Thrombosis, Ischaemia, Embolism And Infarction

Question 1

Define thrombosis

Answer 1

Haemostasis occurring in the wrong place

Question 2

What are the 3 components of Virchow’s triad?

Answer 2

• blood composition
• blood flow
• vessel wall

Question 3

Describe artieral thrombus

Answer 3

• white thrombus from higher pressure of flow
• related to primary haemostasis and platelet aggregation
• small amounts of fibrin

Question 4

Describe venous thrombosis

Answer 4

red thrombus due to fibrin mainly rather than platelets

Question 5

What are the risk factors of DVT?

Answer 5

• vessel wall changes (increasing age, varicose veins, surgery)
• blood flow (obesity, pregnancy, immobilisation, IV catheters, external vein compression)
• composition of blood (thrombophilias, inflammatory conditions, oestrogen)

Question 6

What tests aid a DVT diagnosis?

Answer 6

• D-dimer (measure of dissolved thrombus)
• Doppler ultrasound
• venography
• Well’s scoring system

Question 7

What are some possible consequences of DVT?

Answer 7

• painful swollen leg
• PE
• recurrent VTE
• venous insufficiency (residual thrombus)
• post thrombotic syndrome (persistent chronic pain, swollen, ulceration)

Question 8

What is the treatment of DVT?

Answer 8

• anticoagulation for 3-6 months (eg. Heparin, warfarin, DOAC)
• remove all risk factors
• pain relief
• graduated elastic compression stockings
• secondary prevention

Question 9

What are some prevention strategies for avoiding VTE?

Answer 9

• avoid risk factors
• risk assess at hospital admission/surgery
• provide thrombo-prophylaxis (anti-embolism stockings/heparin)
• educate patients on risks and avoidance measures

Question 10

Describe the pathophysiology of coronary artery disease

Answer 10

• atheromatous arterio-vascular disease
• development of atheroma plaque
• progressive narrowing and stenosis
• plaque rupture and formation of acute thrombus
• vascular occlusion and downstream ischaemia and infarction

Question 11

What is the treatment of ACS?

Answer 11

• prevent thrombus extension (antiplatelets eg. Aspirin, anticoagulants eg. Heparin)
• remove thrombus (thombolysis with altepase/PCI)
• widen stenotic plaque (balloon angioplasty + stent)
• prevent further thrombus formation (antiplatelet + statin)