Atherosclerotic Disease Flashcards by Zelds Collins | Brainscape

Q

This is a disease primarily of the

A

Arterial endothelium

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Q

Plaques will invade what layers of the vessels?

A

Tunica intima

And causes thickening and scarring of tunica media

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Q

What sites are most commonly effected?

A

Coronary arteries 
Lower extremities arteries 
Cerebral arteries 
Carotid arteries
aorta

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Q

What lower extremities arteries are

Effected?

A

Aortoiliac segments
Femoral-popliteal segment
Tibial segment

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Q

What multiple factors contribute to the pathogenesis of atherosclerosis

A

Endothelial dysfunction 
Dyslipidemia 
Inflammatory/ immunologic factors 
Plaque rupture 
Smoking

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Q

The formation of plaques cause the tunica media to what and the tunica intima to?

A

Media( thicken)

Intima ( rigid)

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Q

What plays a critical role in the development of atherosclerosis

A

Dyslipidemia and abnormal lipids

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Q

What are the risk factors for atherosclerosic disease

A

Hypercholesterolemia 
HTN
Diabetes Mellitus 
Males
Smokers
Family history

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Q

Types of atherosclerotic diseases

A

Coronary artery disease
Peripheral vascular disease
Acute arterial occlusion of limb
Occlusive cerebrovascular disease

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Q

Causes coronary arterial narrowing

A

Coronary atherosclerosis ( number one killer)

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Q

What are the risk factors for atherosclerotic coronary artery disease

A

Family history 
Males
Hypercholesterolemia 
Diabetes mellitus
HTN
Physical inactivity 
Abdominal obesity 
Smoking 
Excessive alcohol 
Poor diet 
Metabolic syndrome

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Q

PE findings for CAD

A

Chest px
L shoulder px 
Indigestion
N/V
Pale
Diaphoresis 
New heart murmur 
Rales on pulmonary examination 
S3/S4
Sudden cardiac death

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Q

Differential diagnosis for CAD

A

GERD
Esophageal spasm 
Aortic dissection 
Pericarditis/myocarditis 
Palpitations 
Anxiety

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Q

CAD: labs/studies

A

Lipid panel
Fasting glucose
Troponin
EKG

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Q

Treatment CAD no meds

A

Lifestyle changes 
Low fat diet 
Smoking cessation
Mod. ETOH intake 
Control: HTN, Diabetes, Hypercholesterolemia

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Q

CAD med treatment

A

HMG-CoA reductase inhibitors ( statins)
( monitor for hepatotoxicity LFTs repeat in 3-6 months)
Aspirin

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Q

Initial care CAD

A

1 risk factor modification

Signs of AMI ( need to MEDEVAC)
Treat underlying: HTN, diabetes, Hypercholesterolemia

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Q

Complications of CAD

A

AMI
CHF
Arrhythmias 
Sudden cardia death 
Structural valvular heart disease
Unstable angina

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Q

Is an occlusive atherosclerotic lesions that develop in the legs ( less common in arms) lead to decrease in perfusion of extremities

A

Atherosclerotic peripheral vascular disease (PAD)

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Q

PAD may be diffused, but usually occur segmentally ( locations?)

A

Aorto-illiac segments
Femoral-popliteal segments
Tibial segment

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Q

Those with what or do what have a high chance of developing PAD

A

Smokers and patients with diabetes

Q

What are the symptoms/ physical exam findings?

