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Cardiovascular > Atheroma, Thrombus & Emboli > Flashcards

Atheroma, Thrombus & Emboli Flashcards

1
Q

What are the synonyms of atheroma?

A
  • atherosclerosis
  • hardening of the arteries
  • coronary artery disease
  • ischaemic heart disease
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2
Q

What causes atherosclerosis?

A
  • smoking
  • hypertension
  • hyperlipidaemia
  • diabetes
  • age
  • sex
  • genetics
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3
Q

Describe the pathogenesis of atheroma

A
  1. endothelial injury
  2. accumulation of lipids & macrophage
  3. migration of smooth muscle cell s
  4. increase in size
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4
Q

Describe the progression of atheromatous plaques

A

fatty streak –> fibrofatty plaque –> complicated plaque with overlying thrombus

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5
Q

When is atheromatous likely to cause disease?

A
  • if it is the only artery supplying an organ
  • artery diameter is small
  • overall blood flow is reduced
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6
Q

State five complications of atheromatous

A
  • stenosis
  • thrombosis
  • aneurysm
  • dissection
  • embolism
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7
Q

What is arterial stenosis what does it cause?

A

Narrowing of the arterial lumen due to reduced elasticity & flow in systole.
Tissue ischaemia

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8
Q

What are the implications of tissue ischaemia?

A
  • reduced exercise tolerance
  • angina
  • unstable angina
  • MI
  • cardiac failure
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9
Q

Describe cardiac fibrosis

A

Loss of cardiac myocytes which are replaced by fibrous tissue leading to loss of contractility & reduced elasticity & filling

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10
Q

What arteries are commonly affected by arterial stenosis?

A
  • coronary
  • carotid (TIA, stroke, vascular dementia)
  • renal (hypertension & renal failure)
  • peripheral (claudication & foot/leg ischaemia)
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11
Q

Define thrombus

A

formation of a mass from the constituents of blood within the vasculature during life in

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12
Q

Name the three parts of virchow’s triad

A
  1. changes in blood flow
  2. changes in blood coagulability
  3. endothelial damage
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13
Q

State six factors that can lead to hypercoaguability

A
  • MI
  • Immobility
  • Prothesis
  • AF
  • Cardiomyopathy
  • Cancer
  • Contraceptive Pill
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14
Q

Describe arterial thrombi

A

usually lodge in coronary, cerebral and femoral circulations

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15
Q

Define emboli

A

detached intravascular solid/liquid/gas mass carried distal to point of origin

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16
Q

How can endothelial be damaged?

A
  • smoking
  • hyperlipidaemia
  • hypertension
  • toxins
  • infection
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17
Q

What does endothelial damage lead to?

A

increased permeability & macrophage/platlet adhesion activation

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18
Q

What do macrophages do?

A

generate oxidative free radicals & cytokines which leads to the formation of fatty streaks by free radicals ingesting & trapping LDL

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19
Q

What situations are not included in the pre-probability test for DVT?

A
  • those who’ve had a previous DVT

- pregnant women

20
Q

What PTP score equates to high risk?

A

2

21
Q

What is D dimer?

A

a breakdown product of fibrin

22
Q

Low D-dimer indicates…

A

DVT unlikely

23
Q

High D-dimer is a sign post for…

A
  • MI
  • Infection
  • Surgery
  • DVT
24
Q

What does low d-dimer and low PTP mean?

A

DVT can be excluded

25
Q

If D-dimer is high what must be done to exclude DVT?

A

doppler ultrasound

26
Q

What is the treatment for DVT?

A

TED stockings

Anticoagulation

27
Q

Name the condition which results in back pressure due to DVT obstruction

A

Phlegmasia Dolens

28
Q

What is the treatment for Phlegmausia Dolens?

A

IVC filter through artery to prevent thrombus entering lungs

29
Q

What is the preferred investigation for PE?

A

V/Q scan

30
Q

What is the advantage of an IVC filter?

A

Prevents PE short term but increases risk of DVT

31
Q

Why is warfarin not given in pregnancy?

A

Increased risk of haemorrhage

32
Q

Define aneurysm

A

abnormal &; persistent dilatation of an artery due to weakness in its wall

33
Q

Name seven types of aneurysm

A
  • mycotic
  • atherosclerotic
  • dissecting
  • congenital
  • arteriovenous
  • traumatic
  • syphilitic
34
Q

What are the complications of an aneurysm?

A
  • rupture
  • mural thrombus
  • emboli
  • pressure erosion of adjacent structures
  • infection
35
Q

Describe an arterial dissection

A

Splitting within the media by flowing blood, middle aged atheroma. The false lumen in the media fills with blood leading to sudden collapse & mortality

36
Q

What is the difference between a distal and proximal DVT?

A

distal - DVT of the calves - no need to treat

proximal - above the knee needs treatment

37
Q

How will a DVT present?

A

Painful, swollen limb with redness & heat. Tenderness along the vein, sub acute development

38
Q

How will a PE present?

A

SOB, pleuritic pain, collapse, haemoptysis, hypoxia, tachycardia, BP may be low

39
Q

What is used to assess risk the severity of a PE?

A

PESI - takes into account risk factors to assess risk of death

40
Q

If the patient has a massive PE what is done?

A

Thrombolysis - aggressive clot destruction

41
Q

For all DVT/PE other than a massive one what treatment is given?

A

Anticoagulants - Apixaban & Rivaroxaban

42
Q

What treatment is sometimes used in patients with cancer and a PE?

A

Low molecular weight heparin

43
Q

How long are the anticoagulants prescribed for?

A

Provoked VTE - 3-6 months

Unprovoked VTE - long term or life (increased risk of reoccurrence in men)

44
Q

Describe the HERD002 score

A 
Hyper pigmentation 
Edema
Redness of leg 
1 for any one of the above 
D-dimer >250 - 1 point 
Obesity BMI >30 - 1 point 
Older age >65 years - 1 point
45
Q

What is the HERD002 scoring usually used for?

A

Women if >2 points continue to anitcoagulate

Cardiovascular (19 decks)

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