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Cardiovascular system SA > Pathophysiology of thrombosis and embolism > Flashcards

Pathophysiology of thrombosis and embolism Flashcards

1
Q

What is normal blood flow

and two types of abnormal blood flow

A

Laminar - constant streamline no turbulence

Stasis - Stagnation of flow - water is not moving as is being obstructed

Turbulence - Forceful and unpredictable flow

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2
Q

What are examples of conditions that cause defects in the blood

A 
Thromboembolism common
Other causes:
Atheroma - Plaque obtruding into lumen 
Hyperviscosity - increased viscosity 
Vascular spasm - 
external compression - e.g. tumour squishing blood 
vasculitis - inflammation of blood vessels 
vascular steal
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3
Q

Define vascular steal

A

Vascular network in a vascular organ steals blood at the expense of another vascular organ

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4
Q

What is the three mechanisms of Virchow’s Triad

A

Changes in the blood vessel wall

Changes in the blood constituents

Changes in the pattern of blood flow

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5
Q

Define thrombosis

A

Formation of a solid mass from the constituents of blood within the vascular system during life
(if not within the vascular system its a clot not thrombosis)

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6
Q

What is the over all pathogenesis for thrombosis relating to virchows triad

A

Endothelial injury

Stasis or turbulent blood flow

Hypercoagulability of the blood

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7
Q

What is an examples of endothelia injury/change in blood vessel wall resulting in thrombosis

A

atheromatous coronary artery

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8
Q

What is the pathogenesis of atheromatous coronary artery resulting in thrombosis

A

Plaque forms - causes flow to become turbulent - then endothelia surface becomes lost - exposed collagen - creates fibrin network on sticky surface, platetes adhere, RBC trapped - forms thrombosis

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9
Q

What are the lines of zahn that appear

A

Fibrin networks inter dispersed with lines of RBC

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10
Q

What is the biggest risk factors that contributes to virtuous triad

A

Hypercholestoanemia - causes a change in the blood constituents, change in vessel wall, and change in blood flow

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11
Q

What is it called when thrombosis forms on the inner surface of the heart wall due to a

A

Neural thrombosis

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12
Q

What are example of changes in blood constituents that result in thrombosis

A

hyperviscosity - due to reduction in plasma volume

post-traumatic hypercoagulability

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13
Q

What is examples that cause stasis blood flow that can result in deep vein thrombosis

A

Long flights or postoperative - not using lower limbs

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14
Q

What is examples that cause turbulent blood flow resulting in thrombosis

A

atheromatous plaque

aortic aneurysm - localised dilatation in BV

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15
Q

What do the consequences of thrombosis/thromboembolism/embolism depend upon

A

Site
Extent
Collateral circulation

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16
Q

What are common clinical conditions occurring due to thrombosis

A

Deep Vein Thrombosis - follows vein thrombosis
ischaemic limb - follows arterial thrombosis
Myocardial infarction - following thrombosis of coronary artery

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17
Q

How is resolution of thrombosis achieved

A

Spontaneous
Usually need medical intervention
Thrombolytic or fibrinolytic agents -

18
Q

What is the next best outcome if you cant achieve resolution, and what does this allow?

A

Organisation of the thrombosis

Control thombus so doesn’t get any bigger, allowing new blood cell formation, resulting in wider lumina, restoring blood blow = Recanalisation

19
Q

What is the possible outcomes of thrombosis

A

Resolution
Organisation
Death
Propagate

20
Q

What can propagation of thrombus lead to

A

ThromboEmbolism - traveling blood clot

21
Q

Define embolism

A

Movement of abnormal material (detached intravascular solid, liquid or gaseous mass) in the bloodstream and its impaction in a vessel, blocking its lumen
Occurring at distant site to the origin

(doesn’t have to be a thrombus)

22
Q

What is most common embolism

A

dislodged thrombi = thomboembolism

23
Q

Factors causing embolism is dependant the type of embolus involved.

What are the different types of embolus ?

A 
Thrombus 
Fat 
Gas 
Tumour 
Air 
Trophoblast 
septic maternal 
Amniotic fluid 
Bone marrow 
Foreign bodies
24
Q

What are the two types of thromboembolism

A
  • Systemic/Arterial Thromboembolus

- Venous Thromboembolus

25
Q

What is the sources of Systemic/Arterial Thromboembolus

A

Blood vessel thrombus; MI or left atrial dilatation
aortic aneurysms,
atheromatous plaques,
Endocarditis

26
Q

Where do systemic thromboembolus travel

A

Travel to wide variety of sites: lower limbs most common, brain, other organs

27
Q

What is the usually consequence of Systemic/Arterial Thromboembolus

A

Ischaemia / Infarction

28
Q

What is collateral circulation

A

rocess in which a system of small, normally closed arteries connect and start to carry blood to part of the heart when a coronary artery is blocked, or to part of the brain when a cerebral artery is blocked. These arteries can serve as alternate routes of blood supply.

29
Q

Venous Thromboembolus is the most common form of thromboembolic disease, so where does it originate from

A

Originate from deep venous thromboses (lower limbs)

30
Q

What is the pathophysiology of Venous Thromboembolus

A

Travel to the pulmonary arterial circulation

Depending on size, may occlude main pulmonary artery, bifurcation, smaller arteries and Often multiple

31
Q

What is the consequences of Venous Thromboembolus

and what dies the consequence depend upon

A

silent,
pulmonary haemorrhage/infarction,
right heart failure,
sudden death

The size of the embolus

32
Q

What is the result of multiple Pulmonary embolism over time

A

pulmonary hypertension and right ventricular failure

33
Q

What increases the risk factor for pulmonary embolism and DVT
i.e. changing blood flow/vessel/constituents

A 
Cardiac failure, 
severe trauma/burns, 
post-op/post-partum, 
nephrotic syndrome – kindeys not working properly,
disseminated malignancy, 
oral contraceptive,  
age, 
bed rest/immobilisation, 
obesity, 
Past Medical History of DVT
34
Q

What is given to surgical patents at risk of embolism

A

Prophylaxis: TEDS, s/c heparin

35
Q

How does gas embolisms occur

A

Decompression Sickness - N2 forms as bubbles which lodge in capillaries

36
Q

How does air embolism occur

A

Head and neck wounds,
surgery,
CV lines
introduce air bubble

37
Q

How does septic material cause embolism

A

Can result in infective endocarditis, and break of travel in the blood stream causing mycotic aneurysms

38
Q

What can Tumour embolism allow

A

Metastasis

39
Q

How does trophoblast embolism occur

A

Material from the placenta traveling to the mothers lungs

40
Q

How does amniotic fluid embolism occur

A

rare, bits if the amniotic fluid get into maternal circulation migrate to lungs and cause allergic reaction

41
Q

What are examples of foreign bodies that can cause embolisms

A

Intravascular cannulae tips, sutures, etc

42
Q

What embolism occur after fractures (or CPR,

A

Bone marrow embolism

Fat embolism

Cardiovascular system SA (43 decks)

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