Pathophysiology of Thrombosis and Embolism

normal blood flow is...

laminar

- blood is smooth and ordered

how does blood flow

with cells in the middle and plasma surrounding them in contact with endothelial surfaces

what is virchows triad

factors causing thrombosis

- change in blood vessel wall

- change in blood constituents

- change in pattern of blood flow

thrombosis

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

clot

damage to blood vessel - clotting cascade

Jelly like masses of blood

thrombus

clot randomly forming in a healthy vessel

normal artery wall

endothelium

intima

media

adventitia

pathogenesis of thrombosis

atheromatous coronary artery

- turbulent blood flow causing fibrin deposition and platelet clumping

loss of intimal cells, denuded plaque meaning that collagen exposed

platelets adhere

fibrin meshwork

RBC's trapped - bands of Zahn

further turbulence and platelet deposition

propagation

how does high cholesterol contribute to Virchows triad

change in blood constituents

propagation of thrombus

atheroma affecting artery

thrombus forms on surface

more turbulent flow

damage to endothelial surface

further platelets, fibrin and RBC's deposited

thrombus gets bigger

common clinical consequences of thrombosis

DVT

ischaemic limb

MI

outcomes of thrombosis consequences

resolution

organisation

death

embolism

define embolism

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

three types of embolism

systemic/arterial thromboembolism

venous thromboembolism

pulmonary thromboembolism

risk factors for PE and DVT

cardiac failure

severe trauma

post op

post partum

nephrotic syndrome

disseminated pregnancy

oral contraceptive

increasing age

bed rest

long haul flights

obesity

PMH of DVT

Treatment of DVT/PE

-Anticoagulation is the recommended pharmacological approach to prevent DVT and PE

-Thrombolysis

types of embolus

air embolus

fat embolus

gas embolus

trophoblast

septic material

tumour

what is rheumatic heart disease

caused by rheumatic fever

inflammatory changes in heart and joints

common in india

common in children

boys>girls

presentation of rheumatic fever/heart disease

flitting (painful) poly arthritis of large joints - wrists, elbows, knees, ankles

skin rash

fever

pancarditis - affects endocardium, myocardium, pericardium

heart murmurs

• mitral stenosis

• mitral regurgitation

• mainly manifests as valve abnormalities

Aschoff body (nodules) seen in acute rheumatic fever

valvular heart disease pathological problems results from

-valvular stenosis

-regurgitation

- vegetations - infective nodules over valves