Atherosclerosis thrombosis and embolism

Question 1

describe the physiology of blood vessels and endothelial cells

Answer 1

inner layer: intima
middle media
outer- adventitia

Question 2

what is the difference between the media in a vein and an artery

Answer 2

the media in the artery is much bigger diameter

Question 3

what is the origin of endothelial cells

Answer 3

mesodermal origin

Question 4

what are endothelial cells found

Answer 4

interior surface of blood vessels and the lymphatics and on the inside of the heart( called the endocardium)

Question 5

what are endothelial cells called inside the heart

Answer 5

endocardium

Question 6

what is the function of the endothelial cells

Answer 6

semi selective barrier function- allows WBC to move out to the area of infection (diapedesis)

• angiogenesis
• mediator of coagulation
• blood pressure control
• fluid filtration

Question 7

what happens with prolonged inflammation to the endothelial cells

Answer 7

increased permeability and tissue swelling

Question 8

what clotting factors do endothelial cells mediate

Answer 8

von willibrands factor- stabilises factor VIII which binds to collagen linking platelets
heparan sulphate- inactivates clotting cascade

Question 9

what does heparan sulphate control

Answer 9

inactivates clotting cascade

Question 10

which diseases is endothelial cell dysfunction

Answer 10

many diseases
septic shock
hypertension
behcets

Question 11

how else can endothelial cell dysfunction arise

Answer 11

tobacco and air pollution

trans fat consumption

Question 12

how can endothelial cell dysfunction improve

Answer 12

smoking cessation
weight loss
improved diet
exercise

Question 13

what is a atheroma

Answer 13

is an accumulation of intracellular and extracellular lipid in the intima of large and medium sized arteries

Question 14

what is atherosclerosis

Answer 14

the thickening and hardening of arterial walls as a consequence of atheroma

Question 15

why do atheromas form and why in the arteries

Answer 15

due to chronic endothelial cell damage- in the arteries as BP is higher

Question 16

how does an atheroma develop 11 steps

Answer 16

1. chronic endothelial cell dysfuction
   2 endothelial dysfunction
   3 entrance of LDL in intimia
   4 lipid engulfed by macrophages
   5 flat yellow(fatty streak) early atheroma
   6 accumulation of lipids- in macrophages and smooth muscle wall
   7 raised yellow lipid plaque
   8 extracellular lipid deposits and collagen deposition and calcification
   9 fibrous cap over the lipid core(fibroatheroma)
   10 ulceration of plaque
   11 predisposition to thrombus formation- advanced complicated plaque

Question 17

what are the risk factors for atheroma

Answer 17

high LDL/low HDL 
hypertension
diabetes 
sedentary lifestyle
obesity
smoking

Question 18

what are the two forms of prevention for the formation of atherosclerosis

Answer 18

primary- risk factor modification

secondary- includes regulation medications such as aspirin and the prevention of the recurrence of events

Question 19

when do early atheromas start forming

Answer 19

in your early 20s-30s

progressive

Question 20

which medications can be used to stabilise the plaques and prevent rupture

Answer 20

statins

Question 21

what medication can be used if the atheroma was to rupture

Answer 21

antithrombotic agents

Question 22

which sites can be affected

Answer 22

aorta-
coronary artery
iliac and popliteal arteries
internal carotid arteries

Question 23

what happens if the aorta is affected by atheroma

Answer 23

weakening of the aorta leading to dilation (aortic aneurysm)
leads to risk of rupturing

Question 24

what happens if the coronary artery is affected by atheroma

Answer 24

narrowing of the artery lumen-reduced blood flow and ischaemia
thrombus formation over plaque-occlusion of the lumen causing MI

Question 25

what happens if the iliac and popliteal arteries are affected by atheroma

Answer 25

narrowing of the artery lumen | reduced blood flow leading to ischaemia

Question 26

what happens if the internal carotid arteries are affected by atheroma

Answer 26

emboli travels p the the brain causing ischaemia (if transient) or infraction( TIA/stroke)

Question 27

what is a thrombus

Answer 27

a structured solid mass or plug of blood constituents formed within the heart or blood vessels during life

Question 28

what is thrombosis

Answer 28

the process of thrombus formation-

Question 29

what can thombosis be considered as

Answer 29

the inappropriate activation of the normal haemostatic process

Question 30

where can thrombosis occur

Answer 30

in the CVD anywhere

Question 31

what are the types of thrombus

Answer 31

arterial cardiac venous

Question 32

where do arterial thrombus occur

Answer 32

at sites of endothelial injury or turbulence | usually occlusive lesions

Question 33

when are the common sites of arterial thrombus

Answer 33

coronary arteries cerebral arteries femoral arteries

Question 34

what is a cardiac thrombus also known as

Answer 34

mural thrombi

Question 35

where can cardiac thrombus occur

Answer 35

over areas of endomyocardial injury

Question 36

what else can cardiac thrombus occur with

Answer 36

arrhythmia and cadiomyopathy

Question 37

where can venous thrombus occur

Answer 37

at sites of vascular stasis- in the veins of the lower limbs(DVT)

