Download - Embolism 1
-
8/14/2019 Embolism 1
1/33
EMBOLISM
The process of partial or completeobstruction of some part ofcardiovascular system by any masscarried in the circulation.
The transported intravascular mass
detached from its original is calledEMBOLUS.
-
8/14/2019 Embolism 1
2/33
EMBOLISM
-
8/14/2019 Embolism 1
3/33
EMBOLISM
Types:
1. Depending upon the matter: Solid eg: thromboembolism,
atheromatous material, tumor cells. Liquid eg: fat globules, amniotic fluid,
bone marrow. Gaseous eg: air, other gases.
2. Depending upon whether infected or not: Bland- when sterile Septic- when infected
-
8/14/2019 Embolism 1
4/33
EMBOLISM
3. Depending upon source:
Cardiac emboli from left side of
heart. Arterial emboli from systemic
arteries.
Venous emboli eg: pulmonaryarteries
Lymphatic emboli
-
8/14/2019 Embolism 1
5/33
EMBOLISM
4. Depending upon flow of blood:
Paradoxical embolus or crossed
embolus: an embolus which iscarried from the venous circulationto the arterial side or vice versa.
Retrograde embolus: An embolus
which travels against the flow ofblood
-
8/14/2019 Embolism 1
6/33
EMBOLISM
Thromboembolism: detached thrombus or part ofthrombus constitutes common type of embolism.
Arterial (systemic) thromboembolism: Causes within heart(80-85%):These are mural
thrombi in left atrium or left ventricle, vegetationson the mitral or aortic valve, prosthetic heartvalves.
Causes within arteries: emboli developing in relation
to atherosclerotic plaques, aortic aneurysm,pulmonary veins & paradoxical arterial emboli fromsystemic venous circulation.
-
8/14/2019 Embolism 1
7/33
EMBOLISM
Effects of arterial emboli: depends upontheir size, site of dislodgement &adequacy of collateral circulation.
1. Infarction: organ or affected part of
organ spleen, kidneys, brain, intestine.2. Gangrene: following infarction in the
lower limbs.3. Arteritis & mycotic aneurysm: from
bacterial endocarditis.4. Myocardial infarction: following coronary
embolism.5. Sudden death: following coronary
embolism or embolism in middlecerebral artery.
-
8/14/2019 Embolism 1
8/33
EMBOLISM
Venous thromboembolism: may arisefrom following source.
Thrombi in veins of lower legs. Thrombi in pelvic veins.
Thrombi in veins of upper limbs.
Thrombosis in cavernous sinus of thebrain.
Thrombi in right of heart.
-
8/14/2019 Embolism 1
9/33
-
8/14/2019 Embolism 1
10/33
EMBOLISM
Effect of venous embolism isobstruction of pulmonary arterialcirculation.
Pulmonary thromboembolism:
common fatal form of venousthromboembolism in which there isocclusion of pulmonary arterial tree.
-
8/14/2019 Embolism 1
11/33
EMBOLISM
Pulmonary thromboembolism
Etiology: Common in hospitalized or bed-ridden patients.
Thrombi originating from large veins inlower limbs (popliteal, femoral, iliac).
Less common, thrombi in varicosities of
superficial veins of the legs & pelvic veins.
-
8/14/2019 Embolism 1
12/33
EMBOLISM
-
8/14/2019 Embolism 1
13/33
EMBOLISM
Pathogenesis: Thrombi detached fromany of above site producethromboembolism into right side of
heart. If thrombus is large & impacted at thebifurcation of the main pulmonaryartery (saddle embolus) or may be
found in right ventricle or its outflow. Commonly, multiple emboli or a large
embolus may be fragmented intosmaller emboli & impacted in number
of vessels, affecting lower lobes.
-
8/14/2019 Embolism 1
14/33
EMBOLISM
Rarely, paradoxical embolism may occurfrom right heart into left heart throughatrial or ventricular septal defect.
Consequences: Depend on size ofoccluded vessel, number of emboli &cardiovascular status of patient.
Sudden death: Massive pulmonaryembolism. If death delayed thendyspnoea, chest pain & shock.
Acute cor pulmonale: Multiple small
emboli may obstruct- right heart failure.
-
8/14/2019 Embolism 1
15/33
EMBOLISM
Pulmonary infarction: obstruction ofsmall size arteries. Features-
fibrinous pleuritis, haemoptysis &dyspnoea.
Pulmonary hemorrhage: obstructionof terminal branches (end arteries).
Features haemoptysis, dyspnoea,chest pain.
-
8/14/2019 Embolism 1
16/33
EMBOLISM
Resolution: Small pulmonary emboliare resolved by fibrinolytic activity.
