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  • thromboembolism

    1. 1. Thromboembolism
    2. 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. 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. 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. 
    5. 5. 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.
    6. 6. 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)
    7. 7. 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. 
    8. 8. 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 
    9. 9. 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.
    10. 10. 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. 
    11. 11. COMPLICATION      Coonary artery puncture Myocardial trauma Dysrhythmias Pleual laceration Gastric puncture
    12. 12. 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