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Cardiovascular System > Pathophysiology of Thrombosis and Embolism > Flashcards

Pathophysiology of Thrombosis and Embolism Flashcards

1
Q

What is a term to describe normal blood flow?

A

Laminar - travels smoothly and in regular paths

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2
Q

What are two abnormal blood flow patterns?

A

Turbulence

Statis

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3
Q

What is static blood flow?

A

Stagnation of blood flow - occurs due to occlusion

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4
Q

What is turbulent blood flow?

A

Forceful, unpredicatable flow

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5
Q

What are the causes of abnormal blood flow?

A

Thromboembolism

Atheroma
Hyperviscosity 
Spasm 
External compression
Vasculitis 
Vascular steal
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6
Q

What is vascular steal?

A

Dilation of one vascular network (e.g., during exercise or vasodilator therapy) “steals” blood flow from another region within the organ that is already maximally dilated because of the presence of proximal lesions

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7
Q

What are the factors of Virchow’s Triad?

A

Changes too blood vessel wall
Changes in the blood constituents
Changes in the pattern of blood flow

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8
Q

What is Virchow’s Triad?

A

Factors causing thrombosis

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9
Q

What is thrombosis?

A

Formation of a solid mass from the constituents of blood within the vascular system during life

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10
Q

Give an example of change that can occur in the vessel wall?

A

Atheromatous coronary artery

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11
Q

What are three changes that occur that lead to thrombus formation?

A

Endothelial injury
Stasis or turbulent blood flow
Hypercoagulability of the blood

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12
Q

What is the difference between a thrombus and a clot?

A

A thrombus forms within the vascular system during life

A clot can occur anywhere and postmortem in the vascular system it is called a clot

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13
Q

Describe the stages of thrombosis

A
  1. Atheroma causes turbulent blood flow
  2. Loss of intimal cells from denudation of the plaque
  3. Platelet adhere to exposed collagen
  4. Forms fibrin network and trapped RBCs
  5. Lines of Zahn appear
  6. Causes further turbulence and platelet deposition
  7. Leads to propagation
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14
Q

What can cause changes to the vessel wall?

A

MI - can lead to mural thrombosis in the heart

Turbulent flow - denuding intima

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15
Q

What changes can occur to blood constituents?

A

Dehydration
Hyperviscosity
Post-traumatic hypercoagubility
Polycythaemia (increased Hb)

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16
Q

What can causes changes to blood flow (i.e. cause stasis or turbulence)?

A

Stasis: post-op (bed bound), long flights sitting down
Turbulence: atheromatous plaque, aortic aneurysm

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17
Q

What is a mural thrombosis?

A

Blood clot on the wall of the heart

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18
Q

What does the consequences of thrombosis depend on?

A

Site
Extent
Collateral circulation

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19
Q

List some clinical consequences of a thrombosis?

A

DVT, ischaemic limb, MI

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20
Q

What are favourable outcomes of thrombosis?

A

Resolution

Organisation and recanalisation

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21
Q

What are bad outcomes of thrombosis?

A

Death

Propagation -> embolism

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22
Q

What is an embolism?

A

Movement of abnormal material in the bloodstream and its impaction in a vessel, occluding it

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23
Q

What is an embolus?

A

Detached intravascular solid, liquid or gaseous mass

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24
Q

Difference between thrombosis and embolism

A

Thrombosis occurs when a thrombus develops in a blood vessel and reduces blood flow
Embolism occurs when a piece of thrombus, foreign object, or other bodily substance becomes stuck in a blood vessel, occluding it

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25
Q

What are most emboli substances?

A

Dislodged thrombi - thromboembolism

26
Q

What are some of the sources of thrombi in the arterial system?

A

Mural thrombus (MI, LA dilatation and AF)
Aortic aneurysms
Atheromatous plaque
Valvular vegetations (from growth of bacteria)

27
Q

What is paradoxical emboli?

A

An embolus which is carried from the venous side of circulation to the arterial side, or vice versa.

I.e. valvular vegetations (from vv. to aa.)

28
Q

Where can systemic thromboemboli travel to in the body?

A

Lower limbs (common)
Brain
Other organs

29
Q

What do the consequences of a systemic thromboembolism depend on?

A

Vulnerability of affected tissues to ischaemia
Calibre of occluded vessel
Collateral circulation but usually infarction occurs

30
Q

What is the most common form of thromboembolic disease?

A

Venous thromboembolus - originates from deep venous thromboses (lower limb)

31
Q

Where do venous thromboemboli travel to?

