Arterial Disease and Clinical History

Question 1

What is the cause of chronic peripheral arterial disease?

Answer 1

atherosclerosis

Question 2

What is atherosclerosis?

Answer 2

hardening and thickening of arterial wall (intima and media), eventually forming plaque and stenosis

Question 3

What is another name of atherosclerosis?

Answer 3

arteriosclerosis

Question 4

What are the risk factors of chronic PAD?

Answer 4

• diabetes
• hypertension
• hyperlipidemia
• smoking
• age
• family history
• male gender

Question 5

Out of all the risk factors for chronic PAD, what is the most contributing factor?

Answer 5

smoking

Question 6

What are the symptoms of chronic PAD?

Answer 6

• claudication
• rest pain
• tissue loss/necrosis

Question 7

What is claudication?

Answer 7

• pain and muscle fatigue with activity
• pt must stop to rest
• pain is relieved upon rest

Question 8

What is pseudo-claudication?

Answer 8

• not vascular related (instead it’s MSK or neurogenic)
• pt has similar pain in extremity but without muscle fatigue or needing to stop

Question 9

What is rest pain?

Answer 9

pain in the feet and heels at night in bed or when feet and heels are at same level as heart

Question 10

How do we relieve rest pain?

Answer 10

relieved upon dependency (ex: when they lower the limb such as when they hang the feet over the side of the bed, which causes hydrostatic pressure to increase)

Question 11

What is tissue loss/necrosis?

Answer 11

ulcers and gangrene in most distal part of limb like toes or bony regions like top of feet

Question 12

Rate the severity of chronic PAD symptoms:

Hint: moderate, severe, most severe

Answer 12

• claudication: moderate
• rest pain: severe
• tissue loss/necrosis: most severe

Question 13

What are the physical signs that can be found on patient with chronic PAD?

Answer 13

• trophic changes: dry skin, loss of hair, thick toenails
• pale skin, cool to touch
• ulcers

Question 14

Describe the characteristic of chronic PAD ulcers:

Answer 14

dry, deep, painful, toes, tops of feet

Question 15

What is dependent rubor?

Answer 15

pale when leg is elevated, red when leg is dependent (laid flat)

this indicates SEVERE poor arterial perfusion

Question 16

What is delayed capillary filing?

Answer 16

when there is a >3sec delay to get a flush pink color after pressing on the pulp of the digit

this indicates SEVERE poor arterial perfusion

Question 17

What is a normal capillary blushing (opposite of delayed capillary filling)?

Answer 17

when you push on the pulp of the digit, you might see an initial pale color, but it will flush pink within that 3secs

Question 18

What is a bruit?

Answer 18

sound you can hear (auscultate) when there is a high velocity, turbulent flow

Question 19

Is bruit a conclusive of arterial disease?

Answer 19

No, bruit does not definitely mean they have disease. Absent bruit does not mean they do not have disease.

Question 20

What are the acute arterial occlusions?

Answer 20

• thrombus
• embolism

Question 21

What is a thrombus?

Answer 21

blood clot inside the blood vessel

Question 22

What causes a thrombus?

Answer 22

caused by trauma or dissection

• penetrating trauma (such as gunshot or stabbing) causes dissection
• dissection leads to the thrombosis (formation of blood clot) of vessel

Question 23

What is an embolism?

Answer 23

air, liquid, solid that travels and lodges distally in the smaller vessel

Question 24

What is the most common source of embolism?

Answer 24

the heart

Question 25

What are the risk factors of embolism? Hint: Pt known to have ____ and ____ are at risk of embolism.

Answer 25

- aneurysm (thrombus can break off) - PAD (plaque)

Question 26

What is the syndrome that caused by embolism?

Answer 26

blue toe syndrome (usually big toe)

Question 27

Which part of limb does thrombus affect?

Answer 27

major arteries = whole limb

Question 28

Which part of limb does thrombus affect?

Answer 28

smaller vessels = hands, digits

Question 29

What is cold sensitivity/Raynauds phenomenon?

Answer 29

patient experiences symptoms of ischemia in hands or feet when exposed to cold

Question 30

What are the symptoms of cold sensitivity/Raynauds phenomenon?

Answer 30

blue or white discoloration, pain, tingling, numbness

Question 31

What is primary Raynauds?

Answer 31

pt experiences symptoms of ischemia in hands or feet when exposed to cold primary is when patient doesn't have arterial disease to begin with, they just have true cold sensitivity

Question 32

What characteristic of the patient that is most likely to be diagnosed with primary Raynauds?

