Thrombosis/Embolism/Infarction/Shock Flashcards
A ______ is an intravascular clot, often impeding or preventing blood flow.
thrombus
What is thrombosis?
the formation or presence of a thrombus (may result in infarction)
______ Triad = endothelial injury + Alterations in blood flow + hypercoagulability
Virchow’s
True or False: Virchow’s Triad includes hypocoagulability.
False: HYPERcoagulability
Endothelial injury (loss of barrier) will _____ prothrombotic activity.
increase
Alterations in blood flow are commonly of what two types?
- turbulence
2. stasis
What is turbulence?
hyper-coagulative state = increased flow = endothelial activation
What is stasis?
peripheral displacement of platelets or concentration of clotting factors results in decreased flow = endothelial activation
True or False: Thrombosis can occur due to inherited or acquired conditions.
True
What are the three mentioned inherited conditions of hypercoagulability?
Factor V Leiden (Va cannot be cleaved)
AT III deficiency
Prothrombin mutation
In what situations would there be an acquired condition that results in hypercoagulability (and thrombosis)?
prolonged bed rest cancer pregnancy extensive tissue injury anti-PL ab
Is a homozygote of Factor V Leiden at higher or lower risk for developing thrombosis?
Homo = 50% risk Hetero = ~5% risk
Thrombosis can either be arterial or venous. What are the colors associated with each?
arterial = white venous = red
Describe arterial thrombosis.
incorporation of fibrin = makes it WHITE sites of turbulence (endothelial injury) occlusive or mural on heart valves (NBTE) DISTINCT LINES OF ZAHN (layering of red blood cells)
Describe venous thrombosis.
sites of stasis (ex. deep leg veins/bed rest)
INDISTINCT lines of zahn (slower flow rate)
_____ thrombosis is associated with turbulence, whereas, ______ thrombosis is associated with stasis.
arterial
venous
True or False: In an aortic thrombus, there would be distinct lines of zahn.
True.
arterial thrombis = DISTINCT lines
Thrombi form _______ the heart.
toward
What are the four fates of thrombi?
Propagation
Embolization
Dissolution (resolution)
Organization (recanalization)
What is DIC?
Disseminated Intravascular Coagulation
- widespread activation of both the coagulation cascade and the fibrinolytic systems
Why is “consumptive coagulopathy” sometimes used to describe DIC?
coagulation factors and platelets are depleted (causing bleeding problems) while fibrin split products are elevated (microthrombi)
its a big mess of clotting and bleeding issues occuring simultaneously
True or False: Disseminated Intravascular Coagulation is a dangerous disease.
False: it is a CONDITION not a disease
What are the possible etiologies of D.I.C.?
- infection (gram negative bacteria)
- obstetric complications (placental abruption, retained dead fetus)
- neoplasm
- shock
- massive tissue injury
What are the treatment options for DIC?
HIGHLY VARIABLE (but usually you treat the bleeding aspect of the condition preferentially) -depends on the management of underlying disorder
What is an embolus?
an INTRAvascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin
The majority of emboli are dislodged thrombus material and are known as ____________.
thromboembolism
What is the common origin for a Pulmonary Thromboembolism?
Deep leg veins
True or False: A pulmonary thromboembolism may have no manifestations or consequences.
True
- often blood can be re-routed through other vasculature
- however, some CAN cause sudden death (saddle embolus)
What is a “saddle embolus?”
A large emboli obstructing a large pulmonary artery or straddling the bifurcation of the pulmonary arterial trunk
Systemic embolization usually originates in _______.
the left atrium
- almost always it’s ARTERIAL
- could also originate from the left ventricle or atherosclerotic plaque
What is a “paradoxical systemic embolization?”
an embolus that arises in a vein before CROSSING into the arterial side of circulation; often passes through a patent foramen ovale
What is the common passageway for a paradoxical systemic embolus?
the patent foramen ovale
Name the five types of embolism.
- Thrombus *
- Fat (not common- may occur with bad bone breaks)
- Air (“bends” and caisson disease)
- Amniotic Fluid (can be associated with DIC)
- Atherosclerotic Plaque Material
_______ is an area of ischemic necrosis secondary to occlusion of arterial supply or venous drainage.
Infarction
Infarction is an area of ischemic _________ that is _______ to occlusion of arterial supply or venous drainage.
necrosis
secondary
Name a major contributor to mortality associated with cardiovascular disease.
Infarction
What are the two types of infarction?
Red or White
______ infarction is hemorrhagic.
Red
_______ infarction is pale.
White
_______ infarction occurs following ARTERIAL occlusion in a solid organ.
White
______ infarction occurs following VENOUS occlusion.
Red
True or False: “White infarction” can be associated with loose tissues, previous congestion, and reflow of blood to infarcted area.
False….that is all “red”
Arterial blockage in the spleen would be of which type of infarction?
White
True or False: The rate of occlusion influences infarct development.
True
A decreased oxygen carrying capacity of the cardiovascular system would _____ the vulnerability for infarct development.
increase
“Systemic HypoPerfusion” is better known as _____.
shock
What are the Pathophysiologic categories of shock?
- cardiogenic
- hypovolemic (lots of bleeding)
- Septic (endotoxin)
- Anaphylactic
- Neurogenic
_______ is the #1 cause of death in intensive care units.
Septic Shock
What is septic shock associated with?
gram-positive or gram-negative bacteria
In septic shock, there is an activation of _______ on monocytes and neutrophils with release of IL-1, TNF, and other mediators.
toll-like receptors
Activation of mediators in a situation of septic shock would result in ________ and decreased _______
vasodilation and decreased perfusion
What are the three stages of shock?
- Nonprogressive
- Progressive
- Irreversible
In ____ shock, tissue injury is unrecoverable and multiple organ failure can lead to death.
irreversible
In _____ shock, inadequate perfusion leads to anaerobic metabolism, lactic acidosis, and sometimes DIC.
Progressive
In _____ shock, compensatory mechanisms maintain perfusion.
Nonprogressive
What are the clinical manifestations of shock?
- tachycardia (increased HR)
- tachypnea (shallow breathing)
- hypotension
- cool clammy skin (except “septic” is warmer)
- pallor/cyanosis
- confusion
- low urine output
- acidosis
- high lactic acid
