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
La adrenaline with heart issues
Normal adrenaline (in blood released during stress) release can increase X 20 during stress.
Recommendation: Patients with mild to moderate CVS disease can have LA containing adrenaline.
Severe CVS disease (unstable angina, recent MI, dysrythmias, severe HBP or CHF) may be considered relative contraindications to VC use
cariac disease and when to do dental treatment
AMI: postpone elective Rx till 3-6 months later
Unstable angina: dental care in suitable facilities/postpone
Cardiac failure: dyspnoea (breathlessness- do not lie flat)
monitoring high risk patients
Clinical signs & symptoms BP Pulse oximetry ECG not in primary care
CCB and what oral manifestation they cause
Nifedipine Amlodipine Nicardipine Nimodipine Verapamil Diltiazem
gingival hypoplasia
management of Angiodema and the drug that causes it
ACE inhibitors
Stop drug and go to hospital if airway is lost due to tongue oedema can go and be intubated- rara to have surgery
drug that causes ulceration
nacranavil a K+ channel blockers used for angina vasodilator biopsy if worried
rheumatic fever facts
can occur 2-3 weeks after a streptococcal URTI
Predominantly a childhood disorderInflammation at multiple sites
Heart Rheumatic Heart Disease Endocarditis Myocarditis (Aschoff bodies) Pericarditis Arteries Arteritis Joints Flitting polyarthritis Skin Erythema marginatum Skin rashes Subcutaneous nodulesBacterial culture of affected tissues negative- it is a autoimmune condition
Antibodies to streptococcal polysaccharide
Antistreptolylin O titres (ASOT) raised
Antibodies cross-react with cardiac antigens on cardiac tissues – biological accident
this can cause: vegitations/fibrous pericardium/myocardial Aschoff bodies
sites of infective endocarditis
Heart valve
Mural endocardium- especially if the has been a HA
Congenital defect in heart lining
things that predispose to ineffective endocarditis
-Acquired valvular heart disease with stenosis or regurgitation
-Hypertrophic cardiomyopathy- heart is enlarged
Previous infective endocarditis
- Structural congenital heart disease, including surgically corrected or palliated structural conditions, but excluding isolated atrial septal defect, fully repaired ventricular septal defect or fully repaired patent ductus arteriosus, and closure devices that are judged to be endothelialised
- Valve replacement.
local effects of infective endocarditis
Local effects
Valve incompetence
Perforation of valve leaflets
Rupture of cordae tendineae (prolapse)
Myocarditis
Embolism to coronary vessels- can enter blood stream
systemic effects of infective endocardiditis
Systemic effects
Fever, weight loss & malaise
Splenomegaly- enlargement of spleen
Embolism- lodge somewhere and cause infection here.
infective endocardiditis symptoms
Embolism
Spleen abscess
Kidney abscess
Brain abscess
Skin & nail beds haemorging
Mucous membranes
Retina
Glomerulonephritis
Finger clubbing
diagnosis and treatment of infective endocarditis
Embolism
Spleen abscess
Kidney abscess
Brain abscess
Skin & nail beds haemorging
Mucous membranes
Retina
Glomerulonephritis
Finger clubbingAntibiotics
Surgical removal of the valve
pathenogensiis of thematic ever
Repeated episodes of rheumatic fever
Fibrosis of endocardium & valves edges
Vegetations on heart valve leaflets-composed of platelets and fibrin
Fusion of heart valve leaflets
Calcification of heart valves
60% mitral valves and stenosis and incompetence
40% aortic value stenosis and incompetence
what is mitral valve prolapse
Mitral valve prolapse- cordie tenoni
