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Cardiovascular Week 4 2016/17 > 5: Peripheral vascular disease > Flashcards

5: Peripheral vascular disease Flashcards

1
Q

What is chronic lower limb ischaemia?

A

Lack of blood reaching the tissues of the lower limb (inadequate perfusion)

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2
Q

What causes ischaemia?

A

Arterial obstruction due to atheroma

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3
Q

What are four modifiable risk factors which contribute towards endothelial cell damage?

A

Cigarette smoke
Hypertension
Increased conc. glucose (diabetes)
Increased conc. cholesterol

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4
Q

Plaque formation is due to activated ___, __ cholesterol and the ___ response.

A

platelets , LDL , inflammatory

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5
Q

Which kind of cholesterol is taken up by macrophages during plaque formation?

A

Oxidised LDL

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6
Q

What kind of peripheral vascular disease is obvious to spot in a patient?

A

Intermittent claudication

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7
Q

What are two kinds of vascular disease which are more difficult to spot in patients?

A

Coronary artery disease

Cerebrovascular disease

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8
Q

What is claudication?

A

Muscle ischaemia ON EXERCISE

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9
Q

Why may claudication be described as intermittent?

A

Only occurs on exertion when oxygen demand of muscle increases

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10
Q

Collateral arteries can deliver (more / less) blood than the obstructed artery itself.

A

less

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11
Q

Obstruction can be detected by taking a patient’s __ __ pressure index.

A

Ankle brachial pressure index

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12
Q

How is ABPI calculated?

A

Ankle pressure (mm Hg) / brachial pressure (mm Hg)

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13
Q

Are ABPI measurements systolic or diastolic?

A

Systolic

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14
Q

What else is considered apart from the ABPI when trying to figure out the occlusion of an artery?

A

Tone & pitch of the sound on auscultation

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15
Q

What tool can be used to look at the narrowing of an individual blood vessel?

A

Ultrasound

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16
Q

What lifestyle change slows the progression of lower limb ischaemia?

A

Stopping smoking

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17
Q

How often should patients with intermittent claudication exercise?

A

30 mins 3x per week (into pain)

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18
Q

Apart from exercise, the second most effective way of treating intermittent claudication is prescribing ___ drugs.

A

anti-cholesterol

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19
Q

Which surgical methods can be used to treat blocked arteries?

A

Angioplasty +/- stent

Inflow / outflow bypasses (look these up)

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20
Q

Where would pain be felt in a patient with critical limb ischaemia?

A

Toe/foot

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21
Q

When is critical limb ischaemia pain felt?

A

At rest:

  • lying down
  • sleeping
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22
Q

What may occur in the feet of people with critical limb ischaemia?

A

Ulcers, gangrene

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23
Q

Why do people with critical limb ischaemia develop severe damage (ulcers, gangrene) when they damage their feet (trauma, poor fitting footwear)?

A

Lack of blood supply –> lack of proper healing

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24
Q

What alleviates the pain at rest associated with critical limb ischaemia?

A

Getting up and walking about, moving the leg

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25
Q

What should you look out for on examination of the foot of a patient with critical limb ischaemia?

A 
Cold
Absence of peripheral pulses
Colour change
Hairless, thick nails, shiny
Venous guttering
Ulcers, gangrene
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26
Q

Why would a lower limb be amputated?

A

If critical limb ischaemia was threatening the patient’s life

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27
Q

What influences the level at which a patient’s limb should be amputated?

A

Healing abilities of the limb

Function of the limb

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28
Q

What is an aneurysm?

A

Dilation of a vessel by >50% of its normal diameter

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29
Q

What is a true aneurysm?

A

An aneurysm where the vessel wall is intact

30
Q

What is a false aneurysm?

A

Breach in vessel walls (ballooning)

31
Q

Name three further types of aneurysm.

A

Saccular (ballooning)
Fusiform
Mycotic (secondary to infection, involves all 3 layers of arterial wall)

32
Q

Which layer of the blood vessel is affected in AAAs?

A

Tunic media

33
Q

The occurrence of abdominal aortic aneurysm increases with __.

A

age

34
Q

You are more likely to have a AAA if you are (male / female).

A

male

35
Q

75% of AAAs are (symptomatic/asymptomatic).

A

asymptomatic

36
Q

If a AAA is symptomatic in a patient, what would they experience?

