a. THROMBOSIS :- The term thrombosis describes the formation of a blood clot in a blood vessel. The blood vessel can be a vein (venous system) or an artery (arterial system). The symptoms that occur with a clot depend on where the clot occurs, the size of the clot, and whether the clot breaks off and travels to another part of the body (a process called embolization). For example, a blood clot in the leg can break off and travel to the lungs (called a pulmonary embolism) or travel to the brain (called an embolic stroke). ....... b. EMBOLISM :- Definition : An embolism is an obstruction in a blood vessel due to a blood clot or other foreign matter that gets stuck while traveling through the bloodstream. The plural of embolism is emboli. Description : Emboli have moved from the place where they were formed through the bloodstream to another part of the body, where they obstruct an artery and block the flow of blood. The emboli are usually formed from blood clots but are occasionally comprised of air, fat, or tumor tissue. Embolic events can be multiple and small, or single and massive. They can be life-threatening and require immediate emergency medical care. There are THREE general CATEGORIES OF EMBOLI : ARTERIAL, GAS, and PULMONARY. Pulmonary emboli are the most common. ........ c. SPASM :- Vasospasm typically occurs 4-10 days after subarachnoid hemorrhage. Reversible Cerebral Vasoconstriction Syndromes – A condition in which the arteries of the brain develop vasospasm (a blood vessel spasms causing less blood flow) without a clear cause, such as hemorrhage or trauma. Vascular spasms temporary limit blood flow to tissue supplied by that vessel. The most common symptom is pain. Causes : Vascular spasms can be caused by tobacco or drug use (especially cocaine), trauma, irritation to the blood vessels, exposure to cold weather, extreme emotional stress, or inflammation disorders affecting the blood vessels etc. ....... d. ATHEROMA :- An atheroma is an accumulation of degenerative material in the inner layer of an artery wall. The material consists of mostly macrophage cells, or debris, containing lipids, calcium and a variable amount of fibrous connective tissue. The accumulated material forms a swelling in the artery wall, which may intrude into the channel of the artery, narrowing it and restricting blood flow. ATHEROMA occurs in atherosclerosis, which is ONE OF the THREE SUBTYPES OF ARTERIOSCLEROSIS (which are ATHEROSCLEROSIS, MONCKEBERG'S ARTERIOSCLEROSIS and ARTERIOLOSCLEROSIS). In the context of heart or artery matters, atheromata are commonly referred to as atheromatous plaques. It is an unhealthy condition found in most humans. VEINS DO NOT DEVELOP ATHEROMATA, unless surgically moved to function as an artery, as in bypass surgery. The accumulation (swelling) is always in the tunica intima, between the endothelium lining and the smooth muscle middle layer of the artery wall. e. COMPRESSION :- The effects of external compression on venous blood flow and tissue deformation in the lower leg..... Results show that A compression produces greater vessel collapse and generates larger blood flow velocities and shear stresses than C compression..... f. VASCULITIS :- Vasculitis (plural: vasculitides) is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis. Vasculitis is primarily caused by leukocyte migration and resultant damage. Although both occur in vasculitis, inflammation of veins (phlebitis) or arteries (arteritis) on their own are separate entities. Classification : Vasculitis can be classified by the cause, the location, the type of vessel or the size of vessel. Underlying cause. For example, the cause of syphilitic aortitis is infectious (aortitis simply refers to inflammation of the aorta, which is an artery.) However, the causes of many forms of vasculitis are poorly understood. There is usually an immune component, but the trigger is often not identified. In these cases, the antibody found is sometimes used in classification, as in ANCA-associated vasculitides. ........ g. STEAL :- As for example : In nephrology, vascular access steal syndrome or dialysis-associated steal syndrome (DASS) is a syndrome caused by ischemia (not enough blood flow) resulting from a vascular access device (such as an arteriovenous fistula or synthetic vascular graft–AV fistula) that was installed to provide access for the inflow and outflow of blood during hemodialysis. Signs : Pallor, Diminished pulses (distal to the fistula), Necrosis, Decreased wrist-brachial index (ratio of blood pressure measured in the wrist and the blood pressure measured in the upper arm), especially if below 0.6 ....... Reference : Zanow J, Kruger U, Scholz H (2006). "Proximalization of the arterial inflow: a new technique to treat access-related ischemia". J Vasc Surg. 43 (6): 1216–21. h. HYPERVISCOSITY :- As for example : Hyperviscosity syndrome is a group of symptoms triggered by increase in the viscosity of the blood. Symptoms of high blood viscosity include spontaneous bleeding from mucous membranes, visual disturbances due to retinopathy, and neurologic symptoms ranging from headache and vertigo to seizures and coma. What causes increase in blood viscosity? Hyperviscosity syndrome can also be caused by conditions that affect the bones, including: leukemia, which is a cancer of the blood. polycythemia vera, which occurs when bone marrow produces too many red blood cells. What are some things that can cause blood to become more viscous? Blood viscosity is the thickness and stickiness of blood. It is a direct measure of the ability of blood to flow through the vessels..... Blood viscosity is defined as the inherent resistance of blood to flow.....
