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W's MoD > Lect 13 - Atheroma, Thrombosis & Embolism > Flashcards

Lect 13 - Atheroma, Thrombosis & Embolism Flashcards

1
Q

what is Atherosclerosis

A

“Degeneration of arterial walls characterised by fibrosis, lipid deposition and inflammation which limits blood circulation and predisposes to thrombosis”

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2
Q

what vessels are commonly affected by Atherosclerosis

A 
Bifurcations (sites of turbulent flow)
Abdominal aorta 
Coronary arteries
Popliteal arteries
Carotid vessels
Circle of Willis
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3
Q

What are the common nonmodifiable risk factors for Atherosclerosis

A

Age
Male
FH
Genetic

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4
Q

what are the modifiable risk factors for atherosclerosis?

A

Hyperlipidaemia (LDL:HDL)
Hypertension
Smoking
Diabetes

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5
Q

talk though the Pathophysiology of Atherosclerosis formation, up to the point of fatty streak formation.

A

endothelial injury -> lipid accumulates in intima ->Monocytes come and ingest the lipid becoming foam cells

FORMS FATTY STREAK

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6
Q

what do foam cells do?

A

secrete chemokines attracting more monocytes/macrophages, lymphocytes and smooth muscle cells

CONSTITUENTS OF THE ATHEROSCLEROTIC PLAQUE

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7
Q

What different zones within the plaque form?

A

the edges = “shoulders”
the top = “fibrous cap”
the middle = “necrotic core”

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8
Q

what tends to happen after atherosclerosis formation?

A

Occlusion

Weakening of vessel walls
Aneurysm formation

Erosion
Thrombosis formation?

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9
Q

what is a Thrombosis

A

Solidification of blood contents formed in the vessel during life.

it is different to a clot in pathogenesis and morphology.

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10
Q

what factors make up virchow’s triad

A

The intimal surface of the vessel
The pattern of blood flow
Blood constituents

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11
Q

what are platelets fragments of?

A

Fragments of megakaryocytes in the bone marrow

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12
Q

what do Platelets release?

A

Alpha granules: fibrinogen, fibronectin, PDGF

Dense granules: chemotactic chemicals

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13
Q

why would plaque rupture lead to arterial thrombus?

A

causes turbulent flow and intimal change. also Hyperlipidaemia – change in blood constituents

Platelets bind and fibrin is produced entrapping RBC

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14
Q

what is Venous thrombosis caused by?

A

Intimal change: valves

Change in blood flow: Immobile

Change in blood constituents:
Inflammatory mediators (infection, malignancy)
factor V leiden
Oestrogen

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15
Q

what is a thrombi in the heart known as?

A

mural thrombi

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16
Q

where do mural thrombi form?

A

over areas of endomyocardial injury:
MI
Myocarditis

NOTE : Can also occur with arrhythmias and cardiomyopathy

17
Q

what is the major risk of thrombosis?

A

Embolisation

18
Q

what is an Embolus

A

A mass of material in the vascular system able to lodge in a vessel and block it

19
Q

what is the most common type of emboli?

A

PE.

Very common cause of hospital morbidity and mortality

20
Q

what are the clinical effects of a small PE

A

initially asymptomatic, if multiple may result in pulmonary hypertension

21
Q

what are the clinical effects of a medium PE

A

Cause acute respiratory and cardiac failure (V/Q mismatch, RV strain)

22
Q

what are the clinical effects of a large (saddle) PE

A

Death

23
Q

what are the types of emboli? (6)

A 
infective
tumour
gas
Amniotic fluid embolism
Fat embolism
Foreign body embolism
24
Q

where do Infective emboli come from?

A

Usually from the vegetations on infected heart valves

Effects compounded by the infective nature – may lead to mycotic aneurysm formation

25
Q

where do Tumour emboli come from?

A

Bits may break off as tumours penetrate vessels

Do not usually cause immediate physical problems

26
Q

where do Gas emboli come from?

A

Air (vessel opened into the air)

Nitrogen
Decompression sickness (“the bends”)
27
Q

where do Amniotic fluid emboli come from?

A

Increased uterine pressure during labour may force AF into maternal uterine veins (1:50,000 deliveries)

28
Q

where do fat emboli come from?

A

Microscopic fat emboli found in 80% patients with significant trauma at PM

Sudden onset of respiratory distress

29
Q

where do foreign body emboli come from?

A

Particles injected intravenously

E.g. talc in IVDU’s

Leads to a granulomatous reaction

W's MoD (18 decks)

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