Athermoma, Thrombosis and Embolism Flashcards
What are the consequences of an atheroma?
Stenosis Dissection Aneurysm Thrombosis Embolism Ischaemia
What causes arterial stenosis
loss of elasticity in the artery
what causes cardiac fibrosis
consequence of ischaemia- reduced contractility
What is an aneurysm
Abnormal dilation of an artery
What is a dissection
Blood enters a tear in the intima creating a flase lumen
What are the risk factors for a dissection?
Hypertension Atheroma Trauma Coartication of the aorta Marfans Pregnancy
What are the risk factors for a DVT?
obesity inactivity pregnancy surgery after long flight or car journey varicose veins cancer previous ischaemic event heart failure sepsis
What diseases can predisopose to a DVT
nephrotic syndrome IBD vasculitis thrombocytosis inheritied coagulation disorders, antithrombin deficiency etc
What medications/drugs can predispose to a DVT
IVD
birth control pill
chemotherapy
heparin induced thrombocytopenia
What is virchows triad
hypercoagulabolity
stasis
endothelial injury
where do dvt’s mostly form
valves
What are the symptoms of a DVT
pain swelling hot/inflammed red tender
What blood test can be done to look for a dvt?
D dimer
not specific
what imaging can be done to look for a dvt
duplex scan
venous plethosomography
ultrasound
venogram
what is the treatment for a dvt
anticoagulate with LMWH and warfarin
compression stockings
What emergency complication can arise from a DVT
phlegmasia dolens= DVT causes so much back pressure that it obstructs arterial flow
“venous gangrene”
How could you treat phlegmasia dolens
IVC filter
femoral arterial line
amputation
How can an acute PTE be classified?
massive= with shock/syncope
Major= RV dysfunction
Major- normal RV function
minor
What signs could indicate a PTE
fourth heart sound
pleural rub
What is the first test you do if a PE is suspected?
D dimer then CXR
When do you do a VQ scan
if d dimer raised
What can you do after a VQ scan
Ct pulmonary angiogram will give definitie diagnosis
What is the usual treat ment of PE
anticoagulation
What can be done in a major PE
thrombolytic therapy but higher risk of bleed
What can be done to prevent recurrence?
IVC filter will decrease recurrent PE in short term nut may increase DVT and require long term anticoagulation
When is warfarin contraindicated
Pregnancy
Drug or alcohol abuse
dementia and mental illness
What foods are high in vitamen K
Spinach
brocolli
lettuce
soya beans
When is lifelong anticoagulation indicated?
Recurrent PE Antiphospholipid syndrome Inherited thrombophilia malignancy pulmonary hypertension
How long should you be anti coagulated after a first PE
3-6 months
