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This Concept Map, created with IHMC CmapTools, has information related to: Hershel Greene, Hershel Greene, 65 y/o man c/o of SOB, anxiety, & CP Blood tests and imaging were significant for the following: Special Tests: PF4-Heparin ELISA - Positive Serotonin-release assasy - Positive 4T Score - 7 EKG - Sinus Tachycardia Chest X-Ray - Unremarkable US - Abnormal blood flow D-Dimer - Negative, Antithrombin (AT) AT inactivates thrombin within the coagulation cascade Thrombin, Platelets Platelets bind vWF is response to endothelial trauma, connecting it to subendothelial collagen Endothelium, Fibrinogen Thrombin converts Fibrinogen to Fibrin in the final step of the coagulation cascade Fibrin, Thrombosis both venous and arterial thrombi tend to propagate towards the heart and may cause an area of infarction Myocardial infarction, Heparin Heparin has a positive charge, PF4 has a negative charge, and they may bind to become a complex PF4, Tissue Factor tissue factor can activate factor VII within the clotting cascade Factor VII, IgG IgG-PF4-Heparin complex bind to Fc on platelets and triggers thrombosis Thrombosis, Warfarin warfarin acts as a VKOR1C vitamin K antagonist. It is not recommended if there are acute issues since it takes days for the full anti-thrombotic effects to decrease coagulation cascade factors and proteins Vitamin K, Extrinsic pathway Both the intrinsic and extrinsic pathways are needed to synthesize Factor Xa within the coagulation cascade, which ultimately results in the sysnthesis of fibrin. Fibrin, Fibrinogen Thrombin converts Fibrinogen to Fibrin in the final step of the coagulation cascade Thrombin, Heparin Induced Thrombocytopenia (HIT) HIT can present with fatigue, changes in heartrate, and skin symptoms like purpura, which the pt has over his arms and legs. Fatigue, PF4 ELISA Serotonin, a platelet dense granule, is released by activated platelets, causing vasoconstriction. Serotonin release assay, CBC Findings: - WBC 7,000 cells/mcL - Hgb 10 grams/dL Hematocrit: 30% Platelets: 90,000 / mcl Thrombocytopenia is seen when platelet count is less than 150,000/ucl Platelets, Plasmin Plasmin dissolves fibrin in blood clots Fibrin, Myocardial infarction workup for cardiac complaints often includes an electrocardiogram which may reveal abnormal rhythms and/or signs of blockage EKG, Special Tests: PF4-Heparin ELISA - Positive Serotonin-release assasy - Positive 4T Score - 7 EKG - Sinus Tachycardia Chest X-Ray - Unremarkable US - Abnormal blood flow D-Dimer - Negative D-Dimer is a major product of fibrinolysis. A negative test suggests that there wasn't recent intravascular coagulation. However, this test is non-specific. D-Dimer test, Myocardial infarction may result from a mural thrombi from the heart chambers or aortic lumen Thrombosis, CBC Findings: - WBC 7,000 cells/mcL - Hgb 10 grams/dL Hematocrit: 30% Platelets: 90,000 / mcl Both Hgb and Hct are low within this pt, suggesting anemia. Hemoglobin, Heparin Heparin inhibits coagulation factors IIa, IXa, Xa, XIIa and increase PTT Partial thromboplastin time (PTT)