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Sem2: MDSA30160: Cardiorespiratory Disease > L3 Thrombosis-Embolism > Flashcards

L3 Thrombosis-Embolism Flashcards

1
Q

Solid Mass of blood constituents formed within vascular system responsible for nearly 50% of adult deaths?

A

Thrombus

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2
Q

Mass of material in vascular system mobile within vessel cable of blocking the lumen

Examples?

A

Embolism

Thromboembolism (from damage to blood vessel)

Fat Embolus (Fractured Bone)

Air Embolus

Amniotic Fluid

Tumor Fragment (Metastasis)

Septic Emboli

Foreign Body (Talc in IV drug Users)

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3
Q

What is Virchow’s Triad?

A

Changes in any 1/3 can lead to thrombosis:

  1. Endothelial Injury
  2. Abnormal Blood flow
  3. Hypercuogulbility
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4
Q

Intact versus Injured Epithelium?

A

Intact Epithelium

Anticoagulant

Fibrinolytic

Injured Epithelium:

Platelets adhere to exposed extracellular matrix

–> Endothelium becomes PRO CUAGULANT

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5
Q

Normal blood flow is __________ while during Stasis/Turbelence _______________

A

Normal flow is LAMNINAR:

Blood components flow centrally

Clear zone of plasma separating from endothelium

During Statis/Turbulence:

Platelets contact vessel wall

Inflow of clotting factor inhibitors slows

Promotes endothelial cell activation

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6
Q

Where do Arterial Thrombi usually occur?

A

Arterial Thrombi typically occur at:

site of endothelial injury

Bifurcation(turbulence)

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7
Q

Where do venous Thrombi usually occur?

A

Venous Thrombi occur at site of stasis

90% in Lower Extremities

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8
Q

Uncommon alteration of coagulation pathway that predisposes to thrombi with Primary (Genetic) Secondary (Acquired)

A

Hyper Coagulability

Alteration of coagulation pathway that predisposes to thrombi

Uncommon

Causes:

Primary (Genetic)

Secondary (Acquired)

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9
Q

_______________ are common in cardiac and aortic thrombosis and are used to determine is clot formed during patient’s life or postmorbid

A

Lines of Zahn:

Pale layers: Platelets mixed w/ Fibrin

Dark Layers: Red Blood cells

Common in cardiac or aortic thrombosis

Used to determine is clot formed during a patient’s life or post morbid

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10
Q

In which direction do arterial thrombi extend?

A

Extend in direction towards blood flow

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11
Q

In which direction do venous thrombi extend?

A

Extend in direction of blood flow

Propagating tail not well attached

Prone to fragmentation –> embolus

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12
Q

In which direction do venous thrombi extend?

A

Extend in direction of blood flow

Propagating tail not well attached

Prone to fragmentation –> embolus

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13
Q

Which type of thrombi is ALWAYS Occlusive?

A

Venous Thrombosis

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14
Q

Which type of thrombi are superimposed on Atherosclerotic lesion and lead to infarction of distal tissue?

A

Arterial Thrombosis

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15
Q

______________: form on wall of underlying structure

Heart chamber –> _____________

Aorta–> ___________________

A

Mural Thrombosis:

Form on wall of underlying structure

Heart chamber –> MI or Arrythmia

Aorta–> Atherosclerosis or Aneurysmal Dilation

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16
Q

Proximal vs. Distal DVT?

A

DISTAL Vein Thrombosis:

Deep Veins of Calf

PROXIMAL Vein Thrombosis:

Popliteal, Femoral, Iliac

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17
Q

Outcomes of DVT? (3)

A
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18
Q

Clinical Features of DVT?

A

Symptoms:

Pain

Swelling (Edema)

Redness (Erythema)

Signs:

Tenderness

Homan’s Sign (Sharp pain in calf upon dorsiflexion)

Increased calf diameter

30% of patients are Asymptomatic!!

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19
Q

Homan’s Sign is indicative of what?

A

Homan’s Sign (Sharp pain in calf upon dorsiflexion) is indicative of DEEP VEIN THROMBOSIS

Not done often due to risk of dislodging thrombosis

20
Q

Phlegmasia Cerulea Dolens (‘___________’)

Very Rare

_________ Venous Thrombosis

Findings:

Venous _______

________ syndrome

Circulatory _______

A

Phlegmasia Cerulea Dolens (‘painful blue edema’)

Very Rare

Proximal Venous Thrombosis

Findings:

Venous Gangrene

Compartment syndrome

Circulatory Collapse

21
Q

What is the investigation for DVT?

A

D-Dimer Blood Test:

D-Dimer: unique product of plasmin mediated breakdown of crosslinked fibrin

Negative D-Dimer + Low Clinical Probability (Well’s Score): excludes possibility of presence of a DVT

22
Q

Treatment of Acute, Chronic and Massive DVT?

A

Acute:

  • Subcutaneous LMW Heparin
  • Unfractionated Heparin

Chronic

  • Oral Anticoagulants:
  • Warfarin
  • Rivaroxaban
  • Dabigatram

Massive

  • Thrombolysis
  • Surgical Thrombectomy
23
Q

Prevention of Primary and Secondary DVT?

A

Prevention of DVT:

Primary

LMW Heparin

Movement after surgery

Compression Stockings

Secondary

Anticoagulation

Inferior Vena Cava Filter (to catch clot before entering heart)

24
Q

From where do the majority of Pulmonary Emboli arrise?

A

DVT

Majority are clinically silent

25
Q

Consequences of Pulmonary Embolism?

