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semiology cardio > arteries > Flashcards

arteries Flashcards

1
Q

The semiological analysis of the peripheral pulse

A

[*] Sites

[*] Rate

[*] Rhythm

[*] Amplitude (pulse volume, intensity)

[*] character

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2
Q

PAD
Risk factors

A
  • Age less than 50 years with diabetes, and one additional risk factor (e.g., smoking, dyslipidemia, hypertension, or hyperhomocysteinemia)
  • Age 50 to 69 years and history of smoking or diabetes
  • Age 70 years and older
  • Known atherosclerotic coronary, carotid, or renal artery disease
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3
Q

Rate/rythm

A

Rate- beats/min

  • count the number of beats over 15 seconds and then multiply by four
  • Slow/irregular – 60 sec.!

Rhythm:

  • Regular
  • Irregular

[*] Complete arh.
[*] Extrasystolic arh.
[*] Respiratory arh.- NORMAL !!!
–In young
–the heart rate increases slightly during inspiration- vagal tone

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4
Q

Pulse intensity

A

–0, absent
–1, diminished
–2, normal
–3, bounding

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5
Q

Pulsus Paradoxus

A

[*] the blood pressure falls more than 15 mmHg in inspiration (20)
–Tamponade

(It represents an “exagerate” response)

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6
Q

Auscultation of the arteries

A
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7
Q

PAD
Cassification

A
  • functional- spasm
  • organic- obstruction of the blood flow:
  • Acute
  • Chronic
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8
Q

PAD
causes

A
  • ATS; diabetes
  • Buerger disease (Thromboangiitis Obliterans): segmental vascular inflammation, vasoocclusive phenomenon
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9
Q

PAD
Clinical Manifestation

A

Asymptomatic: Without obvious symptomatic complaint (but usually with a functional impairment).

Classic claudication: Lower extremity symptoms confined to the muscles with a consistent (reproducible) onset with exercise and relief with rest.

“Atypical” leg pain: Lower extremity discomfort that is exertional but that does not consistently resolve with rest, consistently limit exercise at a reproducible distance

Critical limb lschemia: Ischemic rest pain, nonhealing wound, or gangrene

Intermittent claudication- muscle pain (calf muscle)
– ache, cramp, fatigue, during exercise and relieved by rest.
–claudication index

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10
Q

PAD Physical exam:

A

–Absence of the peripheral pulses
–Hair loss, cold legs, pallor (trophic changes)
–Murmur- stenosis
–ulcer, gangrene

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11
Q

PAD Differential DG

A

[*] Peripheral neuropathy
[*] Osteoarthritis of the hip or knee
[*] Venous pathology
[*] Compartment syndrome ( pressure within a limited space compromises the circulation and function of the tissues within that space)
[*] Muscle spasms or cramps
[*] Restless leg syndrome

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12
Q

1.Resting Ankle-Brachial Index (ABI)

A

Step 1: the blood pressure cuff placed on the arm is inflated over the artery until the pulse ceases

Step 2: Turn on the Doppler and place the probe in the area of the pulse; the cuff is slowly deflated

The corresponding sphygmomanometer pressure at the instant the pulse returns provides the systolic blood pressure.

Step 3: the same manner for leg

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13
Q

Interpreting the Ankle-Brachial Index

A

BBorderlineordBorderlineerline

ABI

Interpretation

  1. 00–1.29Normal
  2. 91–0.99Borderline
  3. 41–0.90Mild-to-moderate disease

≤0.40Severe disease

≥1.30Noncompressible

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14
Q

Acute ischemia

A

Embolization: atrial Fi, endocarditis, mitral valve disease, aneurysmal origin, post CV Surgery

Thrombosis: pre-existing ATS plaque

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15
Q

Acute ischemia

symptoms

A

5 P-s”:

  • Pulselessness (distal of the level of occlusion)
  • Pain
  • Palor
  • Paresthesia
  • Paralysis

–Number 6 of the “P” is recently added: prostration.

