vascular disease

Question 1

embolism

Answer 1

Embolus is a detached intravascular solid, liquid or gass carried by blood to a site distant from its point of origin

Inevitably, lodge in small blood vessels, causing vascular occlusion

This vascular occlusion can have both downstream (usually) and upstream consequences

Question 2

Pulmonary Thromboembolism

Answer 2

vast majority of pulmonary emboli originate in the legs, some in the pelvis or abdomen (as thromboses)

Insitu pulmonary thrombosis are rare

It all starts with A DVt

Question 3

Virchows triad

Answer 3

Endothelial injury: thrombus formation over ulcerated plaque sites of trauma, inflammatory vascular injury (vasculitis), indwelling devices

Stasis: aneurysms, acute MI, atrial fibrillation, decreased mobility, surgery

Hypercoagulability: Factor V leiden: prothrombin gene mutation, homocysteinemia, pregnancy, OCPs, cancer, nephrotic syndrome, antiphospholipid syndrome

Question 4

clinical significance of pe depends on…

Answer 4

Extent to which the PA blood flow is obstructed, size of occluded vessel, number of emboli, pre existing cardiopulmonary status, release of vasoactive substance such as thromboxane A2 from activated platelets

Question 5

Pulmonary emboli

Answer 5

Respiratory compromise: ventilation of Non perfused area, increased dead space, increased work of breathing, worsened ventilation perfusion mathcing, hypoxemia, hypercapnia, respiratory failure

Cardiac compromise: increased resistance to flow of blood from RV through to LA, acute RV failure, remember that RV and LV are connected in series, RV fails, LV gets progressively under filled, shock, death

Question 6

Clinical course PE

Answer 6

Chest pain, dyspnea, hypotension, low grade fever, cough, hemoptysis, sudden cardiac death
Usually diagnosed with help of CT scan of chest
Usually treated with anticoag and rarely throbolysis

Preventing DVTand PE is done via surgical and early mobility and compression devices

Question 7

Pulmonary infarction

Answer 7

Smaller emboli travel to the peripheral vessels, this may cause hemorrhage, very rarely, the emboli cause infarction (bronchial circulation comes from aorta and sustains the pulmonary parenchyma)

dual blood supply

Question 8

Pulmonary infarcts

Answer 8

Most affect the lower lobes, typically wedge shaped (extending out from the ischemic focus to the periphery), usually a hemorrhagic infarct, eventually eals but leaves a small scar