8. Cardiac and Vascular Disease Flashcards
What disease causes false lumen and which layers of the aorta are affected
Aortic dissection. Tearing of intima and blood rushes into media
What are diseases that can cause aortic dissection
Diseases that can weaken wall like:
Marfan/ CTD
Previous aneurysm
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Abnormal haemodynamics like hypertension or bicuspid Aortic Valve
Sx of acute aortic dissection and how does it vary based on the type
Sudden onset chest pain that radiates to back or abdomen
Type A- ascending aorta, most commonly above the sinotubular junction above the root. Can affect brachiocephalic, carotids, subclavian arteries and even coronary artery
Syncope or focal neurological Sx.
Type B- Descending aorta. Can go down and affect coeliac, renal vessels. Hence will have flank or abd pain with renal fx being affected
When may aortic dissection lead to:
- Heart failure
- MI
-Cardiac tamponade - Aortic valve
- CA (often RCA)
- Pericardium may fully rupture and bleed
What does lower extremity pain, pulselessness and weakness suggest in aortic dissection
What does upper extremiry pulselessness and hypotension pain mean
Common iliac artery
Subclavian artery
What does it mean if stroke or syncope results from aortic dissection
Brachiocephalic, common carotid or left subclavian arteries are addected
Examples include right sided weakness- due to brachiocephalic and left carotid
What Ix should be done for acute aortic dissection. What is definitive imaging What is useful for excluding dissection
CT angio of aorta - Many pts commonly referred for query PE. Redo fully auto scan to see where dissection is coming from and how much of vasc tree it is affecting
ECG to exclude STEMI, CXR may show widened mediastinum, suggests expansion of aorta. D-dimer can exclude if low. High D-dimer can be heart attack, PE, aortic dissection or pneumonia etc.
Do troponin and cross match also.
Mx of acute aortic dissection. Which is more urgent
Type A- Needs urgent surgery. BP control and stabilsation before sending for surgery
Ensure good IV access and take bloods for group and safe
Type B- Endovascular or open repair if high risk factors for impending rupture, conservative Mx like IV BB for strict BP control
Risk factors for Aortic Dissection
History of Marfan, FHX, Hypertension esp in younger pts, Bicuspid aortic valve
Which layer does the fatty deposit deposit under
Subendothelial layer
Risk factors for PVD
Smoking
Advancing age
High cholesterol
Obesity
DM
CKD
What is collateralisationn
Tissue becomes starved of blood as vessel narrows and releases GF that promotes angiogenesis- physio response to hypoxia, collateral vessels
Sx of PVD
Intermittenr claudication, comes back when pt walks
Critical limb ischaemia- sunset red foot - buerger’s test (Pt lies flat on bed and leg lifted to 45 deg. Colour goes pale)
Rest pain is relieved by hanging foot esp out of bed at night
Gangrene or ulcers
Infection or pus
What is one index that can be used to measure PVD severity
ABPI - ankle pressure/brachial pressure
Severe pressure esp in pts with ESKD or diabetes (>1.2, due to incompressible vessels), or < 0.5 due to critical limb ischaemia
How to feel for pulses for PVD
Aortic pulse when Pt is lying flat, btw umbillicus and xiphysternum.
Femoral pulse on the groin behind skin crease, pt lying flat
Popliteal pulse behind the knee, with knee slightly flexed
Dorsalis pedis pulse on the dorsum between 1st and 2nd metatarsals, posterior tibial pulse behind middle malleolus, halfway between bony prominence and heel
Posterior tibial pulse - behind middle malleolus, halfway between prominence and heel
What does it mean if only this pulse is felt but all other pulses are diminished
- aortic pulse
- femoral pulse
Problem is with
- common iliac artery
- Superficial femoral artery ( femoral pulse is felt on common femoral
Difference between CT Angio and MR angio for imaging in PVD
CT better for calc, MR better for gym
What would doppler US show for vessel stenosis
Doppler can show bloodflow through vessel, if stenosis, velocity will go up but volume goes down
Mx for PVD
Stop smoking
Antiplatelet agent - aspirin or clopi
Statin
BP control
DM control
Role of calf compression in PVD
DON’T DO ITTTTTTTTTTTTTTTTTTTTTTTTTTTTTT- may precipitate critical limb ischaemia
Feel pedal pulse to exclude PVD
Fx of critical limb ischaemia
Features should include 1 or more of:
rest pain in foot for more than 2 weeks
ulceration
gangrene
Surgical treatment for PVD
Angiogram and PC balloon angioplasty or stent
Or endarterectomy- expose groin and remove atherosclerotic plaque. Usually performed in the common femoral artery with small blockages
Bypass surgery - bypass occlusion to get blood into the femoral artery
Major limb amputation- only above knee for aorto-iliac segment occlusions
What is an aneurysm
Focal dilated artery 1.5x the normal diameter (>3cm for abdominal aortic aneurysm)
Diseases that predispose to aneurysms
CTD and degenrative disease
