27 thrombotic diseases Flashcards by Jamie Sanderson

what comes under coronary heart disease

angina + heart attack

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when does stroke occur

rapid death of brain tissue due to a disturbance in the blood supply

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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

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what is TIA defined as

stroke symptoms that resolve completely within 24 hours

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what must stroke be differentiated from

TIA

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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

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where are carotid arteries located

anterior supply for front and middle regions of the brain

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where are vertebral arteries located

posterior supply to brain stem and rear regions of the brain

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what are basilar artery

two vertebral arteries join together

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what are communicating arteries

posterior basilar carotid and anterior

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what is the purpose of communicating arteries

Communicating arteries: for cross-over flow during the damage in one of the arteries.

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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.

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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

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how long does it take to notice changes in someone with a ischemic stroke

2-3 hours

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when does complete death of brain tissue occur

6 - 24 hours

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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.

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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

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what is atrial fibrillation

left atrium is less effective in ejection of blood

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what is endocarditis

fungal or bacterial growth in heart valves forms clumps and emobli to the brain

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what can a haemorrhagic stroke be subdivided into

intracerebral

subarachnoid bleeding

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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

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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