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Cardiovascular Week 4 2016/17 > 2: Pathology of thrombosis & embolism > Flashcards

2: Pathology of thrombosis & embolism Flashcards

1
Q

What is the difference between a clot and a thrombus?

A

Clot - outside the vessel

Thrombus - inside the vessel

Clot often used colloquially.

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2
Q

What is Virchow’s Triad?

A

Site of endothelial injury

Turbulent blood flow

Hypercoagulable blood

all favour thrombus formation.

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3
Q

Thrombus is formed by intravascular coagulation. What are the two main steps of this?

A

1) Platelet activation

2) Fibrin production & coagulation cascade

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4
Q

Activated platelets are more “___”.

A

sticky

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5
Q

Platelets attract and aggregate with other __ and __.

A

platelets , fibrin

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6
Q

Which chemical is the endpoint of the coagulation cascade?

A

Fibrin

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7
Q

What activates platelets and how is it exposed?

A

Collagen of connective tissue

Exposed because of endothelial damage

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8
Q

What chemical on platelets do collagen and vWF bind to?

A

Glycoprotein Ia/IIb

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9
Q

What does glycoprotein IIb/IIIa bind to?

A

Fibrinogen

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10
Q

Activated platelets release chemicals (granules) to attract other platelets - what are some examples?

A

vWF, PAF, Thromboxane A2, ADP

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11
Q

The coagulation effect is also known as a ___.

A

cascade

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12
Q

The coagulation cascade has a lot of opportunities for inhibition and stimulation, which can all be targeted by __.

A

drugs

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13
Q

What chemical is important in the formation of specific factors?

A

Vitamin K

(II, XII, IX and X)

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14
Q

Why does liver disease inhibit the coagulation cascade?

A

Vitamin K stored in the liver

So body can’t produce factors II, VII, IX and X

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15
Q

Which drug stops the body’s production of II, VII, IX and X?

A

Warfarin

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16
Q

If someone has been given too much warfarin, what can you do?

A

Give them Vitamin K injections

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17
Q

Which condition can cause endothelial injury in the arteries?

A

Hypertension

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18
Q

Why doesn’t high arterial flow damage the arteries?

A

Pro-coagulant materials (e.g platelets) are washed away before they stick

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19
Q

When may high pressure arterial flow cause thrombosis?

A

If there is underlying atherosclerosis

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20
Q

What is atherosclerosis?

A

Arterial hardening and thickening, formation of plaque at sites of endothelial damage

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21
Q

Fibrous plaque caps which form during atherosclerosis are prone to ___.

A

rupture

22
Q

Arterial stenosis tends not to occur unless there is underyling ___.

A

atherosclerosis

23
Q

Stable angina tends to occur on __.

A

exertion

24
Q

Unstable angina is associated with __ and can occur at __.

A

rupture , rest

25
Q

What is the main factor affecting blood flow through a vessel?

A

Radius

26
Q

What are other causes of endothelial injury?

A

Toxins (e.g tobacco)

Infectious agents

Autoimmune disease (inflammation)

27
Q

What is a historic risk factor for DVT?

A

Having had DVT already

28
Q

What are two effects of turbulent blood flow on a vessel?

A
  1. Swirling of blood (imagine getting stuck in a swirly pool at the bottom of a waterfall)
  2. Stasis
29
Q

Blood flow is usually laminar. If it becomes turbulent, platelets move to the edge of the vessel - what is this called?

A

Margination

30
Q

In marginated blood flow, platelets are more likely to come into contact with?

A

Endothelial wall (or lack thereof)

31
Q

Where is blood flow most likely to slow down and produce stasis?

A

Deep venous system (low pressure, faulty valves etc.)

32
Q

Where do DVTs develop?

A

Calf veins

Femoral veins

33
Q

Thrombi from __ veins tend to circulate further in the blood.

A

smaller

A thrombus is only as wide as the vein it started in

34
Q

What is the name of the process which regulates, amongst other things, clotting and clot lysis in the body?

A

Homeostasis

35
Q

Hypercoagulability may be associated with __ disorders.

A

inherited

36
Q

If someone has developed a DVT on a long haul flight, they probably have…

A

an inherited mutation.

37
Q

Name some causes, other than genetic disorders, of clotting / DVT.

A

Prolonged immobility

Significant tissue injury - burns, RTA

Autoimmune diseases

MI

Atrial fibrillation - blood clots in atria

38
Q

What is an embolus?

A

A dislodged thrombus which travels around the vascular system until it gets stuck

39
Q

What would you see on an X-ray if a patient had suffered a pulmonary embolism?

A

Wedge-shaped infarcs

40
Q

What is ischaemia?

A

Insufficient blood supply

41
Q

What is infarction?

A

Tissue death as a result of ischaemia

42
Q

Turbulent blood flow occurs anywhere a vessel __.

A

branches

43
Q

Branching vessels are a common site of __ __.

A

endothelial damage

44
Q

The most common cause of thromboembolic stroke is embolism where?

A

Bifurcation of carotid arteries

45
Q

Name some anti-clotting proteins produced by the body.

A

Protein C, S and antithrombin III

46
Q

What is a natural clot buster produced by the body?

A

Plasmin

47
Q

Name an inherited genetic disorder causing hypercoagulability of the blood.

A

Factor V Lieden

48
Q

___ increases the production of TNF, which causes hypercoagulability of the blood.

A

Cancer

49
Q

Which particular drug may increase the coagulability of the blood?

A

Contraceptive pill

50
Q

Give two examples of branching vessels which are vulnerable to embolism.

A

Coronary vessels

Bifurcation of aorta

Bifurcation of the carotids

Renal arteries

Superior mesenteric artery

51
Q

What may happen following embolism which blocks…

1) Bifurcation of carotids
2) Superior mesenteric artery?

A

1) Stroke
2) Small bowel infarction

Cardiovascular Week 4 2016/17 (7 decks)

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