A
  1. Pain - may mimic renal colic
  2. “Trashing” - thrombi breaking off from AAA and blocking arteries in legs
  3. RUPTURE
37
Q

What is the presentation of an AAA rupture?

A

Sudden onset epigastic / central pain
Radiates through to back
Collapse

38
Q

What would a ruptured AAA appear like on examination?

A

Pulsatile, expansive mass - may/may not be tender
Transmitted pulse
Peripheral pulses

39
Q

What may contain the rupture of an AAA?

A

Peritoneum (contained if rupture is RETROPERITONEAL)

If rupture is INTRAperitoneal you will probs die

40
Q

What may contain the rupture of an AAA?

A

Peritoneum (contained if rupture is RETROPERITONEAL)

If rupture is INTRAperitoneal you will probs die

41
Q

Generally, the greater the size of the aneurysm, the more likely it is to __ and the more important it is to __.

A

rupture , intervene

42
Q

What imaging tool can be used to look at the AP diameter of possible asymptomatic aneurysms?

A

Duplex ultrasound

43
Q

Which imaging method involves giving the patient contrast and looking at the aneurysm’s morphology - shape, size, iliac involvement.

A

CT scan

44
Q

A CT scan allows you to decide whether or not an AAA has ___.

A

ruptured

45
Q

What name is given to the procedure which opens up a patient’s abdomen?

A

Laparotomy

46
Q

Which polyester can be grafted onto the AA to repair a rupture?

A

Dacron

47
Q

What procedure uses a stent graft to bypass the ruptured AA?

A

Endovascular aneurysm repair

48
Q

What predisposes you to an AAA?

A

Smoking, hypertension

49
Q

Important in treating limb ischaemia is distinguishing ___ from __-on-__ ischaemia.

A

acute , acute-on-chronic

50
Q

What are some causes of sudden occlusion of an artery?

A 
Embolism
Atheroembolism
Arterial dissection
Trauma
Compression
51
Q

What are some causes of sudden occlusion of an artery?

A 
Embolism
Atheroembolism
Arterial dissection
Trauma
Compression
52
Q

What are the clinical features of acute limb ischaemia?

A 
Pain
Pallor (pale)
Pulseless
Cold
Paraesthesia (pins and needles)
Paralysis
53
Q

What is a likely cause of acute limb ischaemia?

A

Embolism

54
Q

Acute ischaemic pain is often resistant to ___.

A

analgesia

55
Q

“Woody” feel of the muscle compartment indicates ___ ischaemia and muscle ___.

A

irreversible , death

56
Q

If mottling of the skin (blue/purple) DOESN’T disappear with pressure, thrombus has spread distally and the ischaemia is ___.

A

irreversible

57
Q

Ischaemia is irreversible beyond __ hours.

A

12

58
Q

Malignancy makes you (pro/anti) thrombotic.

A

pro-thrombotic

59
Q

Troponin levels are used to differentiate between ___ and __.

A

angina , MI

60
Q

Diabetic foot problems encompass…

A
  1. Diabetic neuropathy
  2. Peripheral vascular disease
  3. Infection
61
Q

Diabetic foot problems often end in ___.

A

amputation

62
Q

Diabetic foot problems often end in ___.

A

amputation

63
Q

How may infection be introduced to a diabetic person’s foot, leading to diabetic foot sepsis?

A
  1. Small puncture wound
  2. Nail infection
  3. Ulcers
64
Q

Infection reaches the __ compartments of the foot.

A

muscle

65
Q

Build up of what, associated with infection, increases pressure in foot muscle compartments and loss of capillary blood flow?

A

Pus

66
Q

Build up of what, associated with infection, increases pressure in foot muscle compartments and loss of capillary blood flow?

A

Pus

67
Q

Diabetic foot sepsis is a vascular surgical __.

A

emergency

68
Q

What would a patient with diabetic foot sepsis look like at first glance?

A 
Pyrexia
Tachycardic
Tachypnoeic
Confused
Kussmaul's breathing
69
Q

What are some local findings associated with diabetic foot sepsis?

A 
Swollen
Tender
Ulcer with pus extruding
Erythema
Patchy necrosis
Crepitus (gas in the small tissues, produced by organisms)
70
Q

What is the normal diameter of the aorta?

A

1.2 - 2.0cm

Cardiovascular Week 4 2016/17 (7 decks)

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