MDS2008

What is ischemia?

A deficient supply of oxygen with regards to metabolic needs

Angina pectoris the most common. Pain typical with exercise.

Why painful?

Metabolically:- anaerobic respiration therefore lactic acid production therefore irritation. Tissue
damage initially, it can be reversible.

Causes of ischemia?

 Atherosclerosis
 Thrombus
 Spasm of vessels
 Embolism
 Arthritis (oedema of tissue)

Other complications

1. Stroke
2. Cardiomyopathy
3. Liver damage

What is atheroma?

The process by you get thickening of rigidity of the wall of the artery. Calcification.

Atherosclerosis (in arteries eg aorta) and arteriolosclerosis (in small arteries and arterioles)

Lesion of atheroma consist of:-

First:- starts with fatty streaks but they don’t damage the wall. But they will start to clump starting in
the intima of the muscle. It consists of cholesterol. It goes in the intima and macrophages goes
toward the cholesterol. Overall comes in an amorphous mass effecting the intima and media.

It triggers an inflammatory response therefore inflammatory cells cause to the atheroma therefore
gets bigger and bigger. Fibrous occurs (part of the healing process). Then it because a scar and
calcification develops.

Artery becomes narrow, more rigidity (effecting peripheral resistance), the wall weakens (therefore
develop of aneurysm), bits of atheroma can get detached therefore cholesterol embolization
(gangrene in toe).
Types of cholesterol

HDL:- moves cholesterol from arterial wall to other parts therefore protecting the arterial wall.

LDL:- carries bad cholesterol from liver to arteries therefore damage arteries

How to increase HDL?

 Exercise
 Olive oil
 Fish, fish oil

Major Risk factors for atheroma

 Smoking
 Diabetes
 Hyperlipidaemia
 Family history (this is not correctable therefore major one. The others are revisable)
 hypertension

Less risk factors

 OCP drug (common in women)

 Stress
 Alchodol
 Diet
 Lack of exercise

TIA is like a warning for ischemia

In lower limbs:- angina in skeletal muscle causing gangrene

What is an infarct?

Stuffed up area due to haemorrhagic therefore congested.

Why haemorrhagic? Due to inflammatory response, vessel formation, healing process, fibrosis,
scarring

Area with tissue necrosis due to complete occlusion

Causes:-

 Complete occlusion
 Pulmonary infarct occurs at the periphery (where the pleura is)
 In the brain, infracts are common between the anterior and towards the periphery
End result of infarction?

Loss of function (depends on the organs involved)

Eg in kidneys:- hypertrophy of the neighbouring tissue therefore irregular therefore can compensate
but the brain cannot compensate. the brain shrinks up therefore dementia.

What’s a thrombus?

It’s a blood clot formed from blood constituents (platelets and fibrin), in a blood vessels during life.

Thrombus formation is a physiological process. This is important for blood clot during haemorrhage.

Risk factors for venous thrombosis

 Decrease blood flow

 Hypercardiobility of blood (in blood therefore clotting factors and natural anticoagulants.
They neutralize each other therefore excess of one of them it will become prothrombotic)
 Damage endothelium
 Long distance flights

Happens mostly near valves therefore causing turbulence

Risk factors of Arterial thrombosis

 Diabetes

Where thrombus is formed?

 In legs where there is bifurcation

 Within the heart itself where the valves are. Common cytothrombis formation. Therefore
given prophylactic anticoagulants

Outcome of thrombus

 Embolize
 Propagate by Red cells and white cells
 Dissolution (small clots can solve on itself)
 Can organize (granulation tissue and inflammatory response and gradually become
incorporating in the tissue therefore atheroma)

What is embolisms?

Any material within another vessel that is carried from other site.

Such as Air, foreign bodies, pregnancy (amniotic fluid embolism- during birth), septic emboli
(bacteria)- subacute bacterial endocarditis (central line), malignant cells.
Where does embolization occur?

Lungs originating in the legs expect in the atrial septal defect (paradoxical embolization)

Brain causing strokes

And can occur in anywhere in the heart. Left ventricle common for Heart failure.