2. Arterial and Venous Disease

Question 1

Orthostatic hypotension causes

Answer 1

Neurogenic:
MOST COMMON = Age
Baro receptor dysfunction
SNS degeneration (diabetes)

Non-neurogenic:
Dehydration
Medications

Often idiopathic (40%)

Question 2

Orthostatic hypotension risk factors

Answer 2

Age

Diabetes

Question 3

Orthostatic hypotension symptoms

Answer 3

Syncope

Coat-hanger headache

Dizziness/light headedness

Visual changes

Question 4

Orthostatic hypotension signs

Answer 4

BP drop of 20 systolic OR 10 diastolic upon standing

Question 5

Orthostatic hypotension diagnosis

Answer 5

Take BP after supine for 5 minutes

Take BP again on standing

(CBC = increased Hct if dehydrated)

Question 6

Orthostatic hypotension treatment

Answer 6

Discontinue med causing the condition

Give fludrocortisone

Salt water

Compression stockings

Question 7

What is the most common cause of syncope?

Answer 7

Vasovagal hypotension

Question 8

Vasovagal hypotension cause

Answer 8

Acute trigger (exertion, pain, heat etc.)

Sympathetic activation -> Parasympathetic overcompensation -> vasodilation + bradycardia -> syncope

Question 9

Vasovagal prevention

Answer 9

Avoid triggers

Salt water

Compression

Counter pressure maneuvers

Question 10

Compare and contrast orthostatic and vasovagal hypotension

Answer 10

Orsthostatic:
Older
Chronic
Trigger = standing

Vasovagal:
Younger
Spontaneous
Triggers = stress, pain, heat

Question 11

Prinzmetal/vasospastic angina cause

Answer 11

Middle layer of coronary artery spasms causing obstruction -> angina

Question 12

Prinzmetal/vasospastic angina risk factors

Answer 12

SMOKING

Genetics, insulin resistance, cocaine

Question 13

Prinzmetal/vasospastic angina symptoms

Answer 13

Angina at rest (midnight to early am)

Episodes 5-15 minutes

Occurs without exertion

Question 14

Prinzmetal/vasospastic diagnostics

Answer 14

Diagnosis of exclusion

EKG and stress tests normal

Question 15

Prinzmetal/vasospastic treatment

Answer 15

STOP SMOKING

Nitros PRN

Calcium channel blocker

Question 16

Prinzmetal/vasospastic angina drugs to AVOID

Answer 16

Vasoconstrictors:
Non-selective BBs (propranolol)
Aspirin
5-fluoruracil
Triptans

Question 17

Varicose veins cause

Answer 17

Visibly dilated, tortuous veins permit reverse flow

Valve incompetence (increased age, decreased collagen)

Obstruction or clot

Immobility, loss of muscle pump

Question 18

Varicose veins risk factors

Answer 18

AGE

Female, pregnant

Family history

Obesity

Immobility

Prolonged standing

Question 19

Varicose veins

Answer 19

Visible veins

Ache/swelling/heavy leg

Question 20

Varicose veins signs

Answer 20

Just look at them

Ultrasound to guide treatment

Question 21

Varicose veins treatment

Answer 21

Elevate, exercise, compress

Refractory = ablation

Question 22

Thrombophlebitis cause

Answer 22

Inflammation of vein due to clot

Question 23

Thrombophlebitis risk factors

Answer 23

Varicose veins

Venous stasis

IV therapy/drug use

Malignancy

Question 24

Thrombophlebitis symptoms

Answer 24

Tender, firm, red along a vein path

Question 25

Thrombophlebitis signs

Answer 25

Linear redness (cellulitis = spread the red)

Harder to see in obese

Question 26

Thrombophlebitis diagnostics

Answer 26

Perform ultrasound if clot suspected (lots of swelling)

Proximity of clot to femoral vein = worry about PE

Watch for progression

Question 27

Thrombophlebitis treatment

Answer 27

Elevate, compress for comfort

Re-examine at 7-10 days

If ultrasound finds clot = anticoagulants