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Cardiovascular > Thrombosis > Flashcards

Thrombosis Flashcards

1
Q

What defines virchows triad?

A

1) Site of endothelial injury
2) Turbulent blood flow
3) Hypeprcoaguable blood

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2
Q

What way does blood flow though vessles?

A

It flows in a laminar flow - the vessels are lined with endothelium because it organises the blood in a laminar way

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3
Q

How is thrombus formed?

A

Intravascular coagulation
Platelet activation
Fibrin production via the coagulation cascade
It is an active process

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4
Q

Why do platelets need to be activated?

A

Activated platelets are more sticky and so attract each other and will aggregate with other platelets. They will also aggregate with fibrin to join together to form a clot.

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5
Q

What is the end point of the coagulation cascade?

A

Fibirin

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6
Q

What is exposed when the endothelium is injured?

A

Collagen

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7
Q

What does collagen bind to?

A

It bind to glycoprotein 1A/2b on platelets

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8
Q

What binds to glycoprotein 1a/2b on platelets?

A

Collagen

von Willebrands factor (vWF)

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9
Q

What do activated platelets release?

A

Granules to attract other platelets - vWF, platelet activating factor (PAF), thomboxane A2 (TXA2) and ADP

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10
Q

What is the common pathway in the coagulation cascade?

A

Thrombin along with calcium ions converts fibrinogen to fibrin. Then factor 13 coonverts fibrin to cross-linked fibrin.

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11
Q

Where are the blood factors made?

A

Within the liver and therefore good liver function is needed to clot properly

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12
Q

How is the intrinsic pathway measured?

A

The prothrombin time (PT)

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13
Q

How is the extrinsic pathway measured?

A

By the activation partial thromboplastin time (APPT)

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14
Q

What is the extrinsic pathway?

A

Tissue factor (TF) joins with factor 7 which then proceeds down the normal pathway

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15
Q

What is the purpose of vitamin K?

A

It is required to make factors 2, 7, 9 and 10

It is a fat soluable vitamin stored in the liver

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16
Q

How does endothelial injury occur?

A

Hypertension - there is lots of banging on the side of vessel walls due to high pressure
Thrombosis doesn’t occur in the arterial system unless there is underlying atherosclerosis

17
Q

What is atherosclerosis?

A

The formation of plaques at the sites of endothelial damage

Arterial - relationship to hypertension

18
Q

Where is there likely to be atherosclerosis in arteries?

A

Where arteries branch there is turbulent flow and therefore increased endothelial damage

19
Q

What is the difference between stable and unstable angina?

A

Stable angina is exercise induced

Unstable angina is due to plaque rupture and occurs at rest

20
Q

What extrinsic factors can cause endothelial injury?

A

Toxins
Infectious agents - viruses
Smoking related
Autoimmune diseases - primary vasculitis (churg strauss)

21
Q

What does turbulence cause?

A

Endothelial cell injury (swirling of blood)

Stasis

22
Q

Where will stasis of blood flow occur?

A

Deep venous system
Faulty valves
Venous insufficiency

23
Q

What can cause hypercoagulability?

A

Anything that causes increased viscosity
Dehydration
Polycethemia - increased number of cells (altitude, smoking, bone marrow condition)
Leukaemias

24
Q

What are the anti-clotting proteins?

A

Protein C
Protein S
Antithrombin 3

25
Q

What do protein C and S do?

A

They degrade factors 5 and 8

26
Q

What does antithrombin 3 do?

A

It degrades factors 2, 9 and 10

27
Q

What are the secondary causes of clots?

A 
Prolonged immobility 
Significant tissue injury 
Antiphopholipid syndrome 
Myocardial infarction 
AF
Cancer and cancer therapy 
Marantic endocarditis 
The pill 
Smoking
Renal disease 
Cardiomyopathy
28
Q

What is an embolism?

A

A disloged thrombus that travels around the vascular system until it gets stuck and will cause infarction

29
Q

What are the causes of embolus?

A 
Thrombus
Air
Septic
Amniotic fluid
Tumour
Fat
30
Q

What will increased calcium stimulated?

A

ATPase (makes things worse)
Phsopholipase (membrane damage)
Proteases (membrane and cytoskeleton damage)
Endonuclease (DNA damage and breakdown)
Mitochondiral permeability (release of pro death factors)

31
Q

What are the branching vessels?

A 
Coronary vessels 
Above bifurcation of aorta 
Origin and division of carotid arteries 
Renal arteries 
Superior mesenteric arteries

Cardiovascular (27 decks)

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