A

Claudication 
Px not relieved with rest 
Diminished femoral, popliteal, or pedal pulses 
Tissue ulceration and gangrene 
Erectile dysfunction 
Hair loss
Thinning and cool skin 
Atrophy of muscles

Q

What are the differential diagnosis (PAD)

A

DVT
Muscle strain or cramp
Neuropathy

Q

Labs/studies

A

Doppler examination
CT and magnetic resonance angiography
Lipid panel
Chemistry

Q

Cramping pain or tiredness in the thigh, calf, or foot, with walking or exercise and relieved by rest

A

Claudication

Q

PAD treatment no meds

A

Smoking cessation
Risk factor reduction
Weight loss
Consistent moderate exercise

Q

Med treatment for PAD

A

Phosphodiesterase inhibitor: cilostazol

Q

Complications of PAD

A

Non healing wound
Limb amputation
Because of extensive atherosclerotic burden, including coronary and cerebral lesions, mortality rate is greatly increased

Q

Is an acute occlusion due to emboli or thrombus

A

Acute arterial occlusion of a limb

Q

What percentage of emboli travel from the heart to the lower extremities and to the cerebrovascular circulation

A

50% heart to lower limbs

20% to the cerebrovascular circulation

Q

Causes of acute arterial occlusion of a limb

A

Atrial fibrillation ( most common) 
Valvular heart disease

Q

Patient with a primary thrombus has had a history of

A

Claudication

Q

Symptoms/PE findings

A

Sudden onset of extremity pain w/ loss or reduction of pulses is diagnostic

Numbness or paralysis
Signs of severe arterial ischemia

Q

Signs of severe arterial ischemia ( 6 Ps)

A

Pain
Pallor ( or mottling with delayed capillary refill)
Poikilothermia 
Pulselessness
Paresthesia 
Paralysis

Q

Differential diagnosis ( acute arterial occlusion of a limb)

A

Chronic limb ischemia 
Acute compartment syndrome 
DVT
Acute gout 
Soft tissue injury

Q

Labs/imaging

A

Chemistry ( systemic acidosis)
Doppler ( show little or no blood flow to distal vessels)
CTA/MRA should be done in operating room to prevent delays to revascularization

Q

Treatment for acute arterial occlusion of the limb

A

Enoxaparin
( creatinine at baseline, CBC at baseline)
Heparin sulfate IV stat ( monitor with PTT)

Immediate revascularization within 3 hours. Delays increase risk of irreversible tissue damage. Risk approaches 100% at 6 hours

Q

Initial care of acute arterial occlusion of a limb

A

Give dose of heparin immediately

MEDEVAC immediately

Q

Complications of acute arterial occlusion of the limb

A

10-25% risk of amputation and 25% hospital mortality rate

Q

In the absence of atrial fibrillation, emboli in occlusive cerebrovascular disease are due to?

A

Emboli from the proximal internal carotid artery

Q

Occlusive cerebrovascular disease can cause

A

Stroke or transient ischemic attack ( TIA)

Q

Symptoms/ PE findings of occlusive cerebrovascular disease

A

Neurological deficits ( depending on the location of the occlusion) 
( range from facial asymmetry, to paralysis  of the entire upper and lower half of body to dizziness and ataxia)

Carotid bruits

Q

Differential dx for occlusive cerebrovascular disease

A

Hypoglycemia 
Intracranial hemorrhage 
Seizure 
Adverse reaction to a medication 
Drug use 
Toxic metabolic effect ( hypo or hypernatremia)

Q

Labs/studies

A

Blood glucose
CBC
PT, INR, PTT 
Lipid panel
CT
MRI/MRA
Duplex ultrasonography

Q

Is the imaging modality of choice looking for carotid stenosis

A

Duplex ultrasonography

Q

Treatment no meds

A

Lifestyle modifications
Smoking cessation
Weight reduction if obese

Q

Treatment meds for occlusive cerebrovascular disease)

A

Aspirin
Statins
Thrombolytics ( present within 6 hours of onset of symptoms)

Q

What long term anticoagulations are given to patients with atrial fibrillation

A

Warfarin or direct thrombin inhibitors

Q

Initial care ( for OCD)

A

Check glucose level to r/o hypoglycemia
Head CT ( to evaluate for intracranial hemorrhage)
Blood work
If you cannot adequately evaluate the patient than immediate MEDEVAC

Q

Complications ( OCD)

A

Patients with carotid stenosis who had a TIA or small stroke and no treatment have a 25% chance of a stroke within 1 year

Permanent neurological disabilities
Contractures
Aspiration