Pathophysiology of Thrombosis and Embolism

Question 1

Normal blood flow is

Answer 1

Laminar

Question 2

Stasis

Answer 2

Stagnation of flow

Question 3

Turbulence

Answer 3

Force, unpredictable flow

Question 4

Defects in blood flow

Answer 4

• Thromboembolism
• Atheroma
• Hyperviscosity
• Spasm
• External compression
• Vasculitis
• Vascular steal

Question 5

Virchow’s Triad

Answer 5

1. Changes in the blood vessel wall
2. Changes in the blood constituents
3. Changes in the pattern of blood flow

Question 6

If any of the principles of the Virchow’s triad is compromised what can that cause

Answer 6

Thrombosis

Question 7

What is a thrombosis

Answer 7

formation of a solid mass from the constituents of blood within the vascular system during life

Question 8

Pathogenesis of Thrombosis (3)

Answer 8

1. Atheromatous coronary artery
2. Stasis or turbulent blood flow
3. Hypercoagulability of the blood that produces lines of Zahn

Question 9

What do the consequences of thrombosis depend on (3)

Answer 9

Site
Extent
Collateral circulation

Question 10

Complications (3)

Answer 10

DVT
MI
Ischaemic limb

Question 11

Outcomes of thrombosis (7)

Answer 11

DVT
Ischaemic limb
MI
Resolution
Organisation
Death
Propagation - Embolism

Question 12

Embolism

Answer 12

movement of abnormal material in the blood stream and its impaction in a vessel, blocking its lumen

Question 13

Embolus

Answer 13

detached intravascular solid, liquid or gaseous mass

Question 14

Types of Embolus (11)

Answer 14

Systemic/arterial
Venous
Fat
Gas
Air
Tumour
Trophoblast
Septic material
Amniotic fluid
Bone marrow
Foreign body

Question 15

Where do systemic/arterial emboli originate from (4)

Answer 15

Mural thrombus
Aortic aneurysms
Atheromatous plaques
Valvular vegetations

Question 16

Where do systemic/arterial emboli travel (3)

Answer 16

Lower limbs
Brain
Other organs

Question 17

What does systemic/arterial emboli cause

Answer 17

Infarction

Question 18

Where does venou emboli travel

Answer 18

Pulmonary artery circulation

Question 19

What does venous emboli cause (6)

Answer 19

RHF
Silent pulmonary haemorrhage/infarction
Sudden death
Hypertension
Right ventricular failure

Question 20

What is Rheumatic heart disease (2)

Answer 20

• Disordered immunity

* Inflammatory changes in the heart and joints and cause neurological symptoms

Question 21

What is the epidemiology of Rheumatic Heart Disease (3)

Answer 21

Common in India, Middle East and Central Africa
More common in boys
Ages 5-15

Question 22

Presenting Features of Rheumatic Heart Disease

Answer 22

Flitting polyarthritis of big joints( wrist, elbow, knee and ankle)
Pancarditis
Sore throat
Beta-haemolytic strep infection

Question 23

What is Pancarditis

Answer 23

inflammation affecting endocardium, myocardium, pericardium) in the acute phase; heart murmurs commons

Question 24

What causes damage to heart in Rheumatic heart disease

Answer 24

combination of antibody-mediated and T cell-mediated reactions

Question 25

What can be seen during histology in rheumatic heart disease (3)

Answer 25

Aschoff body (Inflammatory cells, necrosis Anitschkow cells)

Question 26

Cause of Valvular Heart Disease (3)

Answer 26

Valvular stenosis Valvular regurgitation Vegetations

Question 27

What does inflammation of the endocardium and left side valves cause

Answer 27

Fibrinoid necrosis of the valve cusps/chordae tendineae which lead to small vegetations

Question 28

What valve does Rheumatic fever normally involve

Answer 28

Mitral valve

Question 29

What typically happens to the mitral valve

Answer 29

typically leaflet thickening, commissural fusion and shortening, thickening and fusion of chordae tendineae