1. Thrombosis and Embolism

2. Thrombus Thrombus: a blood clot occurring in a vessel or the heart Thrombus: a blood clot occurring in a vessel or the heart A thrombus can occlude a vessel resulting in anoxic death of cells A thrombus can occlude a vessel resulting in anoxic death of cells

3. ©http://www.chelationtherapyonline.com/articles/images/plaque2.jpg

4. Infarction: tissue that has been starved of oxygen resulting in tissue death Infarction: tissue that has been starved of oxygen resulting in tissue death What would you call heart tissue deprived of oxygen resulting in death? What would you call heart tissue deprived of oxygen resulting in death?

5. Myocardial Infarction (heart attack) Myocardial Infarction (heart attack) For individuals who suffer a first time heart attack, 50% are fatal For individuals who suffer a first time heart attack, 50% are fatal

6. Ischemia: tissue that has been starved of oxygen, but had not yet died Ischemia: tissue that has been starved of oxygen, but had not yet died It is possible to reverse ischemia with clot dissolving drugs It is possible to reverse ischemia with clot dissolving drugs

7. What is the difference between anoxia and infarction? What is the difference between anoxia and infarction? Anoxia is the term applied to cell death, infarction is the term applied to tissue death (many cells) Anoxia is the term applied to cell death, infarction is the term applied to tissue death (many cells)

8. Thrombus

9. Embolus Embolus: a blood clot that has ruptured or broken up and flows with the blood until it lodges or dissolves Embolus: a blood clot that has ruptured or broken up and flows with the blood until it lodges or dissolves

10. Thrombus and Embolus ©http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18120.jpg

11. Embolism/Embolus ©http://images.healthcentersonline.com/heart/images/article/Embolism_and_embolus.jpg

12. What Causes the Formation of a Thrombus? 1. Atherosclerosis

13. 2. Vascular injury: injury to the endothelium of a blood vessel can cause a clot Why? Why?

14. When an injury occurs, platelets stick to each other and form a clot When an injury occurs, platelets stick to each other and form a clot Platelets: solid, circulating cell fragments that are vital to stopping bleeds Platelets: solid, circulating cell fragments that are vital to stopping bleeds

15. Platelets

16. http://www.youtube.com/watch?v=-- bZUeb83uU http://www.youtube.com/watch?v=-- bZUeb83uU

17. Steps of Thrombus Formation 1. Platelets stick together to plug the injured area. 1. Platelets stick together to plug the injured area. 2. Clotting factors reinforce the platelets. 2. Clotting factors reinforce the platelets.

18. 3. Fibrin creates a mesh over the platelets that acts as a glue. 3. Fibrin creates a mesh over the platelets that acts as a glue. 4. Other cells also stick to the platelets to reinforce the damaged area. 4. Other cells also stick to the platelets to reinforce the damaged area.

19. 2. Causes of Vascular Injury Injury may be caused by phlebitis Injury may be caused by phlebitis Phlebitis: inflammation of veins caused by lack of blood flow Phlebitis: inflammation of veins caused by lack of blood flow Multiple causes: chemical injury, traumatic injury, bacterial injury Multiple causes: chemical injury, traumatic injury, bacterial injury

20. Phlebitis

21. 3. Blood flow: any change in blood flow bringing platelets into contact with the endothelial lining

22. 3. Blood Flow Changes Major areas affected by blood flow that may result in a thrombus: Major areas affected by blood flow that may result in a thrombus: Plasmatic zone: Plasmatic zone: Along the tunica intima there is a layer of just plasma Along the tunica intima there is a layer of just plasma Purpose: to keep solids from hitting the lumen’s wall Purpose: to keep solids from hitting the lumen’s wall Why? Why?

23. Provides a buffer so rbcs, wbcs, and platelets do not hit the wall Provides a buffer so rbcs, wbcs, and platelets do not hit the wall

24. 3. Blood Flow Changes Valves Valves Large veins can become stretched out and not function properly Large veins can become stretched out and not function properly Stretched out valves cause turbulence of blood—not good Stretched out valves cause turbulence of blood—not good

25. Thrombus Caused by a Valve ©http://myhealth.reidhosp.com/library/healthguide/en-us/images/media/medical/hw/n5551339.jpg

26. Varicose veins Varicose veins Veins have become enlarged and twisted Veins have become enlarged and twisted

27. Varicose Veins ©http://www.originmedical.co.uk/client_files/default/Varicose-Veins-legs.jpg

28. Varicose Veins ©http://www.vascularweb.org/graphics/northpoint_graphics_jpg/Varicose_02_Base_300.jpg

29. 4. Hypercoagulability Spontaneous blood clot Spontaneous blood clot Reason is not always known Reason is not always known

30. Location of Thrombi Can occur anywhere in the cardiovascular system Can occur anywhere in the cardiovascular system Mural thrombi: form in the heart Mural thrombi: form in the heart Occlusive thrombi: form in the lumen of the vessels Occlusive thrombi: form in the lumen of the vessels

31. Treatment of Thrombi 1. Clot dissolving drugs Break up the clot and, hopefully, prevent a myocardial infarction or stroke Break up the clot and, hopefully, prevent a myocardial infarction or stroke Without the drugs: Without the drugs: Necrosis of the thrombus occurs (after several days) Necrosis of the thrombus occurs (after several days) Tissue damage will occur Tissue damage will occur

32. Two of the common clot dissolving drugs: Two of the common clot dissolving drugs: Streptokinase Streptokinase tPA: tissue plasminogen activator tPA: tissue plasminogen activator These can halt the progression of ischemia These can halt the progression of ischemia

33. Embolism Embolism: the occlusion of a vessel by a foreign mass traveling through the blood system Embolism: the occlusion of a vessel by a foreign mass traveling through the blood system

34. Causes of Emboli Thrombus (main cause) Thrombus (main cause) Undissolved air or gas bubbles in the blood stream Undissolved air or gas bubbles in the blood stream Tumor fragments Tumor fragments Bone fragments Bone fragments

35. Origin of Emboli May arise in the veins or arteries May arise in the veins or arteries

36. Venous Emboli Most arise from thrombi in the legs Most arise from thrombi in the legs Called deep vein thrombosis (if forms in the deeper veins of the legs or pelvis) Called deep vein thrombosis (if forms in the deeper veins of the legs or pelvis) May cause warmth, swelling, pain near the affected vessels May cause warmth, swelling, pain near the affected vessels

37. Venous Emboli ©http://www.ismaap.org/uploads/pics/thrombose_bein.jpg

38. If the thrombus travel towards the heart: If the thrombus travel towards the heart: Pass through the right side of the heart and into the lungs Pass through the right side of the heart and into the lungs Can occlude a vessel in the lungs resulting in pulmonary hemorrhage or pulmonary infarction Can occlude a vessel in the lungs resulting in pulmonary hemorrhage or pulmonary infarction

39. Pulmonary Embolism ©http://jaapa.com/issues/j20060701/screen/pulmonary0706art.gif

40. Pulmonary Embolism ©http://radiology.muhealth.org/new_Radiology_Web/Interventional/irImages/Pulmonary_embolism.gif

41. Animation of Embolus https://www.youtube.com/watch?v=tMrC wtzcVbU https://www.youtube.com/watch?v=tMrC wtzcVbU

42. Pulmonary Embolism Surgery (Graphic) https://www.youtube.com/watch?v=SzsQ WIMYbN8 https://www.youtube.com/watch?v=SzsQ WIMYbN8

43. Pulmonary Infarction Blood clot in the lungs Blood clot in the lungs When no blood reaches a section of the lung, that portion of the lung suffers an infarct, meaning it dies because no blood or oxygen is reaching it When no blood reaches a section of the lung, that portion of the lung suffers an infarct, meaning it dies because no blood or oxygen is reaching it

44. Arterial Emboli Usually form from thrombi in the aorta or heart Usually form from thrombi in the aorta or heart Travel away from the heart into smaller arteries Travel away from the heart into smaller arteries

45. Arterial Embolism ©http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18076.jpg

46. Lab Aorta Clear ©http://www.tigerpath.com/images/unit_01/21_20021204_Aorta.jpg

47. For Lab ©http://www.panaceia-or-hygeia.com/Images/PlaqueRupture-Thrombus.jpg