Answer 32

young women with bilateral symptoms

Question 33

What happens to the vessels of primary Raynaud patients when undergoing coldness or stressfulness?

Answer 33

vasospasm ( a type of vasoconstriction)

Question 34

Primary Raynauds is what type of disease?

Answer 34

functional disease

Question 35

What is secondary Raynauds?

Answer 35

pt experiences symptoms of ischemia in hands or feet when exposed to cold secondary is when pt already has fixed arterial disease

Question 36

What characteristic of the patient that is most likely to be diagnosed with secondary Raynauds?

Answer 36

older patient who has chronic PAD profile (such as hypertension, diabetes, high cholesterol, smoking)

Question 37

What happens to the vessels of secondary Raynaud patients when undergoing coldness?

Answer 37

vasoconstriction

Question 38

What is arteritis?

Answer 38

inflammation of vessel wall

Question 39

What are the two types of arteritis?

Answer 39

- Takayasu - Buerger's disease

Question 40

What is Takayasu?

Answer 40

inflammation of vessel wall that affects larger vessels such as aorta in young asian women

Question 41

Why is Takayasu also known as "pulseless disease"?

Answer 41

because if a larger vessel is inflamed then it's going to affect all of the pulses distally that's fed by that vessel

Question 42

What is another name for Buerger's disease?

Answer 42

thromboangitis obliterans

Question 43

What is Buerger's disease?

Answer 43

inflammation of vessel wall that affects the smallest most distal vessels (digits) in young men <40yo who are heavy smokers

Question 44

What are the symptoms of Buerger's disease?

Answer 44

rest pain, gangrene, ulcers

Question 45

Why is claudication not part of the symptoms of Buerger's disease?

Answer 45

because the major vessels that are going to the muscles are not affect, only the small vessels in the digits get affected

Question 46

What is the most common arteritis?

Answer 46

Bueger's disease AKA thromboangitis obliterans

Question 47

What is a true aneurysm?

Answer 47

dilatation of all 3 layers of the wall

Question 48

What are different types of true aneurysm?

Answer 48

1) fusiform 2) saccular

Question 49

What are the symptoms of aneurysm?

Answer 49

- bounding pulse (strong pulse) - abdominal/back pain (if that is AAA)

Question 50

What is the most common location of an aneurysm?

Answer 50

infrarenal aorta

Question 51

What is the most common cause of aneurysm?

Answer 51

atherosclerosis

Question 52

What is the most common type of aneurysm?

Answer 52

fusiform

Question 53

What is the most likely complication of AAA?

Answer 53

rupture (especially when aneurysm is >5cm)

Question 54

What is the most likely complication of a peripheral aneurysm?

Answer 54

embolization (of a little piece of clot that forms inside of the aneurysm)

Question 55

What is a false aneurysm?

Answer 55

when all the 3 layers are not dilated (a tear of one of the layers)

Question 56

What causes false aneurysm?

Answer 56

weakening of layers causing intimal flap or tear

Question 57

What happens during false aneurysm that is very dangerous?

Answer 57

- flow goes into both "lumens" - very dangerous because it has high risk of rupture

Question 58

False aneurysm is most often found in what location and what type of patient?

Answer 58

thoracic aorta in hypertensive pt with severe back/chest pain

Question 59

What is a pseudoaneurysm?

Answer 59

puncture of all 3 layers

Question 60

What causes pseudoaneurysm?

Answer 60

most often post procedure such as catheterization or angiogram

Question 61

What happens when patient has pseudoaneurysm?

Answer 61

the blood flow escapes the artery, swirls around in a pocket, and then goes back into the artery

Question 62

How to confirm pseudoaneurysm on ultrasound?

Answer 62

must have communicating neck or channel (yin-yang sign)

Question 63

What is coarctation?

Answer 63

- congenital narrowing of aortic arch - diminished pulses and hypertension in younger people

Question 64

What is popliteal entrapment?

Answer 64

compression of popliteal artery by gastrocnemius muscle (calf muscle)

Question 65

Popliteal entrapment is found in which type of patient?

Answer 65

younger athletic men experiencing intermittent claudication

Question 66

What is thoracic outlet syndrome?

Answer 66

compression of nerves or blood vessels by shoulder, ribs, and muscles

Question 67

What is compartment syndrome?

Answer 67

compression of artery by swelling trapped inside fascia layers

Question 68

What is the most common region in the body that has compartment syndrome?

Answer 68

anterior tibial region