27 thrombotic diseases Flashcards

1
Q

what comes under coronary heart disease

A

angina + heart attack

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2
Q

when does stroke occur

A

rapid death of brain tissue due to a disturbance in the blood supply

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3
Q

what is the who definition of a stroke

A

neurological deficit of cerebrovascular cause that persists byeyond 24 hours or is interrupted by death within 24 hours

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4
Q

what is TIA defined as

A

stroke symptoms that resolve completely within 24 hours

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5
Q

what must stroke be differentiated from

A

TIA

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6
Q

what are the risk factors of a stroke

A
Inactivity
age
family history
ethnicity
high blood pressure
heart disease
diabetes 
smoking
obesity
oral contraception + HRT
previous strokes and TIAs 
binge drinking and substance misuse
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7
Q

where are carotid arteries located

A

anterior supply for front and middle regions of the brain

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8
Q

where are vertebral arteries located

A

posterior supply to brain stem and rear regions of the brain

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9
Q

what are basilar artery

A

two vertebral arteries join together

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10
Q

what are communicating arteries

A

posterior basilar carotid and anterior

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11
Q

what is the purpose of communicating arteries

A

Communicating arteries: for cross-over flow during the damage in one of the arteries.

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12
Q

what is ischemic stroke

A

Causes thrombosis of large and small arteries alike.

Thrombosis occurs when blood clots block your blood vessels. It may be caused by injury, immobility and other factors.

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13
Q

what is ischemic stroke caused by

A

atherosclerotic plaque rupture leads to thrombosis

interrupts bloods supply to neurons

rapid death of brain tissues lead to loss of brain function

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14
Q

how long does it take to notice changes in someone with a ischemic stroke

A

2-3 hours

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15
Q

when does complete death of brain tissue occur

A

6 - 24 hours

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16
Q

what is an embolism

A

A blood clot that forms in a blood vessel in one area of the body, breaks off, and travels to another area of the body in the blood is called an embolus.

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17
Q

what is the effect of congestive heart failure / myocardial infarction in causing an embolism

A

failure or heart attack (MI) ejection fraction of left ventricle is low leading to blood stasis and thrombosis. Thrombus may stick to ventricle wall and become embolised and this can break up to pieces and block arteries resulting in a stroke

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18
Q

what is atrial fibrillation

A

left atrium is less effective in ejection of blood

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19
Q

what is endocarditis

A

fungal or bacterial growth in heart valves forms clumps and emobli to the brain

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20
Q

what can a haemorrhagic stroke be subdivided into

A

intracerebral

subarachnoid bleeding

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21
Q

describe intracerebral haemorrhagic stroke

A

Intracerebral (within brain): due to hypertension, trauma, bleeding disorders & vascular defects

Arteriovenous malformation: feeder artery to NIDUS (nest of small arteries) and lead to collection vein

High pressure in AVM causes rupture and bleeding forms haematoma

Haematoma compress/ rupture/ damage neurons – irreversible damage

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22
Q

describe subarachnoid (surface) haemorrhagic stroke

A

most of the aneurysm occur in the circle of willis such as at the junctions of anterior communication and anterior cerebral arteries

two types saccular and fusiform

damages compression of tissues from expanding haematoma

leading to direct toxic effect of blood cells and interruption of blood supply to neurones

23
Q

what is needed in a subarachnoid haemorrhagic stroke

A

surgical intervention

24
Q

what is transient ischemic attack (TIA)

A

mini stroke, temporary blockage of blood supply due to small blood clots

can be overcome in 30 - 60 minutes or 24 hours

can occur repeatedly in multiple regions

25
Q

what is important to note about TIA

A

leads to major ischemic stroke

26
Q

what is ABCD2

A

a prognostic score to identify people at high risk of stroke after a transient ischemic stroke

27
Q

what does prognostic mean

A

relating to or serving to predict the likely course of a medical condition.

