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Heart Failure RCM:5 > Thrombosis and Embolism > Flashcards

Thrombosis and Embolism Flashcards

1
Q

What is thrombosis

A

Process leading to the formation of a thrombus

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2
Q

What is a thrombus

A

Solid mass composed of blood constituents which have aggregated together in flowing blood in the lumen of a blood vessels;

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3
Q

What are the main constituents of a thrombus

A

Platelets and fibrin

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4
Q

What is thrombosis limited by

A

Fibrinolysis

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5
Q

When does thrombosis become a pathological process

A

When it isn’t controlled by fibrinolysis

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6
Q

How Is a thrombus formed

A
  • VEssel wall is breached
  • Circulating platelets aggregate to plug the gap
  • Platelets release factors which trigger coagulation cascade
  • Coagulation cascade converts fibrinogen to large molecules of insoluble fibrin
  • Long fibrin molecules bind together platelets and entrapped red and white cells
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7
Q

What controls the size of the thrombus

A

Fibrinolysis

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8
Q

What holds the thrombus together

A

FIbrin

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9
Q

What is the active enzyme which fragments fibrin

A

Plasmin

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10
Q

What is a measure of thrombosis

A

D-Dimer test

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11
Q

What inactive proenzyme does plasma contain

A

Plasminogen

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12
Q

What does plasminogen become

A

Plasmin

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13
Q

What is plasminogen converted to plasmin by

A

Plasminogen activators

-particularly tissue plasminogen activator (secreted by endothelial cells)

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14
Q

What happens in fibrinolysis

A

When fibrin is formed, plasminogen and tissue plasminogen activator bind to it. The tissue plasminogen activator converts nearby plasminogen to plasmin which degrades the fibrin

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15
Q

What are D-dimers and when’re they elevated

A

Breakdown product of a fibrin mesh

-Increased blood levels in thrombosis

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16
Q

What factors contribute to the formation of a thrombus

A
  • Damage to vessel wall
  • Slow or turbulent blood flow
  • Change in character of blood
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17
Q

How does the character of blood change for there to be an increase in the chance of a thrombus

A
  • Increased platelets
  • Increased red cell numbers
  • Increased viscosity
18
Q

Main cause of thrombus formation in arteries

A

Vessel wall damage

19
Q

MAin cause of thrombus formation in veins

A

Stasis of blood

20
Q

Main cause of thrombus formation in ventricles

A

Chamber wlall damage

21
Q

Main cause of thrombus formation in atrium

A

Stasis of blood

22
Q

Main cause of thrombus in heart valves

A

Valve surface damage

23
Q

What does a thrombus in the artery leading to the heart lead to

A

Angina

24
Q

What does a thrombus in a coronary artery lead to

A

Heart attack

25
Q

What does a thrombus in an artery leading to the brain lead to

A

Stroke

26
Q

In a vein, what does an occlusion prevent and so what does this lead to

A

Prevents drainage of tissues. So blood pools and cannot escape. This leads to congestion and infarction

27
Q

What is organised thrombus

A
  • New vessels grow into the thrombus
  • VAscular granulation tissue develops
  • Fibroblasts invade and deposit collagen
  • Fibrovascular granulation tissue develops
28
Q

What is recanalisation

A

When vessels link up inside the thrombus

29
Q

What is embolism

A

Transference of abnormal material by the blood stream with eventual impaction of the material in a vessel distal to its site of origin

30
Q

What are the most important materials to embolism

A

Thrombus and cancer cells

31
Q

What does a thrombus in an artery or the left side of the heart embolism into

A

systemic arterial system

32
Q

Where may a thrombus in an artery or the left hand side of the heart go to

A 
Brain
Lower limbs
Mesentric arteries
Renal arteries
Splenic artery
33
Q

Where would a thrombus in a systemic vein eventually embolise

A

To a pulmonary artery branch

34
Q

What would a pulmonary artery branch thrombus be called

A

Pulmonary embolus

35
Q

What would a small embolus in a pulmonary artery lead to

A

small peripheral lung infarct

36
Q

What would a large embolus in a pulmonary artery branch lead to

A

Sudden death

37
Q

To measure tissue heat, what can you measure

A

Level of lactate

38
Q

What are some other materials which would embolise

A
  • Fat and marrow
  • Air
  • Nitrogen
  • Amniotic fluid
39
Q

How does nitrogen embolism occur

A

When you go deep underwater, the solubility of your blood to nitrogen increases so more nitrogen dissolves in bloodstream.

IF you go up from the deep water too quickly, the nitrogen becomes ‘bubbly’ and you get bubbles in blood

40
Q

How does an amniotic embolism occur

A

Placenta peels off and the amniotic fluid ends up in the blood

squamous cells (petal skin cells) which are present in the amniotic fluid can block the blood vessels

41
Q

Difference between infarction and necrosis

A

Infarction is tissue death (necrosis) due to inadequate supply of oxygen

42
Q

Signs of a previous myocardial infarction

A

Scarring (white)

Heart Failure RCM:5 (10 decks)

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