Atherosclerosis, Thrombosis, Embolism Flashcards Preview

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Flashcards in Atherosclerosis, Thrombosis, Embolism Deck (29)
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1
Q

Define ‘thrombosis’

A

Formation of a mass (thrombus) from the constituents of blood within the vasculature during life

2
Q

How does a thrombus differ from a clot?

A

Thrombus must form during life in the body; clots can form when blood is extracted post-mortem

3
Q

What are the 3 components of Virchow’s triad?

A

Changes in blood flow
Changes in blood coagulability
Endothelial damage

4
Q

Give some examples of hypercoaguable aquired states

A
Myocardial infarction
Immobility
Cancer
Prosthesis
AF
Cardiomyopathy
Oral contraceptive use
5
Q

Arterial thrombi are red. True/False?

A

False

6
Q

Where do arterial thrombi often lodge?

A

Coronary, cerebral, femoral circulations

7
Q

Define ‘embolism’

A

Detached intravascular solid/liquid/gas mass carried distal to point of origin

8
Q

Venous emboli commonly infarct peripheral circulation. True/False?

A
False
Very rare (carried to pul circulation, more likely lodge there)
9
Q

Give examples of factors causing endothelial injury

A
Smoking
Hyperlipidaemia
Hypertension
Toxins
Infection
10
Q

Give examples of what happens due to endothelial dysfunction

A

Increased permeability

Macrophage + platelet adhesion and activation

11
Q

Once macrophages are activated on the endothelial surface, what do they generate?

A

Oxidative free radicals

Cytokines

12
Q

What do oxygen free radicals do to LDL?

A

Ingest and trap it within macrophages, forming foam cells/fatty streaks

13
Q

In a pre-test probability (PTP) score for DVT, the scoring does not apply in what situations?

A

If you have had a previous DVT

If you are pregnant

14
Q

A PTP score for DVT of 3 or more is high risk. True/False?

A

True

15
Q

D-dimer can both rule out and diagnose DVT. True/False?

A

False

16
Q

What is D-dimer?

A

A breakdown product of fibrin

17
Q

If D-dimer levels are low, a DVT is unlikely. True/False?

A

True

18
Q

If D-dimer levels are high, a DVT is very likely. True/False?

A

False

D-dimer levels are raised by many things (infection, MI, surgery)

19
Q

If your PTP score is low and D-dimers are low, a DVT can be excluded. True/False?

A

True

20
Q

If your PTP score is low and D-dimers elevated, what is the next investigation for diagnosing a DVT?

A

(Doppler) ultrasound

21
Q

If your PTP score is high and D-dimers low and US negative, DVT can be excluded. True/False?

A

True

22
Q

If your PTP score is high and D-dimers high but US negative, DVT can be excluded. True/False?

A

False

Repeat US before completely excluding DVT

23
Q

What is the mainstay of DVT treatment?

A

Anticoagulation (LMWH heparin, warfarin)

TED compression stockings

24
Q

What is phlegmasia dolens?

A

DVT causes obstruction of arterial flow due to back pressure created

25
Q

How is phlegmasia dolens usually treated?

A

IVC filter through femoral artery which prevents thrombus entering lungs

26
Q

What is the first line imaging modality of choice for PE?

A

V/Q scan

27
Q

What is the advantage of a caval filter for acute PE?

A

Prevents recurrence of PE in short term

28
Q

What is the drawback of a caval filter?

A

Increases risk of DVT - patients will require anticoagulation if long-term filter

29
Q

When is warfarin contraindicated?

A

Pregnancy

Increased haemorrhage risk (uncontrolled drug abuse, dementia etc.)