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CVS > Atherosclerosis + Thrombus + Embolism > Flashcards

Atherosclerosis + Thrombus + Embolism Flashcards

1
Q

What is an atheroma and what is in it and what does it cause

A

Formation of plaques in arteries
Plaque has lipid core full of debris from MO
Fibrous cap has inflammatory cells

Leads to
Plaque stiffen = hypertension
Stenosis = reduced flow = angina
Can become inflamed and thrombus = IHD / ACS

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2
Q

What is the pathology of formation of atheroma

A

Endothelial injury - smoking / high HDL / HTN

Chronic inflammation
LDL aggregate
Free radicals turn LDL into lipids = inflammation
MO phagocytose LDL into
toxic foamy macrophages
Fatty streak forms
Enhanced expression for cell adhesion (ICAM1 + E selection)
High permeability for LDL + platelets
Growth factor PDGF released from platelet = proliferation
Inflammation + inflammatory cells recruited
Smooth muscle proliferation

Fatty streaks becomes atherosclerotic plaque which can cause stenosis or thrombosis

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3
Q

What are the RF for atheroma

Non modifiable and modifiable

A

Non-modifiable

  • Age
  • FH
  • Male
Modifiable 
Smoking
Alcohol
Diet 
Hypercholesterolaemia - high LDL, low HDL
Hypertension
DM
CKD 
RA as inflammatory process
Atypical anti-psychotic

Less strong
Obesity
Inactivity
Low birth weight

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4
Q

How do you investigate atherosclerosis

A

Bloods - LDL, HDL, cholesterol, triglycerides
Carotid USS - flow (radius decreases, velocity increases)
Ausculate - bruit = stenosis
Neuro exam

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5
Q

What is primary prevention of atherosclerosis

A 
Never had CVS event 
Smoking cessation 
Control BP
Weight loss
Exercise
Control DM
Statin 20mg + aspirin 75mg
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6
Q

What is secondary prevention (prevent another event)

A 
Statin - 80mg
Aspirin (inhibit platelet aggregation) 
BB titrate to max 
ACEI titrate to max 
Surgery
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7
Q

What surgery can be done

A

Bypass - CABG
Stenting - (no GA + minimally invasive and reduce risk of stroke)
Carotid endarectomy if >70% stenosis - open up and remove plaque in common carotid, internal or external

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8
Q

What are risks of surgery

What nerves affected

A 
Endarectomy 
Stroke / MI
Infection
Bleeding 
Scar
Anaesthetic
GA
Nerve damage
Recurrent laryngeal = hoarse
Sympathetic = Horner
Hypoglossal = tongue deivation

Stenting

  • Emboli
  • Groin haematoma
  • Radiation
  • Contrast nephrotoxicity
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9
Q

What are complications of stable atheroma occluding blood flow

A

Stable angina
Coronary artery stenosis
Peripheral vascular disease

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10
Q

When does a plaque become complicated

A

Haemorrhage into plaque causing calcification

Plaque rupture leading to thrombus which travels and blocks distal = ischaemia (ACS / stroke / TIA)

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11
Q

What are the complications of plaque rupture

A

Activation of coagulation as contents exposed
Thrombis + embolism
ACS (Unstable angina +MI)
Stroke
Aneurusm / AAA as calcification weakens walls

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12
Q

What determines flow through vessel

A

Pressure difference / Resistance

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13
Q

What determines resistance

A

Vessel length x (viscosity / radius)

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14
Q

Guidelines following TIA / non disabling stoke

A

BMT to all patient
Carotid imaging within 1 week
If no significant stenosis = BMT
If significant >70% = refer for endarectomy

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15
Q

When do you start primary prevention

A

If QRISK >10% risk of event in 10 years

or if CKD / type 1 DM for 10 years

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16
Q

What should you check when start statin

A

Lipids at 3 months - aim for 40% reduction
LFT at 3 months and 12 months
Monitor for rhabdomyolysis

17
Q

What can statin cause

A

Myopathy
Type II DM
Risk of rhabdomyolysis if with macrolide AX
Rarely haemorrhagic stroke

18
Q

What is a thrombus

A

Solid mass of blood constituents within vascular system

19
Q

What causes thrombus

A

Virchow’s

  • Change in vessel wall
  • Change in blood constituents
  • Change in blood flow
20
Q

What causes change in vessel wall

A

Atheroma as causes tuburlent flow
Exposes collagen leading to platelet and fibrin adhesion
Enlarges

21
Q

What causes change in blood flow

A 
Stasis e.g. post-op / travel
Atheroma = turbulent flow 
AAA
Hyperviscosity
Spasm of vessel
External compression
Vasculitis
22
Q

What causes change in blood constituents

A

High cholesterol / LDL
Hypercoagulable
Surgery

23
Q

What is a mural thrombus

A

Thrombus in heart

  • MI
  • AF
  • Atrial dilatation
24
Q

What does it lead too

A

PE if on ride side

Stroke / renal infarct / bowel ischaemia if L side

25
Q

What is the outcome of a thrombus

A

Resolution as body breaks down
Embolism
Death

26
Q

What are complications of thrombus

A

DVT
Limb ischaemia
MI
CVA

27
Q

What is an embolism

A

Movement of abnormal material in blood stream

28
Q

What can cause embolus

A 
Thromboembolism = most common
Fat
Amniotic fluid
Air - IV line / surgery
Heart valve vegetation
Tumour 
Gas
FB

CVS (30 decks)

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