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Flashcards in Vascular Thromboembolic Disease Deck (47)
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1

Hemostasis

the physiologic process by which bleeding stops

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Thrombosis

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Thrombus

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Embolization

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Emboli

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Key Pathologic Consequence of clot

REDUCTION IN or CESSATION OF BLOOD FLOW

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Underlying Inciting Event in several Clinical Diseases

TIA/CVA, MI, DVT, PE, etc.

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Substances that can embolize

Air
Amniotic Fluid
Foreign Bodies
Parasitic Eggs
Septic Emboli
Tumor Cell
MOST COMMON: Thrombus

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Location of Thromboembolism

can occur anywhere in Cardiovascular System

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Purpose of Hemostatic System

Prevent blood loss due to vascular Injury

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Thrombus: A leading cause of morbidity and mortality
(Epidemiology)

US: cause of death in ~1 million individuals per year

Annual Incidence: ~1 case/1000 individuals

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Components of hemostatic system

Formed Elements: Cells (Platelets, Monocytes, RBCs) &
Plasma Proteins (Clotting Factors, Fibrinolytic Factors, Inhibitors)
Vessel Wall: Epithelium, vonWillibrand Factor (vWF), Collagen, Tissue Factor

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Hemostasis- Vascular Injury

will expose VW factor, collagen matrix, etc. and when this is exposed that’s when coagulation occurs

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Primary Hemostasis

formation of platelet plug

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Secondary Hemostasis

Clotting Cascade: Activate Fibrin (form meshwork that binds everything together)

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Hemostasis- Fibrinolysis and Regulation

once clot is formed, further clot formation is prevented and clot starts to breakdown

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Arteries

Higher Pressure
More smooth muscle
Atherosclerosis

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Veins

More Distensible
Capacitance Vessels
Valves
Virchow’s Triad

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Arterial Thromboembolism may cause

Arterial Occlusive Disease
Myocardial Infarction
Ischemic Cerebrovascular Accident
Mesenteric Ischemia
Vasculitides

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Venous Thromboembolism (VTE) may cause

PE
DVT
Superior Vena Cava Obstruction
Chronic ThromboEmbolic Pulmonary HTN (CTEPH)
Dural Sinus Thrombosis
Portal Vein Thrombosis
Vasculitis-Bechet’s, Granulomatosis with polyangiitis
Mesenteric Vein Occlusion

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Pulmonary venous thromboembolism (AKA PE)

3rd leading cause of death among hospital pts
Often not recognized ante mortem

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Thrombus description

-Most common etiology of emboli
-Most Common Site of Origin is Deep Veins of the Lower extremities
-Found in 50-70% of pts with symptomatic PE
-Can Form AnywhereThrombus

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Diagnosis of VTE (venous thrombolytic embolism)

-NOTORIOUSLY DIFICULT DIAGNOSIS
-Findings depend of size of embolus and preexisting cardiopulmonary disease
-Common signs and symptoms are not specific

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Signs & Symptoms of VTE

*Dyspnea
*Pain on inspiration
*Tachypnea
Cough
Hemoptysis
Leg Pain
Tachycardia
Palpitations
Crackles
Homan’s Sign- Dorsiflex foot and have calf tenderness (may be indication of DVT)

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DIFFERENTIAL DIAGNOSIS for VTE

Pneumonia
Lung Cancer
MI
COPD
Asthma
Traumatic Injury
Muscle Strain
Costochondritis
Inhalation Injury
Aortic Aneurysm
Congestive Heart Failure

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Virchow’s Triad- 3 things that promote coagulability

Stasis, Hypercoagulability, Endothelial injury

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Description of Stasis (part of Virchow's triad)

Stasis
Prolonged immobility
post orthopedic surgery,
Low Cardiac Output
Pregnancy
Post CVA
Travel (Air, Car)

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Description of Hypercoagulability (part of Virchow's triad)

Hypercoagulability
Medications: Oral Contraception, Hormone Replacement
Malignancy
Genetic: Factor V Leiden, Protein C/S/antithrombin III deficiency/dysfunction, prothrombin gene mutation, hyperhomcysteinemia, antiphospolipid antibodies

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Description of Endothelial Injury (part of Virchow's triad)

Traumatic Injury
Recent Surgery
Previous Thrombosis

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EKG findings of VTE

-Abnormal in about 70% of pts with PE
-Most Common Finding: Sinus Tachycardia & Nonspecific SR and T wave changes
-Right Heart Strain: RBBB, Right Axis Deviation, S1Q3T3
-Prominent S wave (lead 1), Prominent Q wave (lead 3) and Inverted T wave (lead 3) -->this may also indicate PE