Pulmonary HTN, Chr. Cor pulmonale &pulmonary arteriosclerosis: Multiplesmall emboli undergoing healing thanresolution.
-
8/14/2019 Embolism 1
17/33
EMBOLISM
Systemic embolism: Arterial embolismarising from thrombi from diseasedheart, especially left heart.
Diseases of heart: MI RHD Cardiomyopathy Congenital heart disease Infective endocarditis Prosthetic heart valves
-
8/14/2019 Embolism 1
18/33
EMBOLISM
Consequences:
Infarction at the site of lodgment
include in descending order offrequency, lower extremity, brain &internal organs like brain, spleen,kidney, intestines.
-
8/14/2019 Embolism 1
19/33
EMBOLISM
Tumor embolism:
-
8/14/2019 Embolism 1
20/33
EMBOLISM
Fat embolism: Obstruction of arterioles &capillaries by fat globule. Obstructionby adipose tissue fragments is known
as FAT TISSUE EMBOLISM.Causes:
Traumatic :
1. Trauma to bones2. Trauma to soft tissue- laceration of
adipose tissue & in puerperium due toinjury to pelvic fatty tissue.
-
8/14/2019 Embolism 1
21/33
EMBOLISM
Non-traumatic:
1. Extensive burns
2. Diabetes mellitus
3. Fatty liver4. Pancreatitis
5. Sickle cell anemia
6. Decompression sickness7. Inflammation of bones & soft tissue
8. Extrinsic fat & oils introduced intobody
-
8/14/2019 Embolism 1
22/33
EMBOLISM
Pathogenesis:
1. Mechanical theory
2. Emulsion instability theory3. Intravascular coagulation theory
4. Toxic injury theory
-
8/14/2019 Embolism 1
23/33
EMBOLISM
Consequences:
Pulmonary fat embolism:
Systemic fat embolism:
-
8/14/2019 Embolism 1
24/33
EMBOLISM
-
8/14/2019 Embolism 1
25/33
EMBOLISM
Amniotic fluid embolism:
During labour & in immediate post-partum period, the contents of
amniotic fluid may enter the uterineveins & reach right side of heartresulting in fatal complications.
Amniotic fluid embolus: epithelialsquames, vernix caseosa, lanugohair, bile from meconium & mucus.
-
8/14/2019 Embolism 1
26/33
EMBOLISM
Clinical syndrome:
Sudden respiratory distress & dysponea
Deep cyanosis
Cardiovascular shock
Convulsions
Coma
Unexpected death- mechanical blockage,anaphylactoid reaction, DIC,
haemorrhagic manifestations due tothrombocytopenia & afibrinogenaemia.
-
8/14/2019 Embolism 1
27/33
EMBOLISM
Gas embolism: Air, nitrogen & other gasescan produce bubbles within circulation &obstruct the flow.
Air embolism: when air is introduced intoarterial or venous circulation.
Venous air embolism: Causes
1. Operations on head, neck, & trauma.
2. Obstetrical operations & trauma.
3. Intravenous administration of blood &fluid.
4. Angiography.
-
8/14/2019 Embolism 1
28/33
EMBOLISM
Effects depend upon following factors:
1. Amount of air- 100-150 ml fatal
2. Rapidity of entry.
3. Position of patient.4. General condition of patient.
Arterial air embolism:1. Cardiothoracic surgeries.
2. Paradoxical air embolus
3. Arteriography
-
8/14/2019 Embolism 1
29/33
EMBOLISM
Decompression Sickness/Caissons disease/Divers Palsy: Special form of gas embolism.
Pathogenesis: produced when the individualdecompresses suddenly, either from high
atmospheric pressure to normal level, or fromnormal pressure to low atmospheric pressure.
Effects depend upon:
Depth or altitude
Duration of exposure to altered pressure
Rate of ascend or descent
General condition of the individual
-
8/14/2019 Embolism 1
30/33
EMBOLISM
-
8/14/2019 Embolism 1
31/33
EMBOLISM
Clinical Effects:
Acute
1. The bends: patient doubles in bed dueto acute pain in joints, ligaments &tendons.
2. The chokes: due to accumulation of
bubbles in the lungs, resulting in acutepulmonary distress.
3. Cerebral effects: vertigo, coma &sometimes death.
-
8/14/2019 Embolism 1
32/33
EMBOLISM
Chronic
1. Avascular necrosis of bones :eg- headfemur, tibia, humerus.
2. Neurological symptoms : ischaemic necrosisin CNS. Peraesthesias & paraplegia.
3. Lung involvement: haemorrhage, oedema,emphysema & atelactasis. Dyspnoea, non-productive cough & chest pain.
4. Skin manifestation: itching, patchyerythema, cyanosis & oedema
-
8/14/2019 Embolism 1
33/33
EMBOLISM