Cardiology Flashcards
What is the typical lesion seen in atherosclerosis?
Fatty streak
What are the cellular components of atherosclerosis?
Macrophages, smooth muscle cells, lymphocytes
What are the risk factors for atherosclerosis?
Age Hypercholesterolaemia Family history of diabetes Male Obesity
What are the risk factors for angina?
Age Hypercholesterolaemia Diabetes Male Obesity Smoking Drinking
What is the clinical presentation of angina?
Constricting chest pain
Chest pain on exertion
Pain relieved by rest or GTN
What investigations would you do for a patient with ?angina?
ECG - t wave changes or ST changes, pathological Q wave changes
Bloods - FBC, LFTs, RBG, TFTs, cholesterol, troponins
What is the management for angina?
Lifestyle modification to modify risk factors
GTN spray on attack
Aspirin daily
Statins
Calcium channel blocker or beta blocker
Long-acting nitrate
Revascularisation if patient is high risk of persistent
What is acute coronary syndrome?
ST-elevation ACS (STEMI)
Non-ST elevation ACS (NSTEMI)
Unstable angina
What are the risk factors for ACS?
Age Hypercholesterolaemia Diabetes Male Obesity Smoking Drinking
What is the clinical presentation of ACS?
Fatigue Nausea and vomiting Impending sense of doom Chest pain Breathlessness Clammy Pale
What investigations would you do for a patient with ?ACS?
ECG - ST changes with a STEMI
Bloods - FBC, LFTs, RBG, TFTs, cholesterol, troponins
What is the management of ACS?
ABCDE MONA - morphine, oxygen (if hypoxic), nitrates, aspirin Aspirin and ticagrelor LMWH or fondaparinux Revascularisation Statins Calcium channel blocker or beta blocker Long-acting nitrate
What are the possible complications of ACS?
Arrhythmia
Shock
Death
AF
Where do mitral valve murmurs radiate to?
The axilla
Where do aortic valve murmurs radiate to?
The carotid arteries
What investigations would to do for a mitral stenosis?
CXR - small heart but big LA, possible calcification
ECG - sinus rhythm or AF
Echo - LA enlargement, assess mitral valve mobility, gradient and mitral valve area
What is the management of mitral stenosis?
Medical: beta-blockers, calcium channel blockers, digoxin, diuretics Valvotomy to widen the valve Valve replacement Treat AF Treat dyspnoea with low dose diuretics ?Infective endocarditis prophylaxis
What are the causes of mitral regurgitation?
Degenerative IHD Infective endocarditis Ehlers-Danlos syndrome Marfan's syndrome Rheumatic heart disease
What are the symptoms of mitral regurgitation?
Palpitation Dyspnoea Orthopnoea- difficult in breathing when lying flat Fatigue Lethargy
What murmur does mitral regurgitation have?
Pansystolic murmur
Palpable thrill if the regurgitation is severe
What murmur does aortic stenosis have?
Systolic, low pitched ejection murmur that radiates to the carotids
Ejection click
Palpable thrill
What are the symptoms of aortic stenosis?
Exercise induced syncope
Dyspnoea
Angina
What murmur does aortic regurgitation have?
High pitched, early diastolic
Ejection systolic
Mid-diastolic rumble
What BP is stage 1 hypertension?
140/90 in clinic
135/85 at home or ambulatory
What BP is stage 2 hypertension?
160/100 in clinic
150/95 at home or ambulatory
What BP is severe hypertension?
180/110 - NEEDS TREATING ASAP!!
At what point do you treat hypertension?
Stage 2 or 3
Stage 1 if the patient has DM, kidney disease
What is the management of hypertension?
> 55 or not caucasian? Calcium channel blocker
<55 and caucasian? ACEi/ARB
Then combination treatments
Then add a thiazide diuretic
What compensatory changes are seen in heart failure?
Ventricular dilatation Myocyte hypertrophy Increased collagen synthesis Salt and water retention Peripheral vasoconstriction Increased sympathetic stimulation
What are the symptoms of heart failure?
