3. Vascular Disease Flashcards
Three divisions of peripheral vascular disease?
Acute limb ischaemia - sudden decrease in limb perfusion
Critical limb ischaemia - pain at rest
Intermittent ischaemia - pain on exertion
All start as atherosclerosis causing stenosis
Symptoms of acute limb ischaemia?
Pain Pale Pulseless Paralysis Parasthesia Perishingly cold
Symptoms of critical limb ischaemia and claudication?
Hair loss Numbness Brittle, slow growing toe nails Absent pulses Ulcers Atrophic skin
Often asymptomatic - remember claudication is only on movement
What is beurger’s test?
Raise foot 45 degree, leg should stay same colour.
If develops pallor then PVD suspected.
less than 20 degrees is severe limb ischaemia.
If you swing the leg back down and it goes red, this is hyperemia.
Vascular disease investigation?
- Cardio exam - BP, HR, bloods, ECG
- Ankle brachial pressure index - gold diagnostic - take bp in arm and leg and divided leg by arm, it should be 0.9-1.2. if lower, abnormal. <0.5 is chronic
- Colour duplex USS
- Magnetic resonance angiogram
Three types of ulcers?
Arterial
Venous
Neuropathic
Arterial ulcer symptoms?
Punched out appearance, deep Distal Well defined Pale base - grey Hair loss, shiny and pale skin around Calf muscle wasting - no blood supply Absent pulses
Venous ulcer signs?
Large shallow, sloping and poorly defined
More proximal
Swelling, itching or aching
May be associated with - stasis eczema, lipodermatosclerosis (upside down champagne bottle), atrophie blanche (area of white, atrophied skin), hemosiderin depositation (darkened areas)
Investigating arterial and venous ulcers?
Duplex USS of lower limbs.
ABPI
Venous - swab for micro, biopsy
Arterial - ECG, perc angio, bloods.
How to manage venous ulcers?
Compression stockings
Debridement and cleaning
Antibiotics if infected
Moisturising
What is a true and false aneurysm?
True - where all three layers of blood vessels are incorporated
False - only one layer, creates a pouch
Unruptured AAA symptoms?
Asymptomatic
Often incidentally
Pulsatile, laterally expansile mass
Abdo bruit
Ruptured AAA symptoms?
Sudden, severe pain in back, groin or abdo Syncope Shock Pulsatile, laterally expansile mass Abdo bruit Grey-Tuner's sign (bruising on flanks)
AAA investigations?
Bloods (incl. cross match)
Abdominal ultrasound (gold standard) to detect pressure and see how wide (wider than 3cm)
CT angiogram to see if rupture (gold for rupture)
Magnetic angiogram if renal impairment.
Diff of aortic dissection?
Type A (most common) always incldudes ascending aorta - type 1 - before and after aortic arch type 2 - is only ascending aorta Type B - Type 3, only descending aorta
Aortic dissection (false aneurysm that is above the diaphragm)
Aortic dissection symptoms and signs?
Tearing pain down chest and radiating to back Blackout and dysphagia - from carotid Angina - coronary Loss of consciousness - subclavian Renal failure - renal artery
HTN BP difference between arch of more than 50% Murmur heard on back Signs of aortic regurg OR Signs of connective tissue disorder
Aortic dissection investigation?
Bloods (risk factors)
ECG (causes)
CXR (aortic knuckle, widened mediastinum, globular heart)
CT angiogram (gold standard)
What are varicose veins?
Subcutaneous, permanently dilated veins more than 3mm in diameter standing.
Causes of varicose veins?
Primary - idiopathic Secondary - 1. Venous outflow obstruction - pregnancy, ascites, pelvic malignancy, ovarian insufficiency (??) DVT AV malformation
Varicose veins symptoms?
Visible dilation
Leg itching with prolonged standing
Swelling and itching
Bleeding
Signs of varicose veins?
Veins feel tender or hard
Tap test - tap distally and feel thrill at sapheno-femoral junction
Auscultation for bruits
Trendelenburg test (tourniquet above knee whilst leg in air, rapid filling when taking off)
Investigations for varicose veins?
Duplex USS (gold standard) DVT assessment
Manage varicose veins?
Compression stockings Lifestyle changes Radiofrequency ablation Endovenous laser ablation Microinjection sclerotherapy Stripping long saphenous vein Saphenofemoral ligation Avulsion of varicosities
What is gangrene?
Tissue necrosis causes by ischaemia, infarction or trauma
