Atheroma, Thrombus & Emboli

Question 1

What are the synonyms of atheroma?

Answer 1

• atherosclerosis
• hardening of the arteries
• coronary artery disease
• ischaemic heart disease

Question 2

What causes atherosclerosis?

Answer 2

• smoking
• hypertension
• hyperlipidaemia
• diabetes
• age
• sex
• genetics

Question 3

Describe the pathogenesis of atheroma

Answer 3

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

Question 4

Describe the progression of atheromatous plaques

Answer 4

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

Question 5

When is atheromatous likely to cause disease?

Answer 5

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

Question 6

State five complications of atheromatous

Answer 6

• stenosis
• thrombosis
• aneurysm
• dissection
• embolism

Question 7

What is arterial stenosis what does it cause?

Answer 7

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

Question 8

What are the implications of tissue ischaemia?

Answer 8

• reduced exercise tolerance
• angina
• unstable angina
• MI
• cardiac failure

Question 9

Describe cardiac fibrosis

Answer 9

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

Question 10

What arteries are commonly affected by arterial stenosis?

Answer 10

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

Question 11

Define thrombus

Answer 11

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

Question 12

Name the three parts of virchow’s triad

Answer 12

1. changes in blood flow
2. changes in blood coagulability
3. endothelial damage

Question 13

State six factors that can lead to hypercoaguability

Answer 13

• MI
• Immobility
• Prothesis
• AF
• Cardiomyopathy
• Cancer
• Contraceptive Pill

Question 14

Describe arterial thrombi

Answer 14

usually lodge in coronary, cerebral and femoral circulations

Question 15

Define emboli

Answer 15

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

Question 16

How can endothelial be damaged?

Answer 16

• smoking
• hyperlipidaemia
• hypertension
• toxins
• infection

Question 17

What does endothelial damage lead to?

Answer 17

increased permeability & macrophage/platlet adhesion activation

Question 18

What do macrophages do?

Answer 18

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

Question 19

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

Answer 19

• those who’ve had a previous DVT

- pregnant women

Question 20

What PTP score equates to high risk?

Answer 20

2

Question 21

What is D dimer?

Answer 21

a breakdown product of fibrin

Question 22

Low D-dimer indicates…

Answer 22

DVT unlikely

Question 23

High D-dimer is a sign post for…

Answer 23

• MI
• Infection
• Surgery
• DVT

Question 24

What does low d-dimer and low PTP mean?

Answer 24

DVT can be excluded

Question 25

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

Answer 25

doppler ultrasound

Question 26

What is the treatment for DVT?

Answer 26

TED stockings | Anticoagulation

Question 27

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

Answer 27

Phlegmasia Dolens

Question 28

What is the treatment for Phlegmausia Dolens?

Answer 28

IVC filter through artery to prevent thrombus entering lungs

Question 29

What is the preferred investigation for PE?

Answer 29

V/Q scan

Question 30

What is the advantage of an IVC filter?

Answer 30

Prevents PE short term but increases risk of DVT

Question 31

Why is warfarin not given in pregnancy?

Answer 31

Increased risk of haemorrhage

Question 32

Define aneurysm

Answer 32

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

Question 33

Name seven types of aneurysm

Answer 33

- mycotic - atherosclerotic - dissecting - congenital - arteriovenous - traumatic - syphilitic

Question 34

What are the complications of an aneurysm?

Answer 34

- rupture - mural thrombus - emboli - pressure erosion of adjacent structures - infection

Question 35

Describe an arterial dissection

Answer 35

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

Question 36

What is the difference between a distal and proximal DVT?

Answer 36

distal - DVT of the calves - no need to treat | proximal - above the knee needs treatment

Question 37

How will a DVT present?

Answer 37

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

Question 38

How will a PE present?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

If the patient has a massive PE what is done?

Answer 40

Thrombolysis - aggressive clot destruction

Question 41

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

Answer 41

Anticoagulants - Apixaban & Rivaroxaban

Question 42

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

Answer 42

Low molecular weight heparin

Question 43

How long are the anticoagulants prescribed for?

Answer 43

Provoked VTE - 3-6 months | Unprovoked VTE - long term or life (increased risk of reoccurrence in men)

Question 44

Describe the HERD002 score

Answer 44

``` 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 ```

Question 45

What is the HERD002 scoring usually used for?

Answer 45

Women if >2 points continue to anitcoagulate