Exertional dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Cold peripheries
What are the signs of heart failure?
Cardiomegaly Added heart sounds and murmurs Elevated JVP Tachycardia Hypotension Bibasal crackles Ascites Oedema - peripheral and sacral Displaced apex beat Hepatomegaly
What is the management for heart failure?
Lifestyle modification: Education Obesity control Diet Smoking cessation Vaccines Cardiac rehab
Drugs: Diuretics e.g. furosemide ACE inhibitors e.g. lisinopril Beta blockers e.g. bisoprolol ARB e.g. candesartan Calcium glycosides e.g. digoxin
Other:
Revascularisation
Valvular replacement
What is shock?
Failure of the circulatory system to maintain an adequate organ perfusion
What are the causes of shock?
Haemorrhagic Anaphylaxis Septic Cardiogenic Hypovolaemic
What is the management of anaphylaxis?
ABCDE
Oxygen
Adrenaline
Anti-histamines
What is the management for septic shock?
Sepsis six: Blood cultures Urine output Fluids Antibiotics IV Lactate Oxygen
In an acute MI, which drug should you give for thrombolysis?
Streptokinase
What is the downside to streptokinase?
It is derived from a bacteria so resistance is an issue therefore if a patient has had it once then they can’t have it again.
What are the clinical features of infective endocarditis?
Fever Splinter haemorrhages Janeway lesions Osler's nodes Roth spots New murmur Malaise Symptoms of septic emboli e.g. stroke, PE, pneumonia
What investigations would you do for infective endocarditis?
Echo
CXR
Blood cultures
What is Duke’s criteria?
The diagnostic criteria for infective endocarditis
What are the signs for MI?
Levigne’s sign, loss of consciousness, pallor, clammy
What are the diagnostic tests for MI?
12 lead ECG - ST elevation in STEMI or LBBB, may show pre-existing coronary artery disease e.g. Q waves
Bloods: FBC, glucose, renal function, U&Es, TFTs and cardiac enzymes
Echo
CXR
Coronary angiography
What is unstable angina?
An acute coronary syndrome - angina symptoms that come on at rest
What are the complications of an MI?
Heart failure, myocardial rupture and aneurysmal dilatation, ventricular septal defect, mitral regurgitation, arrhythmias, conduction disturbances, post-MI pericarditis
What tests would you do to diagnose heart failure?
History and physical examination
CXR - cardiomegaly
Bloods: FBC, U&Es, LFTs, cardiac enzymes, BNP, TFTs
ECG - ischaemic changes or arrhythmia
Echo - chamber dimensions, systolic and diastolic function, wall abnormalities, valvular heart disease, cardiomyopathies
Myocardial perfusion imaging
What are the causes of mitral stenosis?
Rheumatic heart disease
Congenital
Calcification
Infective endocarditis
What is the pathophysiology involved in mitral stenosis?
Obstruction of LV inflow prevents proper filling during diastole, LA pressure increases and LA hypertrophy and dilatation occur
What are the symptoms of mitral stenosis?
Severe dyspnoea, pink frothy sputum, haemoptysis, palpitations
What are the signs of mitral stenosis?
Mitral facies - ducky pink discolouration of the cheeks
Atrial fibrillation
Prominent “a” wave in jugular pulsations
HEART SOUNDS: loud S1, loud P2, opening snap
What murmur does mitral stenosis have?
Mid-diastolic rumble at the apex
What is the pathophysiology involved in mitral regurgitation?
LA dilatation, LV hypertrophy and increased contractility
What are the signs of mitral regurgitation?
Laterally displaced diffuse apex beat
Systolic thrill
HEART SOUNDS: soft S1, prominent third heart sound
What investigations should be performed to confirm mitral regurgitation?
ECG - LA enlargement, AF, LV hypertrophy
CXR - LA enlargement, central pulmonary artery enlargement
Echo - Estimation of LA and LV size and function, valve structure assessment
What is the management of mitral regurgitation?
