27 thrombotic diseases Flashcards
what comes under coronary heart disease
angina + heart attack
when does stroke occur
rapid death of brain tissue due to a disturbance in the blood supply
what is the who definition of a stroke
neurological deficit of cerebrovascular cause that persists byeyond 24 hours or is interrupted by death within 24 hours
what is TIA defined as
stroke symptoms that resolve completely within 24 hours
what must stroke be differentiated from
TIA
what are the risk factors of a stroke
Inactivity age family history ethnicity high blood pressure heart disease diabetes smoking obesity oral contraception + HRT previous strokes and TIAs binge drinking and substance misuse
where are carotid arteries located
anterior supply for front and middle regions of the brain
where are vertebral arteries located
posterior supply to brain stem and rear regions of the brain
what are basilar artery
two vertebral arteries join together
what are communicating arteries
posterior basilar carotid and anterior
what is the purpose of communicating arteries
Communicating arteries: for cross-over flow during the damage in one of the arteries.
what is ischemic stroke
Causes thrombosis of large and small arteries alike.
Thrombosis occurs when blood clots block your blood vessels. It may be caused by injury, immobility and other factors.
what is ischemic stroke caused by
atherosclerotic plaque rupture leads to thrombosis
interrupts bloods supply to neurons
rapid death of brain tissues lead to loss of brain function
how long does it take to notice changes in someone with a ischemic stroke
2-3 hours
when does complete death of brain tissue occur
6 - 24 hours
what is an embolism
A blood clot that forms in a blood vessel in one area of the body, breaks off, and travels to another area of the body in the blood is called an embolus.
what is the effect of congestive heart failure / myocardial infarction in causing an embolism
failure or heart attack (MI) ejection fraction of left ventricle is low leading to blood stasis and thrombosis. Thrombus may stick to ventricle wall and become embolised and this can break up to pieces and block arteries resulting in a stroke
what is atrial fibrillation
left atrium is less effective in ejection of blood
what is endocarditis
fungal or bacterial growth in heart valves forms clumps and emobli to the brain
what can a haemorrhagic stroke be subdivided into
intracerebral
subarachnoid bleeding
describe intracerebral haemorrhagic stroke
Intracerebral (within brain): due to hypertension, trauma, bleeding disorders & vascular defects
Arteriovenous malformation: feeder artery to NIDUS (nest of small arteries) and lead to collection vein
High pressure in AVM causes rupture and bleeding forms haematoma
Haematoma compress/ rupture/ damage neurons – irreversible damage
describe subarachnoid (surface) haemorrhagic stroke
most of the aneurysm occur in the circle of willis such as at the junctions of anterior communication and anterior cerebral arteries
two types saccular and fusiform
damages compression of tissues from expanding haematoma
leading to direct toxic effect of blood cells and interruption of blood supply to neurones
what is needed in a subarachnoid haemorrhagic stroke
surgical intervention
what is transient ischemic attack (TIA)
mini stroke, temporary blockage of blood supply due to small blood clots
can be overcome in 30 - 60 minutes or 24 hours
can occur repeatedly in multiple regions
what is important to note about TIA
leads to major ischemic stroke
what is ABCD2
a prognostic score to identify people at high risk of stroke after a transient ischemic stroke
what does prognostic mean
relating to or serving to predict the likely course of a medical condition.
what are the different parts of the ABCD2
age >60 = 1 point
blood pressure >140/90mmHg = 1 point
clinical features
- unilateral weakness = 2
- speech disturbance without weakness
duration of symptoms
- 10-59 minutes = 1 point
- 60 mins + = 20 min
presence of diabetes = 1 point
what does a score >4 mean
high risk of stroke
when someone presents with a high stroke risk what should be done
give 300mg aspirin daily
specialist assessment
investigation within 24 hours of TIA symptoms
what are the three ways we can try to recognise a stroke
facial weakness
arm weakness
speech problems
how can we attempt to manage stroke
assess risk of stroke in patients with TIA
specialist care for people with acute stroke using brain imaging e.g. CT / MRI scan
pharmacological approaches
what are the aims of pharmacological approaches
prevent further neuronal loss
repair replace damaged neurones
what does a thrombolytic agent do
promotes the breakdown of fibrin
what IV administration
4.5 hours of stroke improves clinical outcome
describe the alteplase administration
4.5 hours
900 mcg/kg/over 60 minutes
describe the aspirin administration
24 hours 300 mg daily for 2 weeks
what pharmaceutical management can we give for haemorrhagic stroke
removal or clipping of aneurysm antihypertensive reversing anticoagulants surgery to remove blood or heamatoma surgery to treat hydrocephalus (drain CSF)
what are two long term mangements for stroke
clopidogrel at 75mg daily
modofied release dipyridamole 200mg twice daily in combination with aspirin
who should modified release dipyridamole be given too
TIA
ischemic stroke and clopidogrel is contraindicated
what ar the 4 main parts of rehabilitating a stroke patient
resotration of function
learning new skills
adapting to some of the limitations
support network
what is PAD
peripheral arterial disease
describe peripheral arterial disesase
atherosclerotic plaques in lower extremeties lead to hardening of arteries supplying blood to legs
block the blood supply and lead to ischemia
results in myocytes death
what are the causes of PAD
diabetes obesity smoking infection injury yto vessels sedentary lifestyle high blood pressure autoimmune disease nutritional defeciencies high blood cholesterol emboli from other locations inflammation in blood vessels
what are the symptoms of pad
none at first coolness to touch poor skin /nail health infections/injuries dont heal pain when walking stops with rest discolaration
what changes in lifestyle can we recommend to someone with pad
regular exercise
smoking cessation
weight reduction for obese
reduce alcohol
what medications can we give for PAD
anti platelet drugs
naftidrofuryl oxalate
cilostazol
what procedures can we use to treat pad
angioplasty
endartectomy
what is endartectomy
surgical removal of part of the inner lining of an artery, together with any obstructive deposits, most often carried out on the carotid artery or on vessels supplying the legs.
what is angioplasty
Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis
what is deep vein thrombosis
occurs in deep veins in lower extremities
blood flows back to heart due to muscle movement
reduced movement or injuries diminishes or stops blood flow in veins
so accumulation of platelets and plasma and pasma proteins leads to clotting
what are the causes of deep vein thrombosis
inactivity stay at hospitals blood vessel damage medical conditions genetic conditions pregnancy combined contraceptive pills and hormone replacement therapy
what can we use to diagnose DVT
blood test for d - dimer levels
ultrasound scan
venogram
what can we use to treat DVT
Anticoagulants to prevent the clots getting bigger and breaking off
heparin
warfarin sodium
rivaroxaban
apixaban