Question 38

what can be the outcomes of thrombus formation if the patient survives the immediate effects of occlusion

Answer 38

are propagation embolism dissolution-broken down organisation/recanalisation- organise or reattach

Question 39

what are some hypercoagulable conditions

Answer 39

primary( genetic | secondary environmental

Question 40

what are some primary hypercoagulable conditions

Answer 40

protein C or S deficiency antithrombin III factor V mutations prothrombin mutation

Question 41

what are some secondary hypercoagulable decisions

Answer 41

stasis- prolonged bed rest smoking oral contraceptives

Question 42

why can antithrombin III deficiency occur if it is secondary

Answer 42

liver damage

Question 43

what does protein c do

Answer 43

vitamin K dependant glycoprotein inactivates factor Va and VIIIa deficiency increases the risk of clotting

Question 44

describe protein S

Answer 44

vitamin K dependant glycoprotein cofactors works with C helps to inactivate V and VIIIa

Question 45

describe antithrombin III

Answer 45

glycoprotein produced in the liver AKA antithrombin can inherit deficiency can acquire deficiency- due to liver failure

Question 46

what does antithrombin activate

Answer 46

``` factor 9 factor 10 factor 11 12 2 7 ```

Question 47

what are factor V mutations also known as

Answer 47

leiden disease

Question 48

how can oral contraceptive increase the risk of atheroscleorosis

Answer 48

increase in circulating fibrogen

Question 49

how do we clinically prevent thrombosis

Answer 49

aspirin heparin warfarin thrombolysis

Question 50

how is aspirin used

Answer 50

- used for primary and secondary prevention of CVA and MI, and for treatment of MI

Question 51

how is heparin used to prevent thrombosis

Answer 51

to prevent post op DVT

Question 52

how is warfarin used to prevent thrombosis

Answer 52

prevents thrombi in patients with AF and prosthetic heart valves

Question 53

what are the main drugs used in thrombolysis

Answer 53

streptokinase and tissue-type plasminogen activator (TPA)

Question 54

how do streptokinase and TPA work

Answer 54

body’s natural fibrinolytic system to break down thrombus, and minimise myocardial damage.

Question 55

what are some new therapeutics which can be used

Answer 55

Rivaroxaban/apixaban/betrixaban- oral anticoagulant | clopidogrel- anti platelet

Question 56

what is virchows triad

Answer 56

factors predisposing to thrombosis changes in blood constritiency changes in vessel wall changes in pattern of blood flow

Question 57

what can change blood constituents

Answer 57

OCP risks eg obesity personal history social history

Question 58

what can include changes in vessel wall

Answer 58

atheroma trauma inflammation neoplasia

Question 59

what is an embolus

Answer 59

an abnormal mass of material( gas or solid)which is carried in the bloodstream- impacting a vessel whose calibre is too small to let the embolus through

Question 60

describe pulmonary embolism

Answer 60

Embolus originating from detached piece of thrombus sitting in a deep vein of the leg.- Travels via venous system to the right heart, then out through pulmonary artery.- Lodges in pulmonary arterial tree (location depends on size of embolus

Question 61

describe systemic embolism

Answer 61

Embolus originating from detached piece of mural thrombus, or left heart valvular vegetation.- Travels via aorta into systemic arterial circulation.- Can lodge in arteries leading to lower limbs, brain, kidneys or gut.

Question 62

what is a paradoxical embolism

Answer 62

Embolism that originates in systemic veins and enters systemic arterial circulation.

Question 63

what is ischaemia

Answer 63

Impaired vascular perfusion of an area of tissue, thus depriving it of vital nutrients, especially oxygen”

Question 64

what is infarction

Answer 64

Death (necrosis) of an area of tissue due to ischaemia

Question 65

what is shock

Answer 65

’is a life-threatening medical condition of low blood perfusion to tissues resulting in cellular injury and inadequate tissue function’

Question 66

what are the four types of shock

Answer 66

cardiogenic obstructive hypovolaemic distributive

Question 67

what is the patheay for shock

Answer 67

inadequate perfusion cell hypoxia energy deficit lactic acid production

Question 68

what are the symptoms of cardiogenic shock

Answer 68

Distended jugular veins due to increased venous pressure Weak or absent pulse Arrhythmia (most frequently tachycardia) Reduced blood pressure

Question 69

what are the symptoms of obstructive shock

Answer 69

Cardiac Tamponade Pulmonary Embolism Aortic Stenosis

Question 70

what are the symptoms of hypovolaemic shock

Answer 70

``` Rapid, weak thready pulse Tachycardia Cool, clammy skin – vasoconstriction Hypothermia Thirst and xerostomia Cold, mottled skin ```

Question 71

symptoms of distributive shock

Answer 71

SIRS (Systemic Inflammatory Response Syndrome) – High resp rate, body temp >36 deg celsius, tachycardia and WBC count between 4000-12000

Question 72

what is the treatment of shock

Answer 72

ABCDE oxygen and bolus of fluid- saline and RBC later vasopressors if hypotension not improved with fluids

Question 73

what is a cardiac tamponade

Answer 73

fluid around the pericardium- heart cannot contract as well cus of fluid