Arterial Disorders Flashcards
Where do most arterial embolisms originate?
80% originate in the heart
What heart problems cause arterial embolisms?
- Atrial fibriallation
- mitral stenosis
What valvular abnormality causes arterial embolisms most often?
-mitral stenosis, it causes embolisms 20 times more often than any other valve abnormality
What valvular abnormality just cause an arterial embolism to her left arm?
-your gonna say “mitral valve stenosis”
What rhythm is common to arterial embolisim?
a-fib
Other than a fib and mitral stenosis what other things cause emobolisms?
-local arterial trauma, septic emboli, endocarditis, hypercoagulable states
are upper or lower embolisms seen more often?
lower extremity embolisms are more often that upper extremity
Where else might an embolism from a-fib or mitral stenosis travel to?
lower extremity, upper extremity, mesenteric areteries
What would make you think a person might have an arterial embolism in their leg or arm?
- The 6 P’s
Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermia
When your see are or called about an extremity embolism how do you treat first?
-IV heparin if not limb threatening, then call vascular guy
so tx, then call, cause if you don’t tx and he keeps throwing clots it’s going to make the situation worse!!!!!
What are the complete list of tx for an extremity embolism?
- IV heparin if not limb threatening
- Thrombolytics
- Angiography with throbectomy
- Open thrombectomy
What else do you look for when you see an embolism?
-look for the source, hyper coagulable state, septic emboli
A chronic inflammation of medium to large cranial blood vessels?
-Giant Cell Arteritis, AKA temporal arteritis
Temporal arteritis is also associated with what other condition?
-Polymyalgia rheumatica
Person complains of scalp tenderness, brush their hair and it hurts. Says they scratch their head and it hurts. They also have had morning shoulder pain for years. What Dx should you be thinking of?
Temporal arteritis/Giant Cell Arteritis
the body pains is consistent with polymyalgia rheumatic
Person has severe headache, pain with brushing their hair, jaw pain with eating and now c/o decrease unilateral vision (Amaurosis fugax). How do you tx?
-give high dose prednisone ASAP to avoid blindness
You suspect temporal arteritis, what tests do you order?
- ESR, will be increased
- Temporal artery biopsy is diagnostic
Obstruction or narrowing of vessels causing disruption of flow describes what disease?
Peripheral Artery Disease
A guy says he walks a block and his legs are sore. Goes away if he rests. You suspect peripheral artery disease. What is the order of your work up?
1) in office Ankle/Brachial index
A guy comes in with insidious onset of Atrophic skin, hair, loss and dependent rubor of his lower extremities. Your suspicious of what? What medication do you avoid giving to this patient?
- Peripheral Artery Disease, early stage
- dont give Bblocker, makes claudication worse
Guy comes in with lower extremity non healing ulcers, decrease ankle/foot pulses, pallor, and maybe gangrene? What do you suspect? What medication do you avoid giving to this patient?
- Latent signs of Peripheral Artery Disease
- do not give Bblocker, makes claudication worse
Treatment for Peripheral Artery Disease includes what medications and procedures?
- control lipids
- Anti-platelet agents, cilostazol, pentoxifylline
What medication is contraindicated in isolated Peripheral Artery Disease?
-Bblockers
Why do we treat giant cell arteritis quickly and definitively? And what medication is used to tx giant cell arteritis?
- tx quickly to prevent blindness
- tx with high dose prednisone
What is the first step and evaluation of a patient with calf pain when he walks that is relieved with rest?
-Ankle Brachial Index
What is the Gold Standard to evaluate peripheral artery disease?
-Angiography
What blood pressure medication makes peripheral artery disease symptoms worse?
-Beta blockers
What valvular problem is most commonly associated with a peripheral arterial embolism?
-Mitral stenosis
What is the first medication given to a patient with an acute arterial emboli?
-Heparin
