  • Describe the role of thrombolysis for venous thromboembolic (VTE) disease
4-Anticoagulants
  • Identify the various classes of oral and parenteral anticoagulants used in clinical practice
  • Identify short- and long-term indications for anticoagulation
  • Describe the dosing of various direct oral anticoagulants (DOACs) for venous thromboembolism
  • Describe the clearance of various direct oral anticoagulants (DOACs)
  • Identify ideal candidates for direct oral anticoagulants (DOACs)
  • Describe the evaluation and management apporach when considering bridging anticoagulation for valve prostheses
  • Describe the evaluation and management apporach when considering bridging anticoagulation for atrial fibrillation
  • Identify the anticoagulant agents that might be used in pregancy
  • Describe how to manage anticoagulation in pregnancy
5-Thoracic Aortic Aneurysm
  • Define aortic aneurysm
  • Describe the basic anatomical components of the thoracic aorta
  • Describe etiologies associated with thoracic aortic aneurysms and their general growth rates
  • List imaging modalities and their advantages in the evaluation of aortic aneurysms
  • Identify various disease states and aortic aneurysm thresholds to pursure prophylactic surgery
  • Describe the role of and approach to medical management for aortic aneurysms
  • Describe the management approach for pregnant and non-pregnant women with aortic disease
6-Pericardial Disease: Acute Pericarditis
  • Identify structures comprising the pericardium
  • Define acute pericarditis and its prevalence
  • Identify etiologies associated with acute pericarditis
  • Describe how to differentiate acute pericarditis from acute myopericarditis
  • Describe the difference between recurrent pericarditis, incessant pericarditis, and chronic pericarditis
  • Identify factors that increase the risk for recurrent pericarditis
  • Describe the clinical features associated with acute pericarditis
  • Describe the initial diagnostic workup for acute pericarditis
  • Identify ECG features and stages associated with acute pericarditis
  • Identify imaging modalities and their significance in the evaluation of acute pericarditis
  • Describe the treatment approach and available therapies for acute pericarditis
  • Identify scenarios in which corticosteroids might be considered appropriate for treating acute pericarditis
  • Identify steroid-sparing agents approved for the management of acute pericarditis and when they should be considered
  • Identify important screening considerations prior to prescribing steroid-sparing agents for acute pericarditis
  • Describe the management of acute pericarditis during pregnancy
  • Describe the role of pericardiectomy in the management of acute pericarditis
7-Pericardial Disease: Constriction & Effusions
  • Define chronic constrictive pericarditis
  • Identify etiologies associated with chronic constrictive pericarditis
  • Describe the pathophysiology of constrictive pericarditis
  • Describe the jugular venous pressure findings in constrictive pericarditis
  • Describe the hemodynamic effects seen in constrictive pericarditis during respiration
  • Describe the clinical presentation and examanation in constrictive pericarditis
  • Identify imaging modalities that can be used in the evaluation of constrictive pericarditis
  • Identify the treatment for constrictive pericarditis
  • Identify factors that influence the clinical presentation of pericardial effusions
  • Describe the effect of incresing pericardial fluid volume on intrapericardial pressure, right ventricular filling pressure, left ventricular filling pressure, and cardiac output
  • Describe the difference in impaired diastolic ventricular filling between constrictive pericarditis and cardiac tamponade
  • Describe the jugular venous pressure findings in cardiac tamponade and how they differ from constrictive pericarditis
  • Describe the hemodynamic effects seen in cardiac tamponade during respiration and how they differ from constrictive pericarditis
  • Define pulsus paradoxus and what it represents
  • Describe the goals of evaluation for pericardial effusions
  • Describe clinical findings associated with cardiac tamponade
  • Identify the treatment for hemodynamically significant pericardial effusions
Contributors: Nandan Anavekar, MBBCh; Mahmoud Ismayl, MD; Khalid Saeed Al-Asad, MD; Adnan Halboni, MD; Adolfo Martinez Salazar, MD; Anthony Kashou, MD
Last updated: January 2023.
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Teachers
GCU Education Team
Physician Educators