1. Thromboembolism

2. THROMBOEMBOLISM



The blocking of blood vessels by particle that has
broken away from the body clot at its site of
formation
The decrease mobility of the heart with cardiac
disease and the impaired circulation that
accompany these disorder contribute to the
development of intracardiac and intravascular
thrombosis.
Intracardiac thrombi are especially common in
patient with atrial fibrillation.

3. Intracardiac thrombi
 Can be detected by an echocardiogram and treated
with anticoagulants,such as heparin and
waffarin(coumadin)
Sign and symptom of thromboembolism
 Tachypnea
 Tachycardia
 Cyanosis
 Fever
 Normal finding from the lung examination

4. DIAGNOSIS:
Echocardiography
 Doppler ultrasonography of venous system
 Chest radiography
 Acid base status: respiratory alkalosis
TREATMENT:
1.Anticoagulant and thrombolytics therapy are
available to prevent further clot deposition and
allows the patients natural fibrinolytics mechanism
to lyse the existing clot include heparin or LMWH
followed by initiation of oral coumadin derivative.


6. PULMONARY EMBOLISM


is a blockage of the main
artery of the lung or one of its
branches by a substance that
has travelled from elsewhere
in the body through the
bloodstream (embolism). PE
most commonly results from
deep vein thrombosis (a
blood clot in the deep veins
of the legs or pelvis) that
breaks off and migrates to the
lung, a process termed
venous thromboembolism
(VTE).
Is the most common
thromboembolic problem
among patient with HF.

7. CLINICAL INDICATORS OF PULMONARY :
EMBOLISM

Dyspnea
 Tachycardia
 Chest pain
 Hemoptylism
 Symptom of deep venous thrombosis
TREATMENT:
1.anticoagulants.heparin works quickly and is usually
delivered with a needle
2.clot dissolved(thrombolytics)

8. DIAGNOSTIC TEST:
Chest x-ray
 Ventilation perfusion lung scan or high resolution
helical computed tomography
A blood D-dimer assay-is helpful to determine
whether fibrolysis of clots is taking place
somewhere in the body.


9. PERICADIAL EFFUSION AND CARDIAC TAMPONADE
Pericadial effusion-(accumulation of fluid in
the
peicadial sac).
normal pericardial sac(20 ml of fluid),which is needed to
decrease friction for the beating heart.
Increase in pericardial fluid raise the pressure within the
pericardial sac and compress the heart. these are the ff.
effect:
 Elevated pressure in all cardiac chamber
 Decrease venous return due to atrial compression
 Inability of the ventricles to distend and fill adequately


11. CLINICAL MANIFESTATION
Increase pressure within pericardium
 Venous tends to pressure to increase
 Shortness of breath and labile or low BP

Pulsus paradoxus
-systolic BP that is markedly lower
during inhalation.
-characterized by an abnormal difference of
at least 10mmhg systolic pressure between
the point that is heard during exhalation and
the point that is heard during inhalation.

12. DIAGNOSTIC TEST
ECG-confirm to diagnosis and quantify the amount
of pericardial fluid
 Chest X-ray-show large pericardial effusion

Medical management
Pericardiocentesis
Puncture of the pericardial sac to aspirate
pericardial fluid.
 Is performed to remove fluid from the pericardial
sac.


14. COMPLICATION
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Coonary artery puncture
Myocardial trauma
Dysrhythmias
Pleual laceration
Gastric puncture

15. PERICARDIOTOMY

Recurrent pericardial effusions,usually associated
with neoplastic disease,may be treated by
pericardiotomy(pericardial window) under
gen.anesthesia,a potion of the pericardium is
excised to permit the exudative pericardial fluid to
drain into the lympathic system