vascular pathology Flashcards
virchows triad
status of blood flow
hyperagultiantion
endothelial injury
thrombosis formation
Platelet aggregation
Localised activation of the clotting cascade Fibrin
RBCs trapped
Platelet aggregation
Localised activation of the clotting cascade Fibrin
RBCs trapped
Propagation- obstruct lumen
risk factors of status of blood flow
Burns & Trauma Surgery Cardiac failure- back pressure Pregnancy Immobility Long haul flights
cardiac thrombosis
Atrial
Atrial fibrillation
Mitral stenosis
Valvular
Rheumatic fever
Endocarditis
Ventricular
Dead
Myocardial infarction
fate of thrombus
- Lysis and Resolution
- Retraction and Re-canalisation – middle pichealing and scarirng but blood can get past
- Organisation and Scarring- pic 3
- Embolism
things that cause embolisms
Atheromatous debris Vegetations on heart valves (Infective endocarditis- bacteria and fungi at hear valve tip- causing infection) Fat- fracture of long bone marrow Gas (Caisson’s disease- divers) or air in blood Amniotic fluid- embolises in birth Tumour Foreign material –cosmetic filler
how embolism can effect the lungs
whole branch- sudden death
end of branch -ischemia and breathlessness
parts of smaller branches- pulmonary hypertension
the biggest he embolisms the worse
causes of infarction
Atheroma Thrombosis Embolism Vasculitis- inflammation of vessel Compression Spasm Hyperviscosity- effecting blood content
mi evalution
<6 hours No visible changes (ECG changes) 24-48 hours Pallor with red rim Several days Pallor with red rim Soft (Haemopericardium) Several weeks Grey and fibrotic
things that effect infarction
Vascular anatomy Duration of occlusion Metabolic requirements of tissue- brain tissue worse General circulatory factors Heart failure Anaemia Reperfusion injury
dissecting aneurysms
due to interval wall ruptures and vessel wall splits
things that can effects major arteries
- PAD = claudiaction- goes on rest/ not below foot/ stops when standing / Ankle-brachial pressure index < 0.9/ Blood Pressure Control Lipids Antiplatelets –Clopidogrel/aspirin ACE Inhibitors Control Diabetes LIFESTYLE MODIFICATION
- chronic ischemic disease - pain on rest/gangreen/ulcers/ dopler pressure less than 50 mmHg/ ballon angioplasty/
- acute ishcemic - the 5 ps - 4/6hrs permanent damage/ heparin in hospital/ catheter/ embolectomy/ bypass/ amputation
aaa- over 5.5 needs treament/ ultrasounds over 65yr/ EVAR/ GRAFT
Internal Carotid artery stenosis
Causes TIA and strokes by:
embolisation usually
Or restriction of flow occasionally
If symptomatic usually intervene if stenosis > 70%
resolves within 24 hours – can affect vision, speech or limbs commonly
ENDARCHARERTMY- CLEAN AWAY PLAQUE
Management of angina
Stop and rest
GTN spray to shorten attack
Regular anti-anginal drugs:
- Beta blockers e.g. bisoprolol
- Nitrates e.g. isosorbide mononitrate
- Calcium channel blockers e.g. amlodipine
- Others – nicorandil, ivabradine, ranolazine
Percutaneous coronary intervention- ballon stretching
Coronary artery bypass graft
signs in clothed patients
General appearance – breathlessness, pallor, sweating, cyanosis
Pulse – rate(radial pulse), rhythm, volume
Blood pressure
Jugular Venous Pressure (JVP) – raised in heart failure id failed more likely on right side of heart
Peripheral oedema – ‘pitting’ indents on pressure when you put your thumb on it Chest pain – usually ischaemia/can be refered though
Breathlessness – usually heart failure
Ankle swelling – heart failure
Palpitations(abnormal awareness of heartbeat) – arrhythmia
Faintness – low blood pressure, arrhythmia