A

Respiratory Compromise

Lung not properly profused –>

Inflammation

Surfactant dysfunction

Atelectasis (collapse of lung)

hypoxemias

Hemodynamic Compromise

Resistance to flow –> rise in pulmonary blood pressure

–> acute right heart failure (Acute Cor Pulmonale)

–> pulmonary infarction (lung tissue death)

26
Q

____________ straddles the bifurcation of pulmonary arteries and is found in autopsy

A

Saddle Embolus straddles the bifurcation of pulmonary arteries and is found in autopsy

27
Q

________________:

Obstruction >50% of main or proximal artery

–> decreased cardiac output

–> right ventricular dilation (failure)

Example?

Clinical Presentation?

A

Acute Massive PE

Obstruction >50% of main or proximal artery

–> decreased cardiac output

–> right ventricular dilation (failure)

Saddle Embolus straddling the bifurcation of pulmonary arteries found in autopsy

Clinical Presentation:

Collapse

Central Chest Pain

Sudden Death

28
Q

______________________

Small thrombi travel distally to occlude segmental pulmonary arteries

Clinical Signs?

A

Acute Small/ Medium PE

Small thrombi travels distally to occlude segmental pulmonary arteries

Clinical Signs:

Dyspnea

3 days later –> pleuritic (membrane surrounding lungs) chest pain

29
Q

_________________

Exertional Dyspnea

Symptoms of right ventricular failure:

Peripheral Edema

Increased Juglar Venous Pressure (JVP)

Hepatomegaly

A

Chronic PE

Exertional Dyspnea

Symptoms of right ventricular failure:

Peripheral Edema

Increased Juglar Venous Pressure (JVP)

Hepatomegaly

30
Q

Chronic occlusion of pulmonary microvasculature leads to ________________ and __________________

A

Chronic occlusion of pulmonary microvasculature leads to pulmonary hypertension and right heart failure

31
Q

Symptoms of Pulmonary Embolism?

A

Symptoms:

Dyspnea –shortness of breath

Pleuritic chest pain –pain on taking a breath in

Hemoptysis –coughing up blood

Collapse

32
Q

Signs of Pulmonary Embolism?

A

Signs:

Tachypnoea -fast breathing

Tachycardia -fast heart rate

Hypotension -low blood pressure

Fever - if infarcted

Right heart failure

33
Q

Diagnosis of Pulmonary Embolism?

A

Diagnosis of PE

Arterial Blood Gas

D-Dimer Blood Test - Fibrin Degradation Product

BNP** and **Troponin Increase w/ Heart failure

ECG: Sinus tachycardia

Imaging:

Ventilation/ Perfusion Scan

CT Pulmonary Angiogram

34
Q

Where do Systemic Emboli Arise?

A

Arises in:

Arteries

Left of Heart

Aortic Aneurism

35
Q

Consequences of Systemic Emboli?

A

Tissue infarct

Transient Ischemic Attacks:

Cerebrovascular Accident (CVA)

36
Q

__________________:

Shower of small embolisms to brain

Full recovery typical

A

Transient Ischemic Attacks:

Shower of small embolisms to brain

Full recovery typical

37
Q

___________________\_: Large emboli in brain can cause stroke

A

Cerebrovascular Accident (CVA): Large emboli in brain can cause stroke

38
Q

What can cause a systemic embolus to originate from a DVT?

A

Paradoxical Embolism :

Extremely Rare

Systemic embolism in venous part of circulation

Caused by abnormal blood transfer between the left and right sides of the heart

Patent Foramen Ovale

Atrial/Ventricular Septal Defect

39
Q

_______________________: inherited or acquired defect of Haemostasias leading to disposition to thrombosis

A

Thrombophilia: inherited or acquired defect of Haemostasias leading to disposition to thrombosis

Autosomal DOMINANT

DVT and PE occur at early age, in unusual places

40
Q

What is Factor V Leiden Mutation?

A

Factor V Leiden Mutation

Demographics:

Predominantly Caucasian

20-30% of DVT patients present w/

60% of those w/ recurrent DVT

Point mutation in gene encoding Factor V

Mutant form of Factor V cannot be degraded by activated Protein C

–> Anti-thrombotic counter-regulatory pathway lost

41
Q

_______________

Predominantly Caucasian

Chromosome 11 mutation –> 30% increase in circulating Thrombin

A

Prothrombin Gene Mutation

Predominantly Caucasian

Chromosome 11 mutation –> 30% increase in circulating Thrombin

42
Q

__________ is the precursor to thrombin

A

Prothrombin is the precursor to thrombin

43
Q

___________ converts fibrinogen –> fibrin

A

Thrombin converts fibrinogen –> fibrin

44
Q

Antithrombin III deficiency(AD), Protein C deficiency (AD), Protein S deficiency are examples of _______________

A

Antithrombin III deficiency(AD), Protein C deficiency (AD), Protein S deficiency are examples of Thrombophilias

45
Q

What is Antiphospholipid Syndrome?

Diagnosis?

Clinical Presentation?

A

Antiphospholipid antibodies directed against phospholipids bound to plasma proteins

Pro-coagulant effect on Protein C, platelets, and tissue factor

Diagnosis:

Test for presence of anti-cardiolipin, anti-β2 glycoprotein 1

Clinical:

Arterial/ Venous Thrombosis

Repeated abortions due to placental thrombosis

Strokes

Sem2: MDSA30160: Cardiorespiratory Disease (24 decks)

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