534: Cardio Wk 7 PII

What are the major causes of thrombophlebitis?

• short-term venous catheterization of superficial arm veins

• Long term peripheral inserted central catheter (PICC)

What is the MC pathogen associated with superficial thrombophlebitis?

S.aureus

Which systemic system causes secondary hypercoagulability tothta leads to superficial thrombophlebitis?

Abdominal cancer; pancreas carcinoma

What is the pathology behind varicose veins?

• Dilated, bulging, tortuous superficial veins

• >3mm diameter

What is the difference between dilated intradermal veins and telangiectasias?

dilated intradermal veins

• blue-green

• measure 1-3 mm in diameter

• No protrusion

Telangiectasias

• Small at <1 mm in diameter

• Dilated

• spider-web pattern

What is the difference between primary and secondary varicose veins?

Primary

• Origin in superficial system and 50% has + FMHX

  • Defective structure/function of valves of saphenous veins

  • Intrinsic weakness of vein wall

  • High intraluminal pressure

Secondary

• 2nd to HTN, deep-venous insufficiency or deep-venous obstruction

  • → incompetent perforating veins → enlarged superficial veins

• Ex: arteriovenous fistulas - varicose veins in limbs

Define chronic venous insufficiency

Consequence of incompetent veins →:

• venous HTN

• extravasation of fluid

  • blood in tissues of limb

What are some causes to chronic venous insufficiency?

• varicose veins

• disease in deep veins

What is the difference between primary and secondary chronic venous insufficiency

Primary

• consequence intrinsic structural/functional abnl in vein wall or venous valves → valvular reflux/regurg.

Secondary

• obstruction and/or valvular incompetence from previous deep-vein thrombosis.

What is the physiological changes seen in deep-vein insufficiency due to DVT?

Valves become:

• Thickened

• Contracted

• Can’t prevent retrograde flow of blood

  → Vein becomes rigid and thick walled

How does DVT relate to 2nd causes of deep-vein insufficiency?

Due to the high pressures in distal valves →

• distends the veins

  • separate leaflets

What else can cause 2nd varicosities?

R-sided heart disease

What are the primary forms of venous thrombosis?

• DVT in extremities

  • PE in lungs

How does tissue factor contribute to the conversion of fibrinogen to fibrin?

TF combines with VIIa → VIIa/TF which is then added to X → Xa

What is the purpose of antithrombins like TFIPI, heparin, protein C/S?

Limit production of thrombin to prevent prolongation of coagulation and thrombus formation

What is the difference between activation between venous thrombosis and arterial thrombosis?

Venous

• Initiated of coagulation by exposure of TF → formation of thrombus + conversion of fibrinogen to fibrin

Arterial

• Promoted by adhesion of platelets to injured vessel + stimulated by exposed extracellular matrix

What are some heritable causes of arterial and venous thrombosis?

Prothrombin: 202010G → A

Protein C Anticoagulant Pathway: Factor V Leiden: 1691G → A (Arg506Gln)

What are some genetic variation and pharm responses to platelet inhibitors?

Clopidogrel/Prasugrel

• CYP2C19

• CYP3A4

• CYP3A5

ASA

• COX1

• COX2

Abciximab/Eptifibatide/Tirofiban

• PIA1/A2

Define atrial septic defect (ASD)

• Left-to-right shunt

• Intracardiac holes that allows blood to transmit between chambers or spaces

• Size determines R sided dilation

What is the difference between secundum ASD and primum ASD?

Secundum

• MC

• Occurs at fossa ovalis

Primum

• Deficiency of AV canal portion of atrial septum

• Always ass w/ abnl development of AV valves w

  • MC: cleft in mitral valve

both fixed by sx

What is patent foramen ovale (PFO)?

Valve flap of fossa ovalis that did not close after birth and does NOT relate to R sided cardiac dilation

What is Coarctation of the Aorta?

Obstruction at the (MC) descending aorta that passes posterior to junction of main and left PA.

Less commonly at transverse aortic arch

What is patent ductus arteriosus (PDA)?

• ductus arteriosus remains open

• Located between aortic isthmus and origin of one of the branch pulmonary arteries

• Brings oxygenated blood from aorta to lungs

What is the difference presentation between a small PDA and large PDA?

Small

• Silent during auscultation

• Does NOT cause hemodynamic changes

Large

• Left heart dilation → chronic elevated pulmonary vascular resistance

• eisenmenger syndrome

What is the most common congenital anomaly recognized at birth?

ventricular septal defect (VSD)

What presentation is associated with a large VSD?

HF and poor somatic growth

What is the MC location for VSD to occur?

Membranous septum

• also known as perimembranous or outlet defects

What is the common form of cyanotic CHD

Tertralogy of fallot

What is the physical changes seen in tertalogy of fallot?

• R ventricular outflow tract (RVOT) obstruction

• VSD

• R ventricular hypertrophy

• override of aorta