Pathophysiology of thrombosis and embolism 2

Question 1

What can cause air embolism?

Answer 1

Head and neck wounds

Surgery

CV lines

Question 2

What can cause gas embolism?

Answer 2

Decompression sickness - N2 forms as bubbles which lodge in capillaries

Question 3

What are the types of embolus?

Answer 3

Thromboembolus

Fat embolus

Air embolus

Tumour embolus - spread of tumour

Amniotic fluid - cause of collapse in childbirth

Septic material e.g infective endocarditis

Trophoblast - pregnant women -lungs

Bone marrow - fractures from like e,g CPR

Foreign bodies e.g intravascular cannulae tips, sutures etc

Question 4

What is rheumatic fever?

Answer 4

Disease of disordered immunity

Question 5

What are the symptoms of rheumatic fever?

Answer 5

Inflammatory changes in the heart and joints, sometimes neurological symptoms

Question 6

What countries are rheumatic fever common?

Answer 6

India, middle east and central africa.

It is however now rare in Europe and north america.

Question 7

What age does rheumatic fever commonly affect?

Answer 7

Ages 5-15 years

More common in boys than girls

Question 8

What is the presenting feature of rheumatic fever?

Answer 8

• Flitting (painful) polyarthritis of large joints like wrists, elbows, knees and ankles.
• Skin rashes and fever

Question 9

What are the symptoms of rheumatic fever in the acute phase?

Answer 9

Pancarditis and heart murmurs are common.

Question 10

Why do most patient have a sore throat with rheumatic fever?

Answer 10

Usually due to group A beta-haemolytic streptococcal infection

Question 11

Why would may damage to heart tissue caused by in rheumatic fever?

Answer 11

Combination of antibody-mediated and T cell-mediated reactions.

Question 12

What is aschoff body?

Answer 12

Focus of chronic inflammatory cells, necrosis and activated macrophages (anitschkow cells)

Question 13

Where may aschoff body be seen?

Answer 13

In the heart in acute rheumatic fever

Question 14

What does pathological problems of valvular heart disease result from?

Answer 14

Valvular stenosis

Valvular incompetence/regurgitation

Vegetations

Question 15

What happens in valvular stenosis

Answer 15

Valve is thickened/calcified and obstructs normal blood flow into chamber/vessel

Question 16

What causes valvular incompetence/regurgitation?

Answer 16

Valves loses normal function and fails to prevent reflux of blood after contraction of cardiac chamber.

Question 17

What causes vegetations?

Answer 17

Infective or thrombotic nodules develop on valve leaflets impairing normal valve mobility; may embolise

Question 18

What can pancarditis in acute rheumatic fever progress to over time?

Answer 18

To chronic rheumatic heart disease, mainly manifesting as valvular abnormalities

Question 19

What does inflammation of the endocardium and left sided valves result in?

Answer 19

Fibroid necrosis of the valve cusps/chordae tendineae, over which form small vegetations

Question 20

What is rheumatic heart disease virtually the only cause of?

Answer 20

Mitral stenosis

Question 21

What is mitral regurgitation most commonly due to?

Answer 21

Ischaemic heart disease

Question 22

What does rheumatic heart disease potentially still cause?

Answer 22

Aortic regurgitation/incompetence.

Question 23

What valves are rarely and infrequently involved in rheumatic heart disease?

Answer 23

Tricuspid and pulmonary valve

Question 24

What does rheumatic heart disease rarely cause?

Answer 24

Aortic stenosis

Question 25

What is rheumatic heart disease principally characterised by?

Answer 25

Deforming fibrotic valvular disease, particularly involving the mitral valve.