1DIAGNOSTICUL POZITIV AL TVPMALADIA TROMBOEMBOLICA VENOASA- PLANUL CURSULUI -2FIZIOPATOLGIE:TRIADA VIRCHOW. CARACTERISTICILE TROMBULUI VENOS COMPARATIV CU CEL ARTERIAL 3DIAGNOSTICUL POZITIV DE TEP4DEFINITIE. PREVALENTA. PROGNOSTIC.5ETIOPATOGENIETRATAMENT 6FACTORI PREDISPOZANTIRISC INALT RR ! 1"#$ F%&'()%* +, -./+ -&) 0,1)1'2*$ P%.(,3&%, +, -./+ -&) 0,1)1'2*$ C2*%)%0*, 0,1,%&/& 4&5.%&$ T%&)4, 4&5.%,$ L,3*)1* +, 4&+)6& -7*1&%**RISC MODERAT RR ! 2-8#$ A%(%.-'.7*, +, 0,1)1'2*$ L*1** 66 ',1(%&/,$ C2*4*.(,%&7*,FACTORI PREDISPOZANTIRISC MODERAT RR ! 2-8#$ I1-)9*'*,1(& '&%+*&'& -* %,-7$ T,%&7*, +, -):-(*()(*, 2%$ M&/*01*(&(,$ C.1(%&',7(*, .%&/&$ AVC 7&%&/*3&1($ S&%'*1&;7.-(7&%()4$ MTEV *1 APP$ T%.4:.9*/*,FACTORI PREDISPOZANTIRISC SCAZUT RR < 2#$ S,+,%, /& 7&( !3 3*/,#$ I4.:*/*3&%, *1 7.3*(*, -,3&1+&$ V&%-(& *1&*1(&(&$ C2*%)%0*, /&7&%.-'.7*'&$ O:,3*(&(,$ V,1, 6&%*'.&-,$ S&%'*1&;&1(,7&%()4STARILE DE TROMBOFILIE2""21881ALGORITM DE DIAGNOSTIC IN TROMBOZA VENOASA PROFUNDASUSPICIUNE CLINICA DE TVPSCAZUTAD-DIMERI < 5"" 10;+LSE INFIRMA TVPINTERMEDIARA;MAREULTRASONOGRAFIE VASCULARAPOZITIVADIAGNOSTIC DE TVPNEGATIVAPRO=IMAL >INFIRMA TVPDISTAL > REPETARE US;ALTE METODE IMAGISTICE FORME CLINICE DE EMBOLIE PULMONARA1. EMBOLIA PULMONARA MASIVA-Peste 50% din supr!t "ir"u#tiei pu#$%nre este $putt &C#ini"' "%#ps ()ip%tensiune rteri#*"re se p%te s%"i "u sin"%p+#ip%ti$ie, p#%re, trnspirtii, tu#-urri $ent#e, %#i.urie se$ne#e de suprs%#i"itre "rdi" drept dispnee/. INFARC0UL PULMONAR-10% din e$-%#ii#e pu#$%nre %-stru"ti%ne1 dist# % rter pu#$%nr &Apriti -rus" de dispnee, durere de tip p#euriti" si )e$%pti1ie&O-ie"ti2' se$ne de re2rst p#eur# si+su de "%ndensre pu#$%nr 3. EMBOLIA ACU0A FARA INFARC0-Se$ne si si$pt%$e nespe"i!i"e "u dispnee si dis"%n!%rt su-stern#, prent !r ni"i % e4p#i"tie 5. 0ROMBOEMBOLISMUL REPE0I0IVAre d%u 2rinte de pre1entre'-Epis%de d%"u$entte de e$-%#ie pu#$%nr si se$ne+si$pt%$e de )ipertensiune pu#$%nr su "%rd pu#$%nr "r%ni"&Fr epis%de d%"u$entte de e$-%#ie pu#$%nr in nte"edente, dr "u %-stru"tie di!u1"ir"u#tiei pu#$%nre si dispnee pr%.resi2 inst#t 6 se$ne de )ipertensiune pu#$%nr+"%rd pu#$%nrMANIFES0ARI CLINICE IN EMBOLIA PULMONARA1. MANIFES0ARI RESPIRA0ORII-Durere t%r"i"-Dispnee su t)ipnee (NR7/0 respirtii+$in*-0use -8e$%pti1ie-9)ee1in. n%u $ni!estt&Sindr%$ p#eur#&Sindr%$ de "%ndensre pu#$%nr&Sindr%$ de -r%n)%%-stru"tie #%"#i1t/. MANIFES0ARI CARDIOVASCULARE-Sin"%p su )ip%tensiune rteri#&0)i"rdie (AV7100+$in* su rit$ie &:.