Medical: ACE inhibitors, rate control for AF, anticoagulation for AF, diuretics, serial echos, prophylaxis for infective endocarditis
Surgery: Mitral valve replacement or repair
What are the causes of aortic stenosis?
Congenital - aortic stenosis or a bicuspid valve
Acquired - degenerative calcification, rheumatic heart disease
What is the pathophysiology involved in aortic stenosis?
A pressure gradient develops between the LV and the aorta (increased afterload), LV function is initially maintained by compensatory pressure hypertrophy, when compensatory mechanisms fail, LV function declines
What are the signs of aortic stenosis?
Slow rising carotid pulse (pulsus tardus)
Decreased pulse amplitude (pulsus parvus)
Systolic thrill
HEART SOUNDS: soft or absent second heart sound, S4 gallop due to LVH, ejection click
What tests are used to diagnose aortic stenosis?
CXR - relatively small heart with prominent, dilated, ascending aorta, aortic valve may be calcified
ECG - LV hypertrophy and LA delay
Echo - thickened, calcified and immobile aortic valve cusps, LV hypertrophy
Cardiac catheterisation - used to assess pressure gradient but rare
What is the treatment for aortic stenosis?
Surgical replacement - TAVI (transcatheter aortic valve implantation), valvotomy
?Prophylaxis for infective endocarditis
What are the causes of aortic regurgitation?
Rheumatic heart disease, infective endocarditis, severe hypertension and a bicuspid valve
What is the pathophysiology involved in aortic regurgitation?
There is reflux of blood from the aorta into the LV during diastole, to maintain cardiac output the LV enlarges. Diastolic BP falls and coronary perfusion decreases. The longer the LV is mechanically less efficient, the oxygen demand increases resulting in ischaemia
What are the symptoms of aortic regurgitation?
Angina, dyspnoea, orthopnoea, palpitations
What are the signs of aortic regurgitation?
Wide pulse pressure
Hyperdynamic and displaced apical impulse
Collapsing or bounding pulse
Head nodding with each heartbeat
Quincke’s sign - capillary pulsation in the nail beds
What tests are used to diagnose aortic regurgitation?
CXR - LV enlargement and dilatation of the ascending aorta
ECG - LV hypertrophy - tall R waves, inverted T waves in left sided chest leads and deep S waves in right-sided leads
Echo - vigorous cardiac contraction, dilated LV, regurgitant jet on doppler
Cardiac catheterisation - rare
What is the treatment for aortic regurgitation?
Medical: Consider IE prophylaxis
Vasodilators (e.g. ACE inhibitors)
Surgery: aortic valve replacement
What is the aetiology of infective endocarditis?
Bacteraemia and abnormal cardiac endothelium result in infective endocarditis.
Bacteraemia normally occurs from poor dental hygiene, IVDUs and soft tissue infections
What are some common organisms that cause infective endocarditis?
Streptococcus viridans - prosthetic valves, dental disease
Staphylococcus aureus - IVDUs, prolonged vascular access e.g. central lines, valve surgery
Staphylococcus epidermidis - IVDUs, valve surgery
What are the symptoms of infective endocarditis?
Fever, malaise, night sweats, rigors, joint pain
What are the signs of infective endocarditis?
Finger clubbing Cardiac murmurs Skin lesions - Osler's nodes, splinter haemorrhages, Janeway lesions, petechiae Roth's spots - seen on the retina Septic emboli
What are the diagnostic tests for infective endocarditis?
Duke’s criteria
Blood cultures (3 separate sets from different sites)
ECG
CXR
Echo - visualisation of vegetations on valve leafllets
What is the treatment for infective endocarditis?
Empirically: penicillin and gentamicin
Staphylococcal: vancomycin or flucloxacillin or benzylpenicillin and gentamicin
Streptococcal: penicillin and gentamicin
All antibiotics should be given IV and should be given for a long course e.g. 6 weeks
What are some causes of hypertrophic cardiomyopathy?
