Atherosclerotic Disease Flashcards by Zelds Collins

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

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

Claudication

PAD treatment no meds

Smoking cessation Risk factor reduction Weight loss Consistent moderate exercise

Med treatment for PAD

Phosphodiesterase inhibitor: cilostazol

Complications of PAD

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

Is an acute occlusion due to emboli or thrombus

Acute arterial occlusion of a limb

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

50% heart to lower limbs | 20% to the cerebrovascular circulation

Causes of acute arterial occlusion of a limb

``` Atrial fibrillation ( most common) Valvular heart disease ```

Patient with a primary thrombus has had a history of

Claudication

Symptoms/PE findings

Sudden onset of extremity pain w/ loss or reduction of pulses is diagnostic Numbness or paralysis Signs of severe arterial ischemia

Signs of severe arterial ischemia ( 6 Ps)

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

Differential diagnosis ( acute arterial occlusion of a limb)

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

Labs/imaging

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

Treatment for acute arterial occlusion of the limb

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

Initial care of acute arterial occlusion of a limb

Give dose of heparin immediately | MEDEVAC immediately

Complications of acute arterial occlusion of the limb

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

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

Emboli from the proximal internal carotid artery

Occlusive cerebrovascular disease can cause

Stroke or transient ischemic attack ( TIA)

Symptoms/ PE findings of occlusive cerebrovascular disease

``` 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

Differential dx for occlusive cerebrovascular disease

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

Labs/studies

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

Is the imaging modality of choice looking for carotid stenosis

Duplex ultrasonography

Treatment no meds

Lifestyle modifications Smoking cessation Weight reduction if obese

Treatment meds for occlusive cerebrovascular disease)

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

What long term anticoagulations are given to patients with atrial fibrillation

Warfarin or direct thrombin inhibitors

Initial care ( for OCD)

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

Complications ( OCD)

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