%$%tu# / "rdi" intrit in !%"r pu#$%nr&;#%p drept (1.%$%t3 su 5*&Su!#u de insu!i"ient tri"uspidin&Se$ne de "resterepresiunii 2en%se "entr#e (500 n.+dL*INVES0I;A0II - n.i% = C0- e"%.r!ie "rdi" si d%1re de 0n- 6 US 2ene peri!eri"eDaca angio-CT nu este disponibil sau pacientul este instabil se poate decide tromboliza in functie de probabilitatea clinica, ecografa cardiaca si US vasculara.- S"iti.r$ de per!u1ie& pentru e2#ure !un"ti%n# dup etp "utINVES0I;A0II TRATAMENTUL PROFILACTIC AL MALADIEITROMBOEMBOLICE VENOASES, %,&/*3,&3& 7%,9,%&:*/ ') 2,7&%*1, 9%&'(*.1&(, -*? *1 '&3)/ *1 '&%, &',-(,& 1) -)1( +*-7.1*:*/,? ') 2,7&%*1& 1,9%&'(*.1&(&. D.3,/, -, -(&:*/,-' *1 9)1'(*, +, 1*6,/)/ +, %*-'.I1 0,1,%&/:- H,7&%*1& 1,9%&'(*.1&(&: 5""" UI -.'. /& @-12 2- H,7&%*1, 9%&'(*.1&(, > E1.A&7&%*1&: 4" 40;242 -.'.1TRATAMENTUL EMBOLIEI PULMONAREMASIVE2TRATAMENTUL ANTICOAGULANT > (%&(&4,1( ') 2,7&%*1& 1,9%&'(*.1&(& 1""UI;B0.'.%7 > :./)-? )%4&(& +, 1@UI;B0';2 ') -)7%&7)1,%,& (%&(. &1(*-'.&0)/&1( .%&/ 4*1*4 5-C 3*/,D -, (%,', /& (,%&7*& .%&/& +)7& 2 7%.:, INR '.1-,')(*6, !2 -* -, 4,1(*1, M*1*4 3 /)1*3TRATAMENTUL PRIMAR:- TROMBOLIZA: S(%,7(.B*1&3& 25" """ UI *1 3" 4*1? &7.* 1"" """ UI;2 12-242 -&) 1?5 4*/ UI *1 22#D %(PA 1"" 40 *1 22#- EMBOLECTOMIA- TROMBECTOMIA CHIRURGICALATRATAMENTUL SUPORTIV > .A*0,1.(,%&7*,? 6,1(*/&%, &-*-(&(& *1 '&3 +, *4*1,1(& +, -&) -(.7 %,-7*%&(.%?&4*1, -*47&(.4*4,(*', *1 '&3 +, './&7-TRATAMENTUL EMBOLIEI PULMONAREFARA RISC INALT SI AL TVPTRATAMENTUL ANTICOAGULANT > T%&(&4,1( ') 2,7&%*1& 1,9%&'(*.1&(& 1""UI;B0.'.%7 > :./)-? )%4&(& +, 1@UI;B0';2 ') -)7%&7)1,%,& (%&(. &1(*-'.&0)/&1( .%&/ 4*1*45-C 3*/,D -, (%,', /& (,%&7*& .%&/& +)7& 2 7%.:, INR '.1-,')(*6, !2 -* -, 4,1(*1, 4*1*4 3 /)1*- T%&(&4,1( ') 2,7&%*1& 9%&'(*.1&(&:E1.A&7&%*1& 1 40;B0' /& 122 -&) 1?5 40;B0' . +&(& 7, 3* -.'T*13&7&%*1& 1C5UI;B0' . +&(& 7, 3* -.'.F.1+&7&%*1& 5 40 G< 5"B0#D C?5 40 GE5"-1"" B0#D 1" 40 G!1"" B0#') -)7%&7)1,%,& (%&(. &1(*-'.&0)/&1( .%&/ 4*1*4 5-C 3*/,D -, (%,', /& (,%&7*& .%&/& +)7& 2 7%.:, INR '.1-,')(*6, !2 -* -, 4,1(*1, 4*1*4 3 /)1*