Aortic stenosis, hypertension, mutations in sarcomeric proteins
What is the pathophysiology of hypertrophic cardiomyopathy?
The heart hypertrophies to try and improve contractility and force; this can be due to stenosis or mutated proteins
What are the symptoms of hypertrophic cardiomyopathy?
Chest pain, dyspnoea, syncope or pre-syncope, cardiac arrhythmias, sudden death
What are the signs of hypertrophic cardiomyopathy?
Double apical pulsation Jerky carotid pulse Ejection systolic murmur Pan-systolic murmur (due to mitral regurgitation) 4th heart sound
What tests are used to diagnose hypertrophic cardiomyopathy?
ECG - LV hypertrophy, ST and T wave changes, abnormal Q waves
Echo - hypertrophy of the heart, vigorously contracting ventricle
Cardiac MR - detects hypertrophy and fibrosis
Genetic analysis
What is the treatment for hypertrophic cardiomyopathy?
Prevention of sudden cardiac death e.g. ICD
Surgery - septal myectomy, cardiac transplant
What are some causes of dilated cardiomyopathy?
Mutations in proteins such as dystrophin, myocarditis, autoimmune disorders, endocrine disorders, neuromuscular diseases, toxins e.g. alcohol or chemotherapy
What is the pathophysiology of dilated cardiomyopathy?
Progression of heart failure is associated with LV remodelling which results in gradual increases in the LV end-diastolic and end-systolic volume, wall thinning and a change in chamber geometry
What are the symptoms of dilated cardiomyopathy?
Dyspnoea, syncope and angina
What are the signs of dilated cardiomyopathy?
Pulmonary oedema, elevated JVP, low pulse pressure, arrhythmias, conduction defects
What tests are used to diagnose dilated cardiomyopathy?
CXR - cardiac enlargement
ECG - non-specific ST segment and T wave changes, arrhythmias
Echo - ventricular dilatation
Cardiac MR - ventricular dilatation and myocardial thrombus
Coronary angiography
What is the treatment for dilated cardiomyopathy?
Conventional management of heart failure
Cardiac resynchronisation therapy
ICDs
Surgery - transplantation
What are the causes of a ventricular septal defect?
Post-MI
Congenital - incomplete looping of the heart during days 24-28 of development
What is the pathophysiology involved in ventricular septal defects?
During systole, some blood from the LV leaks into the RV which passes through the lungs and re-enters the LV vie the pulmonary veins and LA. There is volume overload on the LV and increased pulmonary blood flow leading to pulmonary hypertension
What is the epidemiology of a ventricular septal defect?
30-60% of newborns with a congenital heart defect
Frequently associated with other congenital conditions e.g. Down’s syndrome
What are the symptoms of a ventricular septal defect?
Failure to thrive (if VSD is large), dyspnoea, sweaty
What are the signs of a ventricular septal defect?
Pansystolic murmur along the lower left sternal border, tachycardia, palpable thrill. Parasternal heave and a displaced apex beat if the VSD is large
What tests are used to diagnose a ventricular septal defect?
Cardiac auscultation
Echo
Cardiac catheterisation to measure pressures
What is the treatment for a ventricular septal defect?
Monitor - most cases heal within the first years of life
Surgery - transcatheter closure, open surgery
What complication can arise from a ventricular septal defect?
Eisenmenger’s syndrome
What is Eisenmenger’s syndrome?
The process in which a long standing left to right shunt causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic right to left shunt
What are some causes of an atrial septal defect?
Down’s syndrome, foetal alcohol syndrome, Ebstein’s anomaly, patent foramen ovale
What is the pathophysiology involved in an atrial septal defect?
There is a left to right shunt which can increase pulmonary blood flow and therefore cause pulmonary hypertension
What are the symptoms of an atrial septal defect?
Dyspnoea, chest pain
What are the signs of an atrial septal defect?
AF, raised JVP, wide fixed split S2
What tests are used to diagnose an atrial septal defect?
