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Common Congenital Heart Lesions - page 109 / 126

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Acute Arterial Occlusion (AAO) Clinical Presentation:

  • Symptoms are related to reduced blood supply to tissues and are known as the “five P’s”:

    • o

      Pain

      • o

        Pallor

      • o

        Paralysis

      • o

        Paresthesia

      • o

        Pulselessness

  • A sixth “P” is sometimes present:

      • o

        Poikilothermia (coolness)

Etiology:

  • AAO has two possible causes:

    • 1.

      Embolization from a cardiac or vascular site

    • 2.

      Thrombus formation in situ

  • The origins of arterial emboli are:

Cardiac Origin

Aortic origin

From stagnant LA flow (like in atrial fibrillation, mitral stenosis)

From thrombus material overlying an atherosclerotic segment

Venous origin From a paradoxical embolism, that travels through an abnormal intracardiac shunt (e.g. an ASD)

From LV mural thrombus (e.g. dilated cardiomyopathy, MI, ventricular aneurysm) From valvular lesions (endocarditis, mitral stenosis, thrombus on prosthetic valve) From LA myxoma (a mobile tumor in the LA)

  • Thrombus formation in the arteries may appear at sites of endothelial damage, atherosclerotic stenoses, or within

bypass grafts.

Pathophysiology:

  • Extent of tissue damage from thromboembolism in AAO relates to:

    • o

      site of occluded artery

      • o

        degree of collateral circulation serving the tissue distal to the obstruction.

Treatment:

  • Anticoagulation

    • o

      Often heparin – to prevent propagation of the clot and reduce likelihood of additional emboli.

  • Intra-arterial thrombolysis

      • o

        Can use tissue plasminogen activator (TPA) to eliminate acute thrombi

  • Catheter-based thrombectomy

      • o

        Also used to eliminate acute thrombi

  • Surgery (removal of the thrombus or arterial bypass)

      • o

        Done only to improve severely compromised blood flow

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