2. Arterial and Venous Disease Flashcards
Orthostatic hypotension causes
Neurogenic:
MOST COMMON = Age
Baro receptor dysfunction
SNS degeneration (diabetes)
Non-neurogenic:
Dehydration
Medications
Often idiopathic (40%)
Orthostatic hypotension risk factors
Age
Diabetes
Orthostatic hypotension symptoms
Syncope
Coat-hanger headache
Dizziness/light headedness
Visual changes
Orthostatic hypotension signs
BP drop of 20 systolic OR 10 diastolic upon standing
Orthostatic hypotension diagnosis
Take BP after supine for 5 minutes
Take BP again on standing
(CBC = increased Hct if dehydrated)
Orthostatic hypotension treatment
Discontinue med causing the condition
Give fludrocortisone
Salt water
Compression stockings
What is the most common cause of syncope?
Vasovagal hypotension
Vasovagal hypotension cause
Acute trigger (exertion, pain, heat etc.)
Sympathetic activation -> Parasympathetic overcompensation -> vasodilation + bradycardia -> syncope
Vasovagal prevention
Avoid triggers
Salt water
Compression
Counter pressure maneuvers
Compare and contrast orthostatic and vasovagal hypotension
Orsthostatic:
Older
Chronic
Trigger = standing
Vasovagal:
Younger
Spontaneous
Triggers = stress, pain, heat
Prinzmetal/vasospastic angina cause
Middle layer of coronary artery spasms causing obstruction -> angina
Prinzmetal/vasospastic angina risk factors
SMOKING
Genetics, insulin resistance, cocaine
Prinzmetal/vasospastic angina symptoms
Angina at rest (midnight to early am)
Episodes 5-15 minutes
Occurs without exertion
Prinzmetal/vasospastic diagnostics
Diagnosis of exclusion
EKG and stress tests normal
Prinzmetal/vasospastic treatment
STOP SMOKING
Nitros PRN
Calcium channel blocker
Prinzmetal/vasospastic angina drugs to AVOID
Vasoconstrictors:
Non-selective BBs (propranolol)
Aspirin
5-fluoruracil
Triptans
Varicose veins cause
Visibly dilated, tortuous veins permit reverse flow
Valve incompetence (increased age, decreased collagen)
Obstruction or clot
Immobility, loss of muscle pump
Varicose veins risk factors
AGE
Female, pregnant
Family history
Obesity
Immobility
Prolonged standing
Varicose veins
Visible veins
Ache/swelling/heavy leg
Varicose veins signs
Just look at them
Ultrasound to guide treatment
Varicose veins treatment
Elevate, exercise, compress
Refractory = ablation
Thrombophlebitis cause
Inflammation of vein due to clot
Thrombophlebitis risk factors
Varicose veins
Venous stasis
IV therapy/drug use
Malignancy
Thrombophlebitis symptoms
Tender, firm, red along a vein path
Thrombophlebitis signs
Linear redness (cellulitis = spread the red)
Harder to see in obese
Thrombophlebitis diagnostics
Perform ultrasound if clot suspected (lots of swelling)
Proximity of clot to femoral vein = worry about PE
Watch for progression
Thrombophlebitis treatment
Elevate, compress for comfort
Re-examine at 7-10 days
If ultrasound finds clot = anticoagulants
