Thrombosis, Embolism and Pulmonary Hypertension Flashcards Preview

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Flashcards in Thrombosis, Embolism and Pulmonary Hypertension Deck (62):
1

What is the difference between a thrombus and a clot?

Thrombus- inside vessel
Clot- outside vessel

2

Where is thrombosis favoured according to Virchow's triad?

Stasis (turbulent blood flow), endothelial injury and hypercoagulability

3

What can cause a hypercoagulable state?

Malignancy, pregnancy, hormone replacement, bowel disease, sepsis

4

What can cause endothelial injury?

Venous disorders, valve damage, trauma, surgery, catheters

5

What can cause stasis?

LV dysfunction, immobility, venous insufficiency/obstruction, pregnancy, obesity

6

What two things must happen for a thrombus to form?

Platelet activation and fibrin production

7

What does activating platelets do?

Makes them stickier so they aggregate more platelets and fibrin

8

What is the end point of the coagulation cascade?

Aggregation of fibrin

9

What is the first stage of thrombus formation?

Endothelial injury which exposes collagen

10

What happens in the formation of a thrombus after collagen has been exposed?

Collagen and Von Willebrand factor bind to glycoproteins on platelets which increases platelet integrins

11

What do glycoproteins on platelets bind with?

Fibrinogen

12

Describe the intrinsic coagulation pathway?

Hageman factor and Kallikrein through factors XII, IX, VIII

13

What is the extrinsic coagulation pathway?

Tissue factor binding with factor VII

14

What is the common pathway of coagulation?

Activated Factor IIa then through X, V, II

15

What happens after the common pathway of coagulation?

Factors II and XIII activate fibrinogen to fibrin

16

What type of vitamin is vitamin K and where is it stored?

Fat soluble in the liver

17

What does vitamin K produce?

Clotting factors II, VII, IX and X

18

What competes with vitamin K?

Warfarin

19

What is plasmin?

Clot buster

20

What are anti-clotting factors?

Protein S, protein C and antithrombin II

21

What causes inherited disorders of coagulibility?

Protein C/S/antithrombin II deficiency or Factor V Leiden

22

Why are thrombi less common in arteries?

High flow blood moves pro-coagulant material away quickly

23

When is the only occasion that thrombosis occurs in arteries?

Atherosclerosis

24

Why are sites where vessels branch more common?

More turbulent blood flow

25

Where is stasis common?

Depp veins, faulty valves and venous insufficiency

26

Where do the biggest PEs tend to come from?

Femur

27

Most emboli are thrombi, what else could they be?

Gas, fat, foreign bodies, tumour clumps

28

Pulmonary emboli are an important cause of what?

Sudden death and pulmonary hypertension

29

Where is the source of most PEs?

Deep vein thrombosis

30

What is ischaemia?

Insufficient blood flow

31

What is infarction?

Tissue death as a result of ischaemia

32

What do large emboli cause?

Death, infarction, severe symptoms

33

What do small emboli cause?

Pulmonary hypertension but clinically silent

34

What is pulmonary infarction?

Compromised blood and oxygen causes lung tissue to die

35

How does a DVT present?

Hot, swollen, red, tender calf or whole leg

36

What is the 1st line scan for DVT?

Ultrasound Doppler leg scan

37

What is the 2nd line test for DVT?

CT of ileo-femoral vein, IVC and pelvis

38

How will a large PE present?

CV shock, low BP, central cyanosis, sudden death

39

How will a medium PE present?

Pleuritic pain, haemoptysis, breathless

40

How will a small PE present?

Progressive dyspnoea, pulmonary hypertension, right sided heart failure

41

What are risk factors for PE?

Thrombophilia, contraceptive pill, pregnancy, pelvic obstruction, trauma, surgery, immobility, malignancy, vasculitis, obesity

42

What are clinical features of PE?

Tachycardia, tachypnoea, cyanosis, fever, low BP, crackles, rub, pleural effusion

43

What will ABGs for PE show?

Low O2- type 1 respiratory failure

44

What will a CXR of PE show?

Normal early on, may show a wedge shaped infarct

45

What is the gold standard test for PE?

CTPA

46

What is the 2nd line scan for PE which is good in pregnancy?

V/Q scan

47

What is a useful rule out test for PE?

D-dimers

48

What are some ways a DVT can be prevented?

Compression stockings, early post-op mobilisation calf muscle exercise, anticoagulants

49

What are PEs treated with and for how long?

Anticoagulation with LMWH or warfarin for 3 months is provoked and longer if not

50

What is the treatment for large life threatening PEs?

Thrombolysis

51

What are interactions of thrombolysis?

Alcohol, antibiotics, aspirin, NSAIDs, grapefruit

52

What can post-thrombotic syndrome cause?

Pain, oedema, hyperpigmentation, eczema, varicose veins, ulceration

53

What is the relative flow/pressure in the pulmonary circulation?

High flow, low pressure

54

What is classed as pulmonary hypertension?

>25mmHg

55

What can cause pulmonary venous hypertension?

Ischaemia, stenosis, cardiomyopathy

56

What can cause pulmonary arterial hypertension?

Hypoxia, multiple PE, vasculitis, drugs, HIV, left to right shunt

57

What is cor pulmonale?

Right sided heart failure secondary to lung disease

58

What are signs of cor pulmonale?

Central cyanosis, oedema, raised JVP, right ventricular heave

59

What are probably the most important tests for Cor Pulmonale?

ECG, CXR, ABGs, echo

60

How is primary pulmonary hypertension diagnosed?

By ruling out other causes

61

What is the typical presentation of pulmonary hypertension?

SOB on exertion and signs of right sided failure

62

What is treatment for primary pulmonary hypertension?

Pulmonary vasodilators and lung transplant