28
Q

what are the different parts of the ABCD2

A

age >60 = 1 point

blood pressure >140/90mmHg = 1 point

clinical features

  • unilateral weakness = 2
  • speech disturbance without weakness

duration of symptoms

  • 10-59 minutes = 1 point
  • 60 mins + = 20 min

presence of diabetes = 1 point

29
Q

what does a score >4 mean

A

high risk of stroke

30
Q

when someone presents with a high stroke risk what should be done

A

give 300mg aspirin daily
specialist assessment
investigation within 24 hours of TIA symptoms

31
Q

what are the three ways we can try to recognise a stroke

A

facial weakness
arm weakness
speech problems

32
Q

how can we attempt to manage stroke

A

assess risk of stroke in patients with TIA

specialist care for people with acute stroke using brain imaging e.g. CT / MRI scan

pharmacological approaches

33
Q

what are the aims of pharmacological approaches

A

prevent further neuronal loss

repair replace damaged neurones

34
Q

what does a thrombolytic agent do

A

promotes the breakdown of fibrin

35
Q

what IV administration

A

4.5 hours of stroke improves clinical outcome

36
Q

describe the alteplase administration

A

4.5 hours

900 mcg/kg/over 60 minutes

37
Q

describe the aspirin administration

A

24 hours 300 mg daily for 2 weeks

38
Q

what pharmaceutical management can we give for haemorrhagic stroke

A
removal or clipping of aneurysm
antihypertensive
reversing anticoagulants
surgery to remove blood or heamatoma
surgery to treat hydrocephalus (drain CSF)
39
Q

what are two long term mangements for stroke

A

clopidogrel at 75mg daily

modofied release dipyridamole 200mg twice daily in combination with aspirin

40
Q

who should modified release dipyridamole be given too

A

TIA

ischemic stroke and clopidogrel is contraindicated

41
Q

what ar the 4 main parts of rehabilitating a stroke patient

A

resotration of function
learning new skills
adapting to some of the limitations
support network

42
Q

what is PAD

A

peripheral arterial disease

43
Q

describe peripheral arterial disesase

A

atherosclerotic plaques in lower extremeties lead to hardening of arteries supplying blood to legs

block the blood supply and lead to ischemia

results in myocytes death

44
Q

what are the causes of PAD

A
diabetes
obesity
smoking
infection
injury yto vessels
sedentary lifestyle
high blood pressure
autoimmune disease
nutritional defeciencies
high blood cholesterol
emboli from other locations
inflammation in blood vessels
45
Q

what are the symptoms of pad

A
none at first
coolness to touch
poor skin /nail health
infections/injuries dont heal
pain when walking stops with rest
discolaration
46
Q

what changes in lifestyle can we recommend to someone with pad

A

regular exercise
smoking cessation
weight reduction for obese
reduce alcohol

47
Q

what medications can we give for PAD

A

anti platelet drugs

naftidrofuryl oxalate

cilostazol

48
Q

what procedures can we use to treat pad

A

angioplasty

endartectomy

49
Q

what is endartectomy

A

surgical removal of part of the inner lining of an artery, together with any obstructive deposits, most often carried out on the carotid artery or on vessels supplying the legs.

50
Q

what is angioplasty

A

Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis

51
Q

what is deep vein thrombosis

A

occurs in deep veins in lower extremities

blood flows back to heart due to muscle movement

reduced movement or injuries diminishes or stops blood flow in veins

so accumulation of platelets and plasma and pasma proteins leads to clotting

52
Q

what are the causes of deep vein thrombosis

A
inactivity
stay at hospitals
blood vessel damage 
medical conditions
genetic conditions
pregnancy
combined contraceptive pills and hormone replacement therapy
53
Q

what can we use to diagnose DVT

A

blood test for d - dimer levels

ultrasound scan

venogram

54
Q

what can we use to treat DVT

A

Anticoagulants to prevent the clots getting bigger and breaking off

heparin

warfarin sodium

rivaroxaban

apixaban