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MOD > Atheroma and thrombosis > Flashcards

Atheroma and thrombosis Flashcards

1
Q

define atherosclerosis

A

degeneration of arterial wall characterised by fibrosis, lipid deposition and inflammation which limits blood circulation and predisposes to thrombosis.

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2
Q

which vessels or positions on vessels are commonly affected by atherosclerosis.

A 
Bi furcations (tubulent flow)
Abdominal aorta
Coronary arteries
Popliteal arteries vessels in the leg
Carotid vessels
Circle of willis.
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3
Q

what are the common non modifiable risk factors of atheroscerlosis.

A

age, male, FH, genetics.

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4
Q

what are the common modifiable risk factors of atheroscerlosis.

A 
Hyperlipidaemia (LDL:HDL)
Hypertension
Smoking
Diabetes
Other: CRP, ↑homocysteine,(metabolic condition)?
Stress
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5
Q

what causes the atherosclerotic process to begin

A

chronic injury and repair of the endothelium

First step is endothelial injury.

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6
Q

what causes endothelial injury

A

Haemodynamic injury, chemicals, immune complex deposition, irradiation.

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7
Q

In which layer of the artery does lipid deposit in hyperlipademia.

A

intima

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8
Q

what factors are produced upon damage of the endothelium

A

adhesion factors.

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9
Q

what cells migrate to the intima engulfing lipid and forming foam cells

A

monocytes

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10
Q

what is the the name for the point at which monocytes engulf lipid and form foam cells

A

fatty streak.

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11
Q

what do the foam cell secrete to circulate more macrophages, lymphocytes and smooth muscle cells.

A

chemokines

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12
Q

what is the function of smooth muscle cells in the atherosclerotic plaque

A

proliferate and secrete connective tissue.

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13
Q

what forms the fibrous cap of a atheroscleotic plaque

A

smooth muscle, macrophages, foam cells, lymphocytes, collagen, elastin and proteoglycans.

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14
Q

what forms the necrotic centre of the atherosclerotic plaque

A

cell debris, cholesterol crystals, foam cells and calcium.

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15
Q

what pathology follows atherosclerosis

A

occlusion
weakening of vessel wall- aneurysm
erosion (of fibrous cap)- thrombus

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16
Q

define thrombus

A

Solidification of blood contents formed in the vessel during life.

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17
Q

what are the characteristics of a clot which make it different to a thrombus

A

stagnant
enzymatic process
elastic
adopt to the shape of the vessels

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18
Q

what are the characteristics of a thrombus which make it different to a clot.

A

during life
dependent on platelets
firm.

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19
Q

what cell is needed in thrombus formation

A

platelets.

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20
Q

what bone marrow cell gives rise to platelets

A

megakaryocytes.

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21
Q

what is the function of platelets, to what molecule do they bind in endothelial injury

A

circulate in the blood stream

Bind to collagen exposed by endothelial damage and become activated

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22
Q

what molecules do platelets secrete.

A

Alpha granules: fibrinogen, fibronectin, PDGF

Dense granules: chemotactic chemicals

23
Q

how is virchow’s triad important in atherosclerosis formation

A

platelet adhesion and subsequent thrombus formation requires change in intimal surface of the vessel, blood flow and blood constituents.

24
Q

what is the pathogenesis of arterial thrombosis

A

plaque ruptures- turbulent flow and intimal change.
Hyperlipidaemia- change in blood constituents.
Platelets bind and fibrin is produced entrapping RBC.
Thrombus propagation-infront of thrombus is laminar flow and behind thrombus is turbulent flow.

25
Q

what is the pathogenesis of venous thrombosis.

A 
intimal change- valves
change in bloodflow  immobile
change in blood constituents- prothrombogenic
Factor V leiden
oestrogen
inflammatory mediators
26
Q

what are thrombi of the heart also known as

A

mural thrombi.

27
Q

How does MI predispose the heart to thrombi

A

surface of the heart becomes sticky so the platelets adhere

28
Q

How does arrhythmia’s predispose the heart to thrombi

A

stasis occurs and hence a thrombus can form.

29
Q

what does a thrombus predispose you to

A 
occlusion of a vessel
resolution
incorporation into the vessel
recanalisation
embolisation
30
Q

define embolisation

A

A mass of material in the vascular system able to lodge in a vessel and block it

31
Q

what are the acquired risk factors of pulmonary emboli

A

immobility, malignancy, previous VTE, heart failure, oestrogen’s, obesity, pregnancy, renal disease, smokers

32
Q

what are the genetic and hereditary factors of pulmonary emboli

A

Thrombotic disorders
FV Leiden
Protein S defieiciency

33
Q

what are the symptoms of DVT

A

looks hot, red swollen

34
Q

what are the clinical symptoms of of small PE

A

asymptomatic, if multiple may result in pulmonary hypertension

35
Q

what are the clinical symptoms of of medium PE

A

acute respiratory and cardiac failure (V/Q mismatch, RV strain)

36
Q

what are the clinical symptoms of of large PE

A

“saddle emboli”

37
Q

define paradoxical emboli

A

Hole in the heart means that clot can travel from the left to the right side of the heart and then lodge into a pulmonary vessel.

38
Q

where do systemic emboli arise

A

in the heart or within the arterial circulation.

39
Q

where do atheromas arise from

A

eroded plaques

40
Q

where do platelet emboli arise from

A

atherosclerotic plaques.

41
Q

where do infective emboli arise from

A

Usually from the vegetation’s on infected heart valves

42
Q

what are the main causes of infective emboli

A

prosthetic valve and IV drug use.

43
Q

consequence of infective emboli

A

mycotic aneurysm formation.

44
Q

define tumour embolism

A

tumour section dislodges into blood vessel.

45
Q

what are the 2 types of gas embolism

A

• Air (vessel opened into the air)
- Obstetric procedures / chest wall injury

• Nitrogen
– Decompression sickness (“the bends”)
– Divers, tunnel workers
– Nitrogen bubbles enter bones, joints and lungs

46
Q

In an oxygen gas emboli what must the amount of oxygen be to cause significant effects

A

100 ml.

47
Q

what causes amniotic fluid embolism- pathophysiology.

A

Increased uterine pressure during labour may force AF into maternal uterine veins

48
Q

what causes fat embolism

A

significant trauma post menopause

49
Q

what is a consequence of amniotic emboli

A

Lodge in lungs leading to respiratory distress

50
Q

what is a consequence of fat embolism

A

Sudden onset of respiratory distress

51
Q

what causes foreign body embolism

A

Particles injected intravenously

52
Q

where do atheromas commonly form

A

lower limbs after and angiogram which can cause the plaque to dislodge.

53
Q

define atheroma

A

Atheroma is a fatty deposit in the intima, which is the inner lining,

54
Q

does atheroma predispose to atherosclerosis

A

Yes

MOD (19 decks)

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