Atherosclerosis, Thrombosis, Embolism Flashcards by Kerry Hendrie

Define ‘thrombosis’

Formation of a mass (thrombus) from the constituents of blood within the vasculature during life

How well did you know this?

Not at all

Perfectly

How does a thrombus differ from a clot?

Thrombus must form during life in the body; clots can form when blood is extracted post-mortem

How well did you know this?

Not at all

Perfectly

What are the 3 components of Virchow’s triad?

Changes in blood flow
(stasis of blood flow causes MARGINATION of platelets)
Changes in blood coagulability
(protein C and S, antithrombin mutations)
Endothelial damage

How well did you know this?

Not at all

Perfectly

Give some examples of hypercoaguable aquired states

Myocardial infarction
Immobility
Cancer
Prosthesis
AF
Cardiomyopathy
Oral contraceptive use

How well did you know this?

Not at all

Perfectly

Arterial thrombi are red. True/False?

False

How well did you know this?

Not at all

Perfectly

Where do arterial thrombi often lodge?

Coronary, cerebral, femoral circulations

How well did you know this?

Not at all

Perfectly

Define ‘embolism’

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

How well did you know this?

Not at all

Perfectly

Venous emboli commonly infarct peripheral circulation. True/False?

False
Very rare (carried to pul circulation, more likely lodge there)

How well did you know this?

Not at all

Perfectly

Give examples of factors causing endothelial injury

Smoking
Hyperlipidaemia
Hypertension
Toxins
Infection

How well did you know this?

Not at all

Perfectly

Give examples of what happens due to endothelial dysfunction

Increased permeability

Macrophage + platelet adhesion and activation

How well did you know this?

Not at all

Perfectly

Once macrophages are activated on the endothelial surface, what do they generate?

Oxidative free radicals

Cytokines

How well did you know this?

Not at all

Perfectly

What do oxygen free radicals do to LDL?

Ingest and trap it within macrophages, forming foam cells/fatty streaks

How well did you know this?

Not at all

Perfectly

D-dimer can both rule out and diagnose DVT. True/False?

False

How well did you know this?

Not at all

Perfectly

What is D-dimer?

A breakdown product of fibrin

How well did you know this?

Not at all

Perfectly

If D-dimer levels are low, a DVT is unlikely. True/False?

True

How well did you know this?

Not at all

Perfectly

If D-dimer levels are high, a DVT is very likely. True/False?

False

D-dimer levels are raised by many things (infection, MI, surgery)

How well did you know this?

Not at all

Perfectly

If your D-dimers are elevated, what is the next investigation for diagnosing a DVT?

(Doppler) ultrasound

CT scan if ilieo-femoral veins

How well did you know this?

Not at all

Perfectly

If your D-dimers are low and US negative, DVT can be excluded. True/False?

True

How well did you know this?

Not at all

Perfectly

If your D-dimers are high but US negative, DVT can be excluded. True/False?

False

Repeat US before completely excluding DVT

What is the mainstay of DVT treatment?

Anticoagulation (LMWH heparin, warfarin/NOACS)
TED compression stockings
Analgesia
Calf muscle exercises

What are the investigations of choice for PE?

D dimer
V/Q scan
CTPA (gold standard)

What is the advantage of a caval filter for acute PE?

Prevents recurrence of PE in short term

What is the drawback of a caval filter?

Increases risk of DVT - patients will require anticoagulation if long-term filter

When is warfarin contraindicated?

Pregnancy

Increased haemorrhage risk (uncontrolled drug abuse, dementia etc.)

What are the risk factors for atheroma?

Smoking, hypertension, hyperlipidaemia, DM, age, sex (males), genetics

What is the pathogenesis of atheroma?

Primary endothelial injury Accumulation of lipids and macrophages Formation of foam cells and fatty streak Increased size of collagen cap Fibrofatty plaque Arterial wall weakness and loss of lumen patency (Can form a collagen cap and platelet plug = THROMBUS)

What are the complications of atheroma?

Stenosis (narrowing of lumen) Thrombosis Aneurysm (abnormal dilatation due to weakness in wall) Dissection (splitting within media by flowing blood) Embolus

What are the common causes of aneurysm?

``` Myocytic AV Dissecting Congenital Atherosclerotic Traumatic Syphilitic ```

What are the common causes of dissection?

``` Atheroma Hypertension Trauma Coarctation Marfans Pregnancy ```

What do statins inhibit?

HMG-CoA reductase (reduce LDL formation)

What is metabolic syndrome?

Type 2 DM Obesity Hyperlipidaemia (Predisposes you to atherosclerosis)

What score is used to calculate risk of atherosclerosis?

Assign score

What is the difference between DVT and PE?

DVT: Thrombi in venous valve pockets and sites of stasis PE: Thromboembolus detach and travel to RHS of heart, blocking vessels in the lung

What score is used to predict the probability of DVT/PE?

Wells score (0: D dimer) (1-3: imaging)

What are the challenges of new forms of anticoagulation?

NOACS (e.g. rivaroxaban, epixaban, dabigatron) are irreversible, wherease VKA is

What is the treatment of choice in VTE for active cancer patients?

Fragmin

Compression stockings are the only treatment for...

Post thrombotic syndrome (a venous stasis syndrome occurring after DVT)

When are IVC filters indicated?

When anticoagulation is contraindicated

The two main complications of deep vein thrombosis (DVT) are...

PE | Post thrombotic syndrome

What are the main risk factors for VTE?

``` HRT Thrombophilia Pregnancy Trauma Surgery Malignancy Immobility Pulmonary hypertension Vasculitis Obesity Previous VTE ```

What are the two main types of DVT?

Proximal (ileo-femoral) | Distal (popliteal)

In what situation of DVT would thrombolysis be considered?

If it is ilieo-femoral veins affected

What are some common signs of DVT?

Calf warmth, tenderness, swelling, erythema, mild fever, pitting oedema

What are some differentials for DVT?

Bakers cyst Superficial thrombophlebitis Calf cellulitis

What are some symptoms associated with PE?

``` SOB (typically acute) Pleuritic chest pain Haemoptysis Leg pain/ swelling Collapse/dizziness (Pyrexia, tachycardia, hypotension) ```