In one way all are same that they produce features of ischaemia in supplied territory.( Incase of vein - impaired drainage) - The basic pathophysiology:-- 1. Mechanical- thrombosis, Embolism, atheroma, compression & Vasculitis. 2. Functional- spasm 3. Both - steal 4. Neither- ( rheology) hyperviscosity THROMBOSIS- Formation of clot in situ ( Virchow' triad) . Ex. ACS - coronary thrombosis , DVT EMBOLISM- Formation of clot at a proximal site and lodged distally. Ex. CVA- cardioembolic stroke. SPASM- Constriction of vessel either due to local or circulating vasoactive substances. Ex. Vasospastic angina, Renaud's phenomena. ATHEROMA- A collection of fibrous & fatty material in intima protruding in to the lumen.Ex. atherosclerotic coronary artery and aortic disease. COMPRESSION- pressure on vessel from outside. Ex. Cervical rib, thoracic outlet syndrome. VASCULITIS- inflammation of intima or all three layers- leading to thrombosis, stenosis or Aneurism. Ex. Takayasu's arteritis, polyarteritis nodosa. STEAL- diversion of blood flow from a relatively disease segment to a normal segment .The basic mechanism is excessive vasodilation in one segment steals blood from other segment. Ex. Subclavian steal syndrome, coronary steal- produced by vasodilator such as nifedipine & dipyridamole. HYPERVISCOSITY- change in rheology leads to hypoxia due to impaired uptake & release of oxygen. Manifested by headache, visual impairment ,seizure, thrombosis or hemorrhage. Ex. Polycythemia.
Very outstanding information in vascular emergencies .
Cases that would interest you
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Hand started turning blue.with severe pain immediately after intravenous injection of diclofenac sodium in median cubital vein. Now after 16 hours patient presented with severe pain and swollen hand forearm.Dx n Mx?Dr. Prashant Ved9 Likes20 Answers
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42 yrs old male pt admitted with complaints of breathlessness and anasarca. .. 1. ecg findings? 2. differential diagnosis?Dr. Suresh Narayanan2 Likes34 Answers
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Dyspnea It is normal with all of us when we exert excessively.. But Dyspnea that is greater than expected with the degree of exertion... is a symptom of disease. Most cases of dyspnea result from asthma, heart failure and myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenic disorders.. Below mentioned are the pathological causes of Dyspnea by Organ System…. CARDIO-VASCULAR… Pulmonary edema Acute valvular disease Myocardial infarction Cardiac tamponade Heart failure Angina Constrictive pericarditis RESPIRATORY… Acute exacerbations or persistent chronic asthma Acute exacerbation or persistent chronic obstructive lung disease Pulmonary embolism Pneumothorax Pneumonia ARDS Anaphylaxis COPD Asthma Interstitial lung diseases Pulmonary hypertension Malignancy (tumor related obstructive lesions and lymphangitic spread) Pleural effusions Sleep apnea Foreign body aspiration GASTROINTESTINAL/HEPATIC Acute liver failure and its consequences Abdominal distention of various causes Ascites Portopulmonary hypertension Hepatopulmonary syndrome RENAL CAUSE Acute or chronic renal failure and its consequences HEMATOLOGICAL… Hemorrhage Anemia NEUROMUSCULAR High cervical cord lesions Trauma to phrenic nerves Central apneas Myasthenia gravis Myopathies Amyotrophic lateral sclerosis ENT cause Vocal Cord Dysfunction Laryngeo-tracheal obstruction PSYCHOGENIC BREATHLESSNESS I hope this list of causes will be HELPFUL to diagnose the aetiology of DYSPNEA…Dr. K N Poddar17 Likes18 Answers
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A 48yrs old male presented to ED having H/o sudden onset LOC and seizure with multiple episode of vomitting.K/c/o HTN not on regular treatment as advice by his family doctor.O/e CNS - conscious,alert,oriented,Right UMN facial palsy,Both pupils are normal in size.GCS-E3V4M4,Bp-170/90mmhg.Diagnosis?Dr. Prashant Ved8 Likes40 Answers
