Deep vein thrombosis is the major problem associated with surgical intervention.

Question

Deep vein thrombosis is the major problem associated with surgical intervention. A dislodged thrombus (clot) can migrate through the venous system all the way to the pulmonary circulation and completely obstruct flow to the lungs. Describe in your own words the pathological process associated with this acute condition. In your answer focus on following points: what happens to the afterload, preload, heart rate etc. how is this situation different from a clot in the systemic arteries why is this an emergency situation?

Explanation / Answer

Question-1:

A dislodged thrombus can migrate through the venous system all the way to the pulmonary circulation result in formation of pulmonary embolism, a life-complicated conditions, that need immediate attention. This is leading to low afterload and heart peridcardium may experience ischaemia due to low oxygenated blood supply due to venous thromboembolism. Preload is decreased and heart rate is increased (tachycardia) due to venous thromboembolism finally sudden heart attack. Due to deep vein thrombosis venous stasis occurs and central venous pressure is increased. Pulmonary vascular resistance will be increased which results in the increase in the right ventricular afterload and hypertrophy of the right ventricle (parasternal heave). Loud P2 is heard. Due to the backward heart failure on the right side, JVP (jugular venous pressure) will be increased and left-side heart failure will occur.

Ques-2: This pulmonary embolism is different with that of "embolus" (clot) formed in the systemic arteries, in which mainly arteries supplying to legs or to the extremities are going to swell due to more fluid accumulation finally redness observed. The deep vein thrombosis supplying pulmonary arteries are mainly associated with generation of hypoxia-inducible factor-1 (HIF-1) and early growth response 1 (EGR-1) with dysponea & chest pain.

Ques-3: During emergency, it is crucial to provide immediate oxygen supply to avoid hypoxia followed by anticoagulant therapy & analgesic therapy, if it is essential then "surgery" should be performed for pulmonary thrombectomy

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