The cardiovascular system
Peter Kopelman, Dame Jane Dacre in Handbook of Clinical Skills, 2019
Chronic arterial narrowing (stenosis) or blockage (occlusion) is almost invariably the result of atherosclerosis, and develops slowly and insidiously. Acute arterial occlusion may also result from atherosclerotic disease, but in a minority of cases it is due to embolism, and in a smaller minority, due to trauma. An embolism is solid matter, almost always thrombus, that has formed at one site in the cardiovascular system, has broken free and has travelled in the bloodstream until it has reached vessels that are too small to allow its onward passage; here it causes a blockage. The most common source of peripheral embolisation is the left atrium, in patients who have atrial fibrillation, which is why most patients with atrial fibrillation are prophylactically anticoagulated. Aneurysms are also liable to accumulate thrombus within them, and this may embolise distally.
Systemic complications
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Pulmonary embolism is suspected in the presence of dyspnoea and tachypnoea, pleuritic chest pain and haemoptysis. Chest radiograph may show pulmonary infiltrates and pleural effusion. ECG may show non-specific dysrhythmias such as sinus tachycardia or atrial fibrillation. The patient may present with a wide range of symptoms or signs from anxiety and confusion to syncope and cardiovascular collapse. The symptoms are non-specific and therefore clinical prediction rules, similar to that used in DVT, is employed together with D-dimer measurements to guide further investigation and treatment. In both DVT and pulmonary embolism, assessment of clinical pretest probability is an important first step in establishing the diagnosis. Objective diagnosis of pulmonary embolism requires imaging studies. CT angiography (CTA) has a sensitivity of 83% and specificity of 96% for the diagnosis of pulmonary embolism. Combination of clinical assessment with CTA has a predictive value of 92–96%. Radionuclide scanning of the lungs is usually used when there is a high risk of contrast induced nephropathy, which is very relevant in elderly patients. A high probability scan has a positive predictive value of 85%. However, unfortunately most of the radionuclide scans are inconclusive, that is, have low or intermediate probability, especially in the presence of chronic lung disease. In these cases a combination of pretest probability, D-dimer and lower extremity ultrasonography is used to establish the diagnosis.
Nursing care of the cardiac catheterisation patient
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
Several treatment options exist, including anecdotal reports of alternative approaches for successful management of air embolism. Treatment consists of administration of 100% oxygen by facemask to help minimise ischemia and produce a diffusion gradient favouring reabsorption of the air.18(p277) Large volume, forceful saline flushes may attempt to disperse smaller bubbles.135 If a large bubble exists, this has been reported to be successfully aspirated using a thombectomy catheter.136,137 Guidewire bougie to disperse a bubble occluding a coronary artery has also been reported.34(p728)Advanced life support is required for prolonged cardiac arrest with an eventual spontaneous return of circulation.
Association between CHARGE-AF risk score and LA mechanics: LA reservoir strain can be a single parameter for predicting AF risk
Published in Acta Cardiologica, 2023
Turkan Seda Tan, Kubra Korkmaz, Irem Muge Akbulut, Kaan Akin, Yakup Yunus Yamanturk, Haci Ali Kurklu, Volkan Kozluca, Kerim Esenboga, Irem Dincer
Stroke is one of the main causes of death and disability worldwide. The global burden of stroke is rising due to the ageing population [1]. Ischaemic stroke, which is a prevalent type of stroke, can result from a variety of causes, such as atherosclerosis of the cerebral circulation, occlusion of small cerebral vessels, and cardiac embolism [2]. Given increases in life expectancy, the incidence of ischaemic stroke is expected to increase in the future [3]. Approximately one-third of ischaemic strokes remain cryptogenic after the standard evaluations of ischaemic strokes [4]. Due to the embolic nature of cryptogenic strokes, these strokes are classified as embolic stroke of undetermined source (ESUS) [5]. Causes of embolism may be due to artery-to-artery embolism, or emboli may originate directly from the heart. Long-term follow-up of cryptogenic stroke (CS) patients with continuous heart rhythm monitoring often reveals paroxysmal AF that was not apparent at the time of stroke [6]. With the hope that oral anticoagulant therapy can prevent most stroke in AF, the detection of patients who are at high risk for developing atrial fibrillation is essential for the primary prevention of stroke.
Early start of thromboprophylaxis does not increase risk of intracranial hematoma progression in multiply injured patients with traumatic brain injury
Published in Brain Injury, 2022
Philipp Störmann, William Osinloye, René D. Verboket, Cora R. Schindler, Mathias Woschek, Ingo Marzi, Thomas Lustenberger
Multiple previous studies have identified risk factors, such as TBI, a higher ISS, and lower extremity fractures, as associated with in an increased risk of VTE in major trauma patients (1,24,25). The overall rate of VTE in our study, including a high-risk population for VTE, was 1.6%, which is in line with previous published data of trauma patients that receive VTEp. In the literature, the rate of VTE in patients with TBI likewise ranges between 0% and 10% (26,27). Despite the low incidence, one of our patients suffered from clinically relevant venous embolism. This patient developed an embolus due to an implanted cool guard catheter in the lower vena cava. This association between intravenous catheters and the occurrence of a thrombus has previously been reported in the literature, showing that femoral catheters significantly increase the risk of a VTE (28).
Intracranial microembolic signals might be a potential risk factor for cognitive impairment
Published in Neurological Research, 2021
Jing Yan, Zhaoxia Li, Melissa Wills, Gary Rajah, Xin Wang, Yaqiu Bai, Pei Dong, Xingquan Zhao
In our retrospective case control study, we found that MES detected in MCA was related to cognitive impairment among patients visiting outpatient clinics for diseases such as stroke, asymptomatic artery stenosis, migraine, and dizziness. The prevalence of MES varies between different diseases. Previous studies suggest that the prevalence of MES is 7% in acute ischemic stroke patients [14], 22.7% in TIA patients [15], 31% in patients with a history of embolic stroke of undetermined source [16], and 87.5% in patients undergoing carotid artery stenting [17]. The prevalence of MES in the whole population was 3.7% (50/1356). One of the reasons for the low MES rate in our study might be that most patients with stroke were not monitored at the early stage (within 72 hours). In addition, most patients have already been on antiplatelet treatment, which may reduce the incidence of emboli. Finally, patients without risk factors of atherosclerosis may be at a low risk of emboli.
Related Knowledge Centers
- Air Embolism
- Amniotic Fluid
- Vascular Occlusion
- Embolus
- Blood Vessel
- Thrombus
- Fat
- Fat Embolism Syndrome
- Amniotic Fluid Embolism
- Hemodynamics