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ICM -- Cardiology > Aortic and Peripheral Vascular Disease > Flashcards

Aortic and Peripheral Vascular Disease Flashcards

1
Q

Risk factors for Aortic dissection

A

Hypertension
Collagen Disorders
Pregnancy
Congenital Heart Defects

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2
Q

Pathophysiology of Aortic Dissection

A

Medial degeneration (loss of smooth muscle/elastic fibers)
Repeated Flexion of the Aorta
Hydrodynamic Stress on the Intima

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3
Q

Which types of Aortic Dissection should be sent straight to surgery

A

DeBakey Type I and II – In the aortic arch

Only do type III if it is compressing a major artery

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4
Q

How does an aortic dissection patient present

A 
Pain -- Tearing, Ripping
Migrating Pain
Vasovagal Symptoms
Syncope
Neurological Defecit
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5
Q

Physical Exam findings in an aortic dissection

A 
Apprehensive, Sense of Impending Doom
Tachycardia
Cool, Clammy Skin
BP Disconnect
Murmur like aortic regurg
Signs of tamponade
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6
Q

Common diognostic tests ordered for aortic dissection

A

Labs (CBC, blood typing, etc.)
ECG
Imaging

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7
Q

Imaging modalities used in an aortic dissection patient?

A

Aortography
CT
Echo/TEE
CXR

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8
Q

How do you treat Type B dissections

A

BP control – Beta Blockers

Surgery if increasing pain, HTN, Major Branch Occlusion

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9
Q

Risk factors for AAA

A

Age over 65
Peripheral Artery Disease
Familial Hypercholesterolemia
Other atrial aneyursms

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10
Q

AAA usually ruptures when bigger than what size

A

5cm

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11
Q

Presentation of an unruptured AAA

A

Abdominal Pain, Back, or Flank Pain
Gradual Onset
Vague/Dull Colicky Pain

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12
Q

Presentation of ruptured AAA

A

Pain
Hypotension
Pulsatile abdominal mass

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13
Q

How to manage AAA

A

Serial ultrasounds until above 4.0 cm or symptomatic

With symptoms or over 4cm, do surgical repair (endovascular or open)

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14
Q

Atherosclerosis risk factors

A

Cigarette smoking
Diabetes
Hypercholesterolemia
HTN

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15
Q

Presentations of PAD

A

Thromboembolic

Symptoms of Claudication

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16
Q

Describe Arterial Insufficiency (Effects of movement, elevation, pulses, compression, overall effect)

A 
Symptoms worse with ambulation
Elevating it makes it worse
Weak/Absent Pulses
Compression worsens it
Lack of oxygenated blood to tissues
17
Q

Describe Venous Insufficiency (Effects of movement, elevation, pulses, compression, overall effect)

A 
Symptoms improve with ambulation
Elevation helps
Normal pulses
Compression helps
Excess of deoxygenated blood pooling in tissues
18
Q

How do you diagnose arterial insufficiency?

A

Segmental Arterial Pressure Study
Ankle Brachial Index
Angiogram

19
Q

What ABI value is considered significant disease

A

Below 0.7

20
Q

When would you treat PAD with surgery?

A

Acute thrombosis
Intractable rest pain from ischemia
Gangrenous limbs

21
Q

Medical therapy for less severe PAD

A

Anti-platelet therapy
Compression therapy
Follow symptoms
Encourage smking cessation

22
Q

Why is there more PVD in superficial veins?

A

Vessels are more fragile, less developed

They lack structural support from superficial tissue

23
Q

Physical findings associated with PVD

A 
Venulectasia/Telangiectasia
Tributary and Small Vessel Disease
Hyperpigmentation
Eczematoid Dermatitis
Atrophie Blanche
Corona Phlebectatica
Stasis Dermatitis
Lipodermatosclerosis
Superficial thrombophlebitis
Stasis Ulceration
24
Q

What is hyperpigmentation in PVD caused by

A

Hemosiderin deposits between the vessel wall and the skin

25
Q

What is eczematoid dermatitis

A

Inflammation adjacent to a bulbous tributaty

26
Q

What is atrophie blanche

A

Inflammation/Scarring leading to plaques of the skin with no pigment

27
Q

What is corona phlebectatica?

A

Red Flare

Precursor to stasis ulceration

28
Q

What is stasis dermatitis

A

Heavy inflammatory changes in the gaiter area bilaterally in a patient with bilateral saphenous reflux

29
Q

What is lipodermatosclerosis

A

Sclerosis Panniculitis
Painful inflammatory lesions that are firm and contracted
Inside of leg caved in, Inflamm calcified

30
Q

What is superficial thrombophlebitis

A

Firm palpable cords over superficial varicies
Overlying Inflammation
Seasonal patterns common

31
Q

Primary causes of varicose veins?

A

Heredity, Hormonal, Pregnancy effects, Gravity

32
Q

Secondary causes of varicose veins?

A

Obesity, Trauma, Gravity, Occupations with prolonged sitting/standing

33
Q

Why are varicose veins a disease

A

They lead to complications from chronic venous hypertension

34
Q

Complications of Vein Disease

A 
Superficial Phlebitis
Deep venous thrombosis
Venous Stasis Demarcation/Ulceration
Bleeding
Chronic Pain
35
Q

How do you evaluate veins?

A

Hand held doppler

Whole leg duplex mapping

36
Q

Virchow’s Triad?

A

Injury
Stasis
Inherited/Acquired Changes

37
Q

When to consider thrombophilia

A 
Young patient with VTE
Recurrent idiopathic or unusual site thrombosis
Family History of VTE
Multiple Miscarriages
Heparin Resistance
Warfarin Induced Skin Necrosis
38
Q

Hereditary causes of thrombophilia

A 
Antithrombin Def
Protein C&S Def
APC/Factor V Leiden Mutation
Prothrombin Mutation
Hyperhomocysteinemia
39
Q

Acquired causes of thrombophilia

A

Anti-PLA Syndrome
HIT
Malignancy

ICM -- Cardiology (9 decks)

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