Arteries , Veins , Lymphatics Flashcards
Causes of DVT
Virchows triad-inflammation, hypercoagualble , endothelial injury
Prothrombotic state
Genetic: factorV leiden and prothrombin gene mutation
Acquired : APAS
Cancer Laong travel Pregnancy Hormone replacement Surgery Trauma
Most common acquired cause of thrombophilia
APAS
Pathophysiology of hypoxia in PE
Increased pulmonary vascular resistance due to vascular obstruction or platelet secretion of vasoconstricting neurohumoral agents such as serotonin. Release of vasoactive mediators can produce ventilation-perfusion mismatching at sites remote from the embolus, thereby accounting for discordance between a small PE and a large alveolar-arterial O2 gradient.
Effect of PE on heart
Pulmonary artery obstruction causes a rise in pulmonary artery pressure and in pulmonary vascular resistance. When RV wall tension rises, RV dilation and dysfunction ensue, with release of the cardiac biomarker, brain natriuretic peptide. The interventricular septum bulges into and compresses an intrinsically normal left ventricle (LV). Diastolic LV dysfunction reduces LV distensibility and impairs LV filling. Increased RV wall tension also compresses the right coronary artery, limits myocardial oxygen supply, and precipitates right coronary artery ischemia and RV microinfarction, with release of cardiac biomarkers such as troponin. Underfilling of the LV may lead to a fall in LV cardiac output and systemic arterial pressure, with consequent circulatory collapse and death.
C/f Of DVT
Calf pain Tenderness Erythema Pitting edema Collateral nonvaricose veins
Lungs Dysnoea Hemopytsis Syncope Hypotension Cyanosis
Chest x ray findings of PE
A normal or nearly normal chest x-ray often occurs in PE. Well-established abnormalities include focal oligemia (Westermark’s sign), a peripheral wedged-shaped density above the diaphragm (Hampton’s hump), and an enlarged right descending pulmonary artery (Palla’s sign).
Dx imaging in DVT/PE
Same for both
Low probability-D-dimer (n:no DVT/PE , high:imaging
Moderate/high: imaging
IMAGING
DVT:doppler(if not dxtic: MR ,CT, phlebography)
PE CT(if not dxtic:vantilation perfusion scan- doppler leg -TE ECHO,MR, angiography)
Leriche s syndrome
Claudication (buttocks, thighs and calves) + impotence in males
Artherosclerotic ds of aorta exending to iliac arteries
C/F in pwripheral artery ds
SYMPTOM
Intermittent claudication
Rest pain
SIGNS Dec/absent pulse Bruits Muscle atrophy Hair loss Thickened nail Smooth shiny skin Reduced skin temp Pallor /cyanosis Ulcer/gangrene Edema(if they keep their leg in dependant position on case of rest pain) Ischemic neuropathy leading to numbness and hyporeflex
What is intermittent claudication
which is defined as a pain, ache, cramp, numbness, or a sense of fatigue in the muscles; it occurs during exercise and is relieved by rest. The site of claudication is distal to the location of the occlusive lesion.
Why is ankle pressure higher than arm
Due to pulse wave amplification
Fibromuscular dysplasia
Hyperplastic ds of small /medium sized vs
Renal and carotid a. mostly involved
on angiography STRING OF BEADS
Thromboangitis obliterans
is an inflammatory occlusive vascular disorder involving small and medium-size arteries and veins in the distal upper and lower extremities.
Men
Cigerette smoking
triad of claudication of the affected extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis
Buergers ds
Thrombosngitis obliterans
Vs effected thromboangitis obliterans
Distal vessel like radial,ulnar ,tibial
Priciple causes of acute limb ischemia
Emboli(heart, aorta)
Thrombus(plaque rupture)
Dissection
Trauma(cathetars, puncture)
Thoracic outlet compression syn
compression of the neurovascular bundle (artery, vein, or nerves) at the thoracic outlet as it courses through the neck and shoulder.
CAUSES
Cervical ribs
abnormalities of the scalenus anticus muscle
proximity of the clavicle to the first rib abnormal insertion of the pectoralis minor muscle
compress the subclavian artery, subclavian vein, and brachial plexus.
Arterivenous fistula
Abnormal communications between an artery and a vein, bypassing the capillary bed,
congenital (embryonic vs)
acquired(trauma, hemodialysis)
C/F Pulsatile mass Inc temp Thrill and bruit( continuosly for sys and diastole) Chronic:venous insufficieny Large: high output cardiac failure
Compression of a large arteriovenous fistula may cause reflex slowing of the heart rate (Nicoladoni-Branham sign)
Raynauds phenomenon
episodic digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis, and rubor of the fingers or toes after cold exposure and subsequent rewarming.
PRIMARY /IDIOPATHIC
Cause:secondry causes excluded ,Due to stress/ emotion
SECONDRY
Collagen vascular diseases: scleroderma, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polymyositis, mixed connective tissue disease, Sjögren’s syndrome
Arterial occlusive diseases: atherosclerosis of the extremities, thromboangiitis obliterans, acute arterial occlusion, thoracic outlet syndrome
Pulmonary hypertension
Neurologic disorders: intervertebral disk disease, syringomyelia, spinal cord tumors, stroke, poliomyelitis, carpal tunnel syndrome, complex regional pain syndrome
Blood dyscrasias: cold agglutinins, cryoglobulinemia, cryofibrinogenemia, myeloproliferative disorders, lymphoplasmacytic lymphoma
Trauma: vibration injury, hammer hand syndrome, electric shock, cold injury, typing, piano playing
Drugs and toxins: ergot derivatives, methysergide, β-adrenergic receptor blockers, bleomycin, vinblastine, cisplatin, gemcitabine, vinyl chloride
Where does raynauds phenomenon occur
Fingers and toes only
Color change in raynauds phenomenon
Sequential
White
Blue
Red
Acrocyanosis
arterial vasoconstriction and secondary dilation of the capillaries and venules with resulting persistent cyanosis of the hands and, less frequently, the feet.
Differentiating from raynauds
1. No ulcer, pain , gangrene
- Persistant , not episodic
- Presence of normal pulses
Livedo reticularis
localized areas of the extremities develop a mottled or rete (netlike) appearance of reddish to blue discoloration
Pernio
Pernio is a vasculitic disorder associated with exposure to cold
. Raised erythematous lesions develop on the lower part of the legs and feet in cold weather
They are associated with pruritus and a burning sensation, and they may blister and ulcerate.