A

Pulmonary arterial circulation

Depending on size, may occlude main pul. artery, bifurcation of trunk or small arteries

32
Q

What is a saddle embolus?

A

A large pulmonary thrombo-embolism that straddles the main pulmonary arterial trunk at its bifurcation

33
Q

What are the consequences of a pulmonary thromboembolism?

A 
Depends on size:
Silent 
Pulmonary haemorrhage/infarction
RHF
Sudden death
34
Q

What can multiple PEs lead to over time?

A

Pulmonary HPT

R ventricular failure

35
Q

What are the risk factors for DVT an pulmonary thromboembolism?

A 
Cardiac failure 
Severe trauma/burns
Post-op/post-partum
Nephrotic syndrome 
Disseminated malignancy 
Oral contraceptive 
Age 
Bed bound/immobilisation 
Obesity 
PMH of DVT
36
Q

What is the management for surgical patients for prophylaxis from DVT and pul. thromboembolism?

A

TEDS stockings

Heparin (anticoagulant)

37
Q

When are patients at risk of a fat embolism?

A

After major fracture

38
Q

What do fat embolism affect?

A

Brain
Kidneys
Skin

39
Q

When are patients at risk of a gas embolism?

A

Decompression sickness - N2 forms as bubbles which lodge in capillaries

40
Q

When are patients at risk of an air embolism?

A

Head and neck wounds
After surgery
CV lines

41
Q

List other types of embolus

A 
Tumour 
Trophoblast (pregnant women - lungs)
Septic material (infective endocarditis)
Amniotic fluid
Bone marrow (fracture i.e. CPR)
Foreign bodies
42
Q

What is a septic material embolism?

A

Embolism that is infected with bacteria, resulting in the formation of pus

43
Q

What is an amniotic fluid embolism?

A

Amniotic fluid enters the blood stream of the mother which causes cardiorespiratory collapse and massive bleeding (coagulopathy)

44
Q

What is a bone marrow embolism?

A

Fat tissue from the bone marrow can occlude vessels

45
Q

List the type of forge in bodies which can cause an embolism

A

Intravascular cannulae tips

Sutures

46
Q

What is rheumatic fever?

A

An inflammatory disease that can involve the heart, joints, skin, and brain, sometimes neurological symptoms

47
Q

Where is rheumatic fever prevalent?

A

India
Middle East
Central Africa
and now Europe and North America

48
Q

What individuals does rheumatic fever commonly affect?

A

5-15 yrs

Boy > girls

49
Q

What does rheumatic fever present with?

A

‘Flitting’ (painful) polyarthritis of large joints (wrist, elbows, knees, ankles)
Skin rashes or nodules
Fever

50
Q

What occurs in the acute phase of rheumatic fever?

A

Pancarditis (inflammation affecting endocardium, myocardium and pericardium)
Heart murmurs common
Aschoff bodies

51
Q

What inflammatory bodies form in the heart in rheumatic fever?

A

Aschoff bodies

52
Q

What are Aschoff bodies composed of?

A

Chronic inflammatory cells
Necrotic mycoses
Activated macrophages (anitfchkow cells)

53
Q

What are three types of valvular heart disease

A

Stenosis
Regurgitation/incompetence
Vegetation

54
Q

What is valvular stenosis?

A

Valve thickened/calcified and obstructs normal blood flow into chamber/vessel

55
Q

What is valvular regurgitation?

A

Valve loses normal function and fails to prevent reflux of blood after contraction of cardiac chambers

56
Q

What are valvular vegetations?

A

Infective or thrombotic nodules develop on valve leaflets impairing normal valve mobility and may embolise

57
Q

What is pancarditis in acute rheumatic fever cause over time?

A

Progresses over time to chronic rheumatic heart disease, manifesting as valvular abnormalities

58
Q

How does pancarditis lead to formation of small valvular vegetations?

A

Inflammation of endocardium and L sided valves causes fibrinoid necrosis of the valve cusps/chordae tendinae (and along line of valve closure)

59
Q

What is a main feature of rheumatic heart disease?

A

Deforming fibrotic valvular disease (esp mitral valve)

Leaflet thickening
Commissural fusion and shortening
Thickening and fusion of chord tendinae

60
Q

What is the (virtually) only cause of mitral stenosis?

A

Rheumatic heart disease

61
Q

What valvular diseases does rheumatic heart disease cause?

A 
Mitral stenosis 
Mitral regurgitation 
Aortic stenosis (rare)
Aortic regurgitation
Tricuspid valve and pulmonary valve involvement rare

Cardiovascular System (37 decks)

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