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16
Q

Buerger disease (trombangiitis obliterans)

A
  • Male, young, heavy smoker
  • Small and medium sized arteries and veins
  • Lower limbs- usually
  • distal limb ischemia: cyanosis, pallor, cold limb, ulcerations or localized gangrene of the digits; secondary Raynaud’s phen.
  • Superficial thrombophlebitis

Amputation is common

17
Q

[*] The Stanford classification divides dissections into 2 types: type A and type B.

A
  • Type A involves the ascending aorta (corresponds to the DeBakey types I and II)
  • Type B involves the aorta distal to the left subclavian artery (DeBakey type III).
18
Q

The DeBakey- 3 types of dissections:

A
  • Type I involves the ascending aorta, aortic arch, and descending aorta.
  • Type II involves the ascending aorta.
  • Type III refers to the descending aorta distal to the left subclavian artery
19
Q

Clinical Manifestation of Aortic dissection

A
  • Chest pain: typically with an abrupt and maximal intensity onset, described as ripping or tearing
  • Anterior thoracic pain- anterior arch or aortic root dissection
  • Neck or jaw pain- aortic arch dissection
  • Interscapular pain radiating to lower back or abdomen- descending aorta dissection.
  • Blood pressure: decreased due to the cardiac tamponade, hypovolemia or increased due to cathecolamine reaction or the underlying hypertension; significant interarm difference
  • Dyspnea- heart failure or tracheal or bronchial compression.
  • Acute aortic regurgitation with acute cardiac failure signs
  • Acute myocardial infarction
  • Cardiac tamponade: muffled heart sounds, hypotension, pulsus paradoxus, jugular venous distension, Kussmaul sign
20
Q

Neurological signs:

A

[*] syncope, cerebrovascular accident, peripheral nerve ischemia, recurrent laryngeal nerve compression (resulting in hoarseness), irritation of the cervical sympathetic ganglia with Claude-Bernard-Horner syndrome (unilateral ptosis, miosis, and anhidrosis)

21
Q

Gastrointestinal manifestations

A

involvement of the renal artery, abdominal aorta

22
Q

[*] DVT of the lower limbs

A
  • Distal
  • Proximal- the highest risk of PE–Phlegmatia caerulea dolens: due to massive ileofemoral veins obstruction; the leg is usually markedly edematous, painful, and cyanotic
  • Plegmatia alba dolens: massive thrombosis and associated arterial spasm; the leg is often pale with diminished or absent distal pulses
23
Q

DVT
Clinica Manifestations

A
  • Edema
  • Swelling of the leg
  • leg pain
  • Tenderness
  • Erythema
  • Superficial distended veins
  • Pulmonary thrombembolism as a primary manifestation- dyspnoea, cyanosis, tachycardia (Mahler sign), fever (Mikaelis sign)
  • Homans’s sign (pain- the calf muscles on forced dorsiflexion of the foot)
  • Lowenberg sign (the cuff compression test): calf pain at a pressure lower than 180 mmHg
  • Lisker’s sign: pain during the percussion of the anteromedial side of the tibia.
24
Q

Upper limb DVT-

A

[*] cancer, trauma, catheter or sustained effort (the abduction of the arm)

25
Q

DVT

Complementary examination

A

[*] D-dimer- negative predictive value
[*] Doppler ultrasound
[*] Venography
[*] Magnetic resonance
[*] CT angiogram- for PE

26
Q

CHRONIC VENOUS INSUFFICIENCY
Causes

A
  • Congenital absence of the valves
  • damage of the valves in the superficial and communicating venous systems (secondary to venous thrombosis)
27
Q

CEAP classif.:

A

[*] Stage 0: no signs of chronic venous insufficiency
[*] Stage 1: reticular veins/ telengiectasis
[*] Stage 2: varicose veins
[*] Stage 3: edema
[*] Stage 4: skin changes
[*] Stage 5: healed ulcer
[*] Stage 6: active ulcer

28
Q

Chronic Venous insufficienyc

symptoms

A

[*] Pain
[*] edema
[*] dermatitis- stasis
[*] varicose veins
[*] Ulcer- internal side of the lower limb

29
Q

Linton maneuver

A

identifies idiopathic varicose veins with normal profound veins:

– the elevation of the leg is followed by a promptly emptying of the varicosities

(in case of affected deep veins the emptying is prolonged)

semiology cardio (5 decks)

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