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OCULAR MANIFESTATIONS OF SLE. SLE is a chronic auto immune disease with multisystem involvement.SLE is multifactorial . Possible factors are genetic susceptibility, environmental factors and disturbances in both innate and adaptive immunity. Early detection and prompt referral to ophthalmologist can prevent permanent visual loss in some instances. OCULAR MANIFESTATIONS. SLE can affect any part of the eye and visual pathway.Eyelids ,orbit, lacrimal system , conjunctiva ,cornea ,sclera ,episclera ,retina , choroid ,uvea ,cataract ,glaucoma and cranial nerve are all involved. EXTERNAL EYE DISEASES : 1.EYELID DISEASE:Discoid lupus rash over the eyelids present as discrete raised scaly lesions. HPE shows hyperkeratotic epithelium with liquefactive degeneration of the basal layer and dense perivascular lymphocytic infiltration. ANA titre,ESR,C reactive protein,CBC,LFT,RFT Complement factors C3 &C4,anti phospholipid antibodies ,immunoglobulins,rheumatoid factor TSH,VDRL,GFR,24 hour urinary protein etc are the investigations necessary. 2.LACRIMAL SYSTEM DISEASE : Dry eye syndrome is the most common ocular presentation. 3.ORBITAL DISEASE. It can present as orbital mass,periorbital oedema ,orbital myositis,panniculitis,acute orbital ischemia and infarction. Clinical presentation can be ptosis,proptosis, orbital pain,limitation of extra ocular movements and enophthalmos. Treatment is by immunosupression. ANTERIOR EYE SEGMENT MANIFESTATIONS 4.CONJUNCTIVA : Chronic conjunctivitis is infrequent.Conjunctiva is inflammed in SLE associated keratitis and scleritis. Treatment NSAID or anti malarial therapy given. 5.CORNEAL DISEASE: Breakdown of corneal epithelium can cause recurrent corneal erosions.The inflammatory process in SLE causes PERIPHERAL ULCERATIVE KERATITIS. Treatment is with systemic corticosteroids and cytotoxic agent during acute phase of the disease and lubrication of corneal surface concommitantly.TOPICAL STEROIDS ARE NOT ADVOCATED AS THEY INHIBIT NEW COLLAGEN PRODUCTION AND THEREBY INCREASE THE RISK OF PERFORATION. 6.EPISCLERA : Episcleritis is benign inflammation of the episclera. 7.SCLERAL DISEASE : Scleritis is a painful and potentially sight threatening disorder.b ANTERIOR SCLERITIS presents as diffuse nodular or necrotising scleritis resulting in significant destruction and scleral thinning. Redness is caused by injection of deep episcleral vessels. POSTERIOR SCLERITIS :Affects the sclera posterior to the equator of the globe. presenting symptoms are pain and blurry vision caused by exudative retinal detachment papillitis and cystoid macular edema. Immunosupression is essential. 8.ANTERIOR UVEITIS Rare presentation.Prompt immunosuppressive therapy is considered. 9.CATARACT : Iatrogenic steroid use in SLE is associated with cataract formation. 10.GLAUCOMA : Open angle glaucoma and angle closure glaucoma are seen in SLE. POSTERIOR EYE SEGMENT MANIFESTATIONS 11.SLE RETINOPATHY. The earliest findings are small intra retinal hemorrhages and cotton wool spots,multiple areas of polygonal retinal whitening between the retinal arterioles and venules. Systemic therapy with steroids, Immunosupression ,laser therapy,intra vitreal anti-vascular endothelial growth factor agents (anti-VEGF) and vitrectomy are all treatments offered. 12.RETINAL VEIN OCCLUSION / RETINAL ARTERY OCCLUSION. Pathogenesis of vaso occlusive retinopathy is due to thrombosis associated with anti- phospholipid syndrome. 13.RETINAL VASCULITIS : This is a rare potentially blinding complication of SLE. 14 CHOROIDOPATHY : Choroidopathy with exudative retinal detachment is a rare ocular manifestation of SLE.It is manifested as multi focal serous detachments of the retinal pigment epithelium (RPE) and the neural retina ,with the transduction of the accumulated fluid through bruch's membrane and RPE affected by the choroidal ischemia and inflammation. The presenting feature is visual loss ,which depends on the extent of the macular involvement. 15. OPTIC NEURVE DISEASE: SLE can cause optic neuritis and ischemic optic neuropathy.The optic nerve damage is believed to be secondary to an occlusive vasculitis of the small arterioles of the nerve , which leads to demyelination and /or axonal necrosis. Signs of optic nerve disease. *Reduced visual acuity. *Impairment of color vision. *Diminished light brightness sensitivity. *Decreased contrast sensitivity. *Afferant pupillary defect. *Visual field defects. 16.CRANIAL NERVE INVOLVEMENT. Ocular motor nerve palsy can occur. MANY OCULAR COMPLICATIONS ARE PREVENTABLE,TREATABLE OR EVEN CURABLE.PROMPT TREATMENT WITH HIGH DOSE SYSTEMIC CORTICOSTEROIDS AND IMMUNOSUPPRESSIVE THERAPY ARE NECESSARY.Dr. Suvarchala Pratap9 Likes14 Answers