Significant ASDs can be detected using in utero USS
Auscultation
Echo - diagnostic
CXR - large heart, dilated pulmonary vasculature
ECG - AF
What are the complications of an atrial septal defect?
Pulmonary hypertension and Eisenmenger’s syndrome
What is the treatment of an atrial septal defect?
Monitoring/conservative management if the ASD is asymptomatic
Closure - surgical closure or percutaneous closure
What are the causes of Tetralogy of Fallot?
Unknown, it is thought to be due to environmental factors, genetic factors or both
What is the pathophysiology involved in Tetralogy of Fallot?
Pulmonary infundibular stenosis, overriding aorta, ventricular septal defect and right ventricular hypertrophy. Thought to be due to unequal growth of the aorticopulmonary septum causing an overriding aorta. This causes stenosis of the pulmonary artery resulting in hypertrophy of the RV.
What are the symptoms of Tetralogy of Fallot?
Dyspnoea on exertion, failure to gain weight, retarded growth and physical development, syncope, difficulty feeding
What are the signs of Tetralogy of Fallot?
Cyanosis, finger and toe clubbing, heart murmur, polycythaemia
What tests are used to diagnose Tetralogy of Fallot?
Auscultation - murmur
CXR - boot shaped heart
ECG - RBBB, RV hypertrophy
Echo - diagnostic
What is the treatment of Tetralogy of Fallot?
Surgical repair of the defects
What are the four right to left heart shunts?
4 T's: Truncus arteriosus Transposition of great vessels Tricuspid atresia Tetralogy of Fallot
What are the left to right heart shunts?
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
What tests can be used to diagnose structural heart defects?
CXR, echo, ECG, auscultation
What are some causes of pericarditis?
Infectious - viral (enterovirus, herpes virus, adenovirus), bacterial (M. tuberculosis)
Autoimmune - Sjogren’s syndrome, rheumatoid arthritis
Neoplastic
Metabolic - uraemic
Traumatic
What is the pathophysiology of pericarditis?
Inflammation of the pericardium, with or without effusion
What are the symptoms of pericarditis?
Sudden onset chest pain, fever, weakness, palpitation, dyspnoea, cough, hiccups
What are the signs of pericarditis?
Pericardial rub, positional chest pain, sweating, signs of effusion - pulsus parodoxus
What tests are used to diagnose pericarditis?
Clinical examination
ECG - PR depression in all territories, diffuse ST elevation, concave ST segment
Bloods: FBC, EXR & CRP (high ESR might suggest aetiology), ANA (young females - ?SLE), troponins
CXR - rule out effusion (>300ml)
Echo
What is the treatment for pericarditis?
Sedentary activity until resolution of symptoms, monitor with ECG and CRP
Treat with NSAIDs
Colchicine reduces the rate of recurrence
What are some causes of hypertension?
Primary - high salt diet, obesity, lack of exercise, increase in age, insulin resistance
Secondary - kidney disease, Cushing’s syndrome, hyperthyroidism, hypothyroidism, pheochromocytoma, hyperaldosteronism, renal artery stenosis
What is the pathophysiology involved in hypertension?
Cardiac output and peripheral resistance are two determinants of arterial pressure
CO = SV x HR
Peripheral resistance is determined by functional and anatomic changes in small arteries and arterioles e.g. atherosclerosis
Which group does hypertension affect more?
Men
What are the symptoms of hypertension?
Usually it is asymptomatic but they can be headaches, lightheadedness, vertigo and tinnitus
What are some signs of hypertension?
Changes in the optic fundus seen on opthalmoscopy
Signs for a cause of secondary hypertension e.g. moon face in Cushing’s or weight loss in hyperthyroidism
How is hypertension diagnosed?
3 separate high BP readings >140/90 or >135/85 if at home
Ambulatory monitoring to confirm diagnosis
Bloods to check for other causes and organ damage
What are some causes of atrial fibrillation?
Ischaemic heart disease Hypertension Pulmonary embolism