Emergency Medicine

CHEST PAIN

52 General Medical Emergencies

Table 2.2 Predisposing risk factors for venous thromboembolism (VTE)

Acute provoking factors

Hospitalization, i.e. reduced mobility

Surgery, particularly abdominal, pelvic, leg

Trauma or fracture of lower limbs or pelvis

Immobilization (includes plaster cast)

Long haul travel – over 3000 miles or 5000 km

Recently commenced oestrogen therapy (e.g. within previous 2 weeks)

Intravascular device (e.g. venous catheter)

Chronic predisposing factors

Inherited Acquired Inherited or acquired

Natural anticoagulant

deficiency such as

protein C, protein S,

antithrombin III

deficiency

Increasing age High plasma

homocysteine

Factor V Leiden Obesity High plasma coagulation

factors VIII, IX, XI

Prothrombin G20210A

mutation

Cancer (chemotherapy) Antiphospholipid syndrome
(anticardiolipin antibodies
and lupus anticoagulant)
Leg paralysis
Oestrogen therapy
Pregnancy or puerperium
Major medical illnessa
Previous venous
thromboembolism
(DVT/PE)
aChronic cardiorespiratory disease, inflammatory bowel disease, nephritic syndrome,

myeloproliferative disorders.
DVT, deep vein thrombosis; PE, pulmonary embolus.
Modified from Ho WK, Hankey GJ (2005) Venous thromboembolism: diagnosis and
management of deep venous thrombosis. Med J Aust 182:476 –81.

3 A small PE causes sudden dyspnoea, cough, pleuritic pain and possibly
haemoptysis, with few physical signs. Look for a low-grade pyrexia (37.5°C),
tachypnoea over 20/min, tachycardia, crepitations and a pleural rub.

4 A major PE causes dyspnoea, chest pain and light-headedness or syncope.
Look for cyanosis, tachycardia, hypotension, a parasternal heave, raised
jugular venous pressure (JVP) and a loud delayed pulmonary second sound.