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RVT > Arterial Disease and Clinical History > Flashcards

Arterial Disease and Clinical History Flashcards

1
Q

What is the cause of chronic peripheral arterial disease?

A

atherosclerosis

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2
Q

What is atherosclerosis?

A

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

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3
Q

What is another name of atherosclerosis?

A

arteriosclerosis

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4
Q

What are the risk factors of chronic PAD?

A
  • diabetes
  • hypertension
  • hyperlipidemia
  • smoking
  • age
  • family history
  • male gender
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5
Q

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

A

smoking

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6
Q

What are the symptoms of chronic PAD?

A
  • claudication
  • rest pain
  • tissue loss/necrosis
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7
Q

What is claudication?

A
  • pain and muscle fatigue with activity
  • pt must stop to rest
  • pain is relieved upon rest
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8
Q

What is pseudo-claudication?

A
  • not vascular related (instead it’s MSK or neurogenic)
  • pt has similar pain in extremity but without muscle fatigue or needing to stop
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9
Q

What is rest pain?

A

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

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10
Q

How do we relieve rest pain?

A

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)

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11
Q

What is tissue loss/necrosis?

A

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

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12
Q

Rate the severity of chronic PAD symptoms:

Hint: moderate, severe, most severe

A
  • claudication: moderate
  • rest pain: severe
  • tissue loss/necrosis: most severe
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13
Q

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

A
  • trophic changes: dry skin, loss of hair, thick toenails
  • pale skin, cool to touch
  • ulcers
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14
Q

Describe the characteristic of chronic PAD ulcers:

A

dry, deep, painful, toes, tops of feet

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15
Q

What is dependent rubor?

A

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

this indicates SEVERE poor arterial perfusion

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16
Q

What is delayed capillary filing?

A

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

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17
Q

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

A

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

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18
Q

What is a bruit?

A

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

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19
Q

Is bruit a conclusive of arterial disease?

A

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

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20
Q

What are the acute arterial occlusions?

A
  • thrombus
  • embolism
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21
Q

What is a thrombus?

A

blood clot inside the blood vessel

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22
Q

What causes a thrombus?

A

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
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23
Q

What is an embolism?

A

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

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24
Q

What is the most common source of embolism?

A

the heart

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25
Q

What are the risk factors of embolism?

Hint: Pt known to have ____ and ____ are at risk of embolism.

A
  • aneurysm (thrombus can break off)
  • PAD (plaque)
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26
Q

What is the syndrome that caused by embolism?

A

blue toe syndrome (usually big toe)

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27
Q

Which part of limb does thrombus affect?

A

major arteries = whole limb

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28
Q

Which part of limb does thrombus affect?

A

smaller vessels = hands, digits

29
Q

What is cold sensitivity/Raynauds phenomenon?

A

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

30
Q

What are the symptoms of cold sensitivity/Raynauds phenomenon?

A

blue or white discoloration, pain, tingling, numbness

31
Q

What is primary Raynauds?

A

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

32
Q

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

A

young women with bilateral symptoms

33
Q

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

A

vasospasm ( a type of vasoconstriction)

34
Q

Primary Raynauds is what type of disease?

A

functional disease

35
Q

What is secondary Raynauds?

A

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

secondary is when pt already has fixed arterial disease

36
Q

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

A

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

37
Q

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

A

vasoconstriction

38
Q

What is arteritis?

A

inflammation of vessel wall

39
Q

What are the two types of arteritis?

A
  • Takayasu
  • Buerger’s disease
40
Q

What is Takayasu?

A

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

41
Q

Why is Takayasu also known as “pulseless disease”?

A

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

42
Q

What is another name for Buerger’s disease?

A

thromboangitis obliterans

43
Q

What is Buerger’s disease?

A

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

44
Q

What are the symptoms of Buerger’s disease?

A

rest pain, gangrene, ulcers

45
Q

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

A

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

46
Q

What is the most common arteritis?

A

Bueger’s disease AKA thromboangitis obliterans

47
Q

What is a true aneurysm?

A

dilatation of all 3 layers of the wall

48
Q

What are different types of true aneurysm?

A

1) fusiform
2) saccular

49
Q

What are the symptoms of aneurysm?

A
  • bounding pulse (strong pulse)
  • abdominal/back pain (if that is AAA)
50
Q

What is the most common location of an aneurysm?

A

infrarenal aorta

51
Q

What is the most common cause of aneurysm?

A

atherosclerosis

52
Q

What is the most common type of aneurysm?

A

fusiform

53
Q

What is the most likely complication of AAA?

A

rupture
(especially when aneurysm is >5cm)

54
Q

What is the most likely complication of a peripheral aneurysm?

A

embolization

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

55
Q

What is a false aneurysm?

A

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

56
Q

What causes false aneurysm?

A

weakening of layers causing intimal flap or tear

57
Q

What happens during false aneurysm that is very dangerous?

A
  • flow goes into both “lumens”
  • very dangerous because it has high risk of rupture
58
Q

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

A

thoracic aorta in hypertensive pt with severe back/chest pain

59
Q

What is a pseudoaneurysm?

A

puncture of all 3 layers

60
Q

What causes pseudoaneurysm?

A

most often post procedure such as catheterization or angiogram

61
Q

What happens when patient has pseudoaneurysm?

A

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

62
Q

How to confirm pseudoaneurysm on ultrasound?

A

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

63
Q

What is coarctation?

A
  • congenital narrowing of aortic arch
  • diminished pulses and hypertension in younger people
64
Q

What is popliteal entrapment?

A

compression of popliteal artery by gastrocnemius muscle (calf muscle)

65
Q

Popliteal entrapment is found in which type of patient?

A

younger athletic men experiencing intermittent claudication

66
Q

What is thoracic outlet syndrome?

A

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

67
Q

What is compartment syndrome?

A

compression of artery by swelling trapped inside fascia layers

68
Q

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

A

anterior tibial region

RVT (4 decks)

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