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Cardiovascular System > Deep Vein Thrombosis & Pulmonary Thromboemolism > Flashcards

Deep Vein Thrombosis & Pulmonary Thromboemolism Flashcards

(52 cards)

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1
Q

What is a thrombus (2)

A
  • Clot arising in the wrong place (arterial or venous)

* A solid structure arising inappropriately in a fluid system

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2
Q

What is Haemostasis

A

Physiological process of maintaining vascular integrity

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3
Q

What does a clot consist of (4)

A

Fibrin
Platelets
Red blood cells
White blood cells

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4
Q

What is one of the functions of the endothelium

A

• Endothelium protects components of blood being activated

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5
Q

What happens when the endothelium is activated (4)

A

endothelium exposes collagen, smooth muscle and connective tissue
• When the damage occurs tissue factors VIII and VII that normally circulate the blood inactivated interact with factor X
• Factor X interacts with Factor V to initiate the conversion of prothrombin to thrombin
• This reaction then causes fibrinogen to be converted to fibrin

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6
Q

What happens to fibrin during coagulation (2)

A

Becomes insoluble

Forms cross links

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7
Q

What components are soluble and what are insoluble

A

Everything before the production of fibrin is soluble

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8
Q

What does Factor XIII hep do

A

Helps cross link polymerised fibrin to make it a strong structure

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9
Q

Define White thrombus

A

white arterial thrombus. This consists of platelets and fibrin, and there is a lack of red blood cells due to the fast flow of the blood preventing the incorporation of red blood cells

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10
Q

Define Red thrombus

A

red venous thrombus. This consists of red blood cells and fibrin and there are more red blood cells due to the slow flow of blood which allows more red blood cells to be incorporated

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11
Q

Mechanism of arterial thrombus

A

usually rupture of atherosclerotic plaque

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12
Q

Mechanism of venous thrombous

A

Combination of Virchows triad especially stasis and hypercoagubility

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13
Q

Location of origin of arterial thrombus (2)

A

Arteries

left heart chambers

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14
Q

Location of origin of venous thrombosis

A

Venous valves and venous sinusoids of muscles

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15
Q

Arterial thrombus results in (2)

A

Ischaemia or Infarction

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16
Q

Venous thrombus results in

A

back pressure

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17
Q

Diseases associated with arterial thrombus

A

DVT

PE

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18
Q

Composition go arterial thrombus

A

Platelets

Fibrin

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19
Q

Composition of venous thrombus

A

Red blood cells

Fibrin

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20
Q

What is Virchows Triad

A

3 broad factors that contribute to thrombosis
Stasis
Hypercoagulability
Endothelial damage

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21
Q

What can causes stasis (2)

Study These Flashcards
A

Immobility

Long haul travel

22
Q

What can cause acquired hypercoagulability (3)

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A

Pregnancy
Cancer
Sepsis

23
Q

What can cause endothelial dysfunction (3)

Study These Flashcards
A

Hypertension
Smoking
High cholesterol

24
Q

What can cause endothelial damage (3)

Study These Flashcards
A

Indwelling venous catheters
Trauma
Surgery

25
How does Pregnancy Cancer Sepsis increase hypercoagulability
Increases the production of tissue factor
26
Embolism
Intravascular material that migrates from its original location to a distal vessel
27
Thromboemolism
Movement of blood clot along a vessel
28
Examples of VTE (4)
* Limb deep vein thrombosis (DVT) * Pulmonary embolism (PE) * Visceral venous thrombosis * Intracranial venous thrombosis
29
Risk Factors of VTE (3)
Surgery Abdominal/Pelvic malignancies Oral contraceptive
30
Signs and Symptoms of DVT (7)
* Unilateral limb swelling * Persisting discomfort * Calf tenderness * Warmth * Redness- erythema * Prominent collateral veins * Unilateral pitting oedema
31
Diagnosis of suspected DVT (3)
1. Clinical assessment and carry out Wells score (pre-test probability sore) 2. Blood test: D-dimer if low Wells score 3. Imagine: compression ultrasound if positive D-dimer or high pre-test probability score
32
DVT Wells Score >/=3 (2)
High probability | Imaging- compression US
33
DVT Wells Score 1 or 2
Intermediate probability | Imaging- compression US
34
DVT Wells Score =0
Low probability | D-dimer blood test
35
A negative D-dimer result
means that DVT or PE can be ruled out.
36
A positive D-dimer result means that
the patient has to undergo further imaging in order to diagnose whether or not he or she has DVT or PE.
37
What is a D-dimer
Breakdown product of cross-linked fibrin
38
Symptoms and Signs of PE (5)
* Pleuritic chest pain * SOB- dyspnoea * Haemoptysis * Tachycardia * Pleural rub on auscultation- usually due to pulmonary infarction
39
Symptoms and signs of massive pulmonary embolism (7)
* Severe dyspnoea of sudden onset * Collapse * Blue lips and tongue- cyanosis * Tachycardia * Low blood pressure * Raised venous jugular pressure * Sudden death
40
Diagnosis of PE (4)
Wells Score or Geneva Score D-dimer blood test Isotope ventilation/perfusion scan CT pulmonary angiogram
41
PE Wells score >/= 6.5 (3)
High probability Imagine- isotope ventilation/perfusion scan CT pulmonary angiogram
42
PE Wells score 4.5-6.0 (3)
Moderate probability Isotope ventilation/perfusion scan CT pulmonary angiogram
43
PE Wells score = 4.0 (2)
Low probability | D-dimer blood test
44
Potential long-term consequence of pulmonary embolism (2)
* Most recover fully | * Pulmonary arterial hypertension
45
In a patient with diagnosed VTE it is important to consider (3)
* Was there a clear cause or precipitant- hospital, surgery * Any symptoms or signs to suggest underlying malignancy * Consider risk of recurrence
46
Aims of Treatment of VTE (3)
* Prevent clot extension * Prevent clot embolism * Prevent recurrent clot
47
Treatment options (anticoagulant) IV
Unfractionated heparin
48
Treatment options (anticoagulant) subcutaneous
low molecular weight heparin
49
Treatment options enteral
Warfarin and direct oral anticoagulants
50
What treatment option must be reserved for thrombolysis
massive PE (Alteplase)
51
Prevention of VTE
* Early mobilisation * Anti-embolism stockings * Other mechanical methods of thromboprophylaxis * Pharmacological thromboprophylaxis
52
How do you develop a pulmonary infarction after a PE (3)
* Blockage to a branch of the pulmonary artery = increase in pressure within pulmonary vasculature * Force within bronchial artery may be insufficient to overcome this * ‘Leakage’ of blood into alveolar space occurs, and leads to infarction

Cardiovascular System (42 decks)

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