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What is ischemia?
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)
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
Exercise
Olive oil
Fish, fish oil
Smoking
Diabetes
Hyperlipidaemia
Family history (this is not correctable therefore major one. The others are revisable)
hypertension
What is an infarct?
Why haemorrhagic? Due to inflammatory response, vessel formation, healing process, fibrosis,
scarring
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?
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.
Diabetes
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)
And can occur in anywhere in the heart. Left ventricle common for Heart failure.