Atherosclerotic Disease Flashcards
Defined atherosclerosis
A variable combination of change in the intimate involving accumulation of :
- lipid
- complex carbs
- blood and blood products
- fibrous deposits
- calcium deposits
- secondary media changes
Risk factors for atherosclerosis
Smoking Age Diabetes Men SADMEN Constitutional: -age -male sex -familial
Hard risk factors:
- hyperlipidemia
- hypertension
- DM
- smoking
Soft risk factors:
- obesity
- stress
- inflammation
- infection
Common sites for atherosclerosis
Infra renal aorta Coronary arteries Carotid bifurcation Mesenteric arteries Iliac Superficial femoral Cerebral
Consequences of atherosclerosis
Decreased blood flow Predisposition to thrombus Bleeding in to the plaque Plaque embolism Periarterial inflammation Weakening of vessel walls
Pathophysiology of intermittent claudication
Atherosclerosis of arteries supplying the lower limbs
-> reduced blood flow -> ischaemia
Hypoxia of calf muscle on increased O2 demand -> cramp like pain
At rest the narrowing is commonly bypassed by the deep femoral artery
Symptoms and signs of intermittent claudication
Symptoms: -muscle pain on walking that is relieved by rest (commonly calf) -begins at a reproducible distance -worse uphill -forced to stop -history of angina -smoking, hypertension, DM Signs: -reduced/absent peripheral leg pulses (may only be on exercise) -signs of ischaemia -ABPI 0.5-0.9
Symptoms and Signs of Ischaemic Rest Pain
Symptoms: -burning pain at rest (commonly top of foot skin) -worse at night -relieved by hanging leg out of bed -not completely relived by analgesia -history of angina/intermittent claudication -smoking, diabetes,hypertension Signs: -reduced/absent pulses -blue/white skin -atrophic shiny skin -hair loss -ulcers -necrosis -positive buegers test, foot becomes pale/worse when leg lifted -ABPI
Differential diagnosis of Ischaemic leg pain
Consider if pulses present!
- spinal claudication-> neurosensory loss, wasting
- peripheral neuropathy-> parasthesia
- osteoarthritis-> joint pain
- popliteal artery entrapment-> young
- venous claudication-> relieved by elevation, bursting pain
- fibromusclular displasia
- buegers disease
Investigation of chronic peripheral arterial occlusive disease
Peripheral pulses
Ankle-brachial pressure index
Duplex
Angiogram
Life style changes for Ischaemic leg pain
Stop smoking
Eat less fat
Decrease wt
Systematic exercise to point of pain
Medical management of Ischaemic leg pain
Blood pressure control Statin Anti platelets ACEI's Treat any other risk factors *pain relief *anticoagulants *HF, infection, anaemia
Surgical management of Ischaemic leg pain
Percutaneous translucency angioplasty -> short term for IM and if surgery not possible in ischaemia
Bypass-> aorta-iliac, femoral instal. Aspirin +- anticoagulants
Endardectomy-> carotid, common femoral
Carotid artery disease clinical features
Amaurosis furax-> transient loss of vision due to retinal micro embolism
Blindness
TIA
Stroke
Management of carotid artery disease
Treat acute stroke
Carotid endardectomy within 2 weeks of symptoms
Chronic mesenteric ischaemia clinical features
Sever abdo pain after eating
Wt loss due to fear of eating
-> USS/angiography
Management of chronic mesenteric ischaemia
Bypass graft
Renal artery stenosis pathophysiology
RAS-> decreased renal perfusion-> renin release
- > angiotensin 2
- > vasoconstriction
- > aldosterone release
- decreased Na excretion
- increased BP
- > ischaemia
- loss of nephrons-> renal failure
Clinical features of renal artery stenosis
Malignant hypertension
Male
Management of renal artery stenosis
Hypertension treatment
1) Ballon angioplasty +/- stent
2) bypass
