Arterial thrombosis

Question 1

What is an arterial thrombosis?

Answer 1

A blood clot in an artery. 

Question 2

What causes an arterial thrombosis?

Answer 2

1. Mainly caused by atherosclerosis. Increased risk of atherosclerosis due to → increased age, smoking, unhealthy diet, lack of exercise, being overweight, alcohol consumption, hypertension, high cholesterol, diabetes, south asian/afro-caribbean descent.
2. May also occur due to conditions that make your blood more likely to clot → atrial fibrillation or antiphospholipid syndrome

Question 3

What are the risk factors for arterial thrombosis?

Answer 3

• Hypercholesterolaemia 
• Hypertension 
• Diabetes mellitus 
• Smoking 
• Lack of activity and obesity. 
• Poor diet. 
• Family history of arterial thrombosis. 
• Immobility, such as after surgery or on a long trip. 

Question 4

What are the presenting symptoms of arterial thrombosis?

Answer 4

• A blood clot does not usually have any symptoms until it blocks the flow of blood to part of the body. 
• Pain in the affected area 
• Numbness and tingling in the arm or leg 
• a swollen leg or arm. 
• chest pain. 
• weakness on one side of the body. 
• mental changes. 
• Temporarily decreased organ function 
• Cold arm or leg 
• Decreased or no pulse in an arm or leg 
• Lack of movement in the arm or leg 
• Pale colour of the arm or leg (pallor) 

Question 5

What signs of arterial thrombosis can be found on physical examination?

Answer 5

• Myocardial Infarction → chest pain, SOB, dizziness
• Stroke → unilateral facial paralysis, unilateral weakness, slurred speech
• TIA (’mini stroke) → blood flow to brain is temporarily blocked, causing short-lived stroke symptoms
• Critical Limb Ischaemia (complication of PAD) → blood supply to limb is blocked, causing it to become painful, pale and cold (6 P’s)

Question 6

What investigations are used to diagnose/ monitor arterial thrombosis?

Answer 6

1. Angiography of the affected extremity or organ 
2. Doppler ultrasound exam of an extremity 
3. Duplex Doppler ultrasound exam of extremity 
4. Echocardiogram 
5. Transesophageal echocardiography (TEE) 

Question 7

How is an arterial thrombosis managed?

Answer 7

1. Reduce Risk by lowering Atherosclerosis Risk
   - Stop smoking, improve diet, exercise, lose weight, cut down on alcohol
   - Medications → statins, anti-hypertensives, anticoagulants (warfarin) and antiplatelets (aspirin/clopidogrel)
2. Treatment for Arterial Thrombosis
   - Thrombolysis → dissolve blood clot
   - Embolectomy → operation to remove clot
   - Angioplasty → operation to widen the affected artery
   - CABG → surgery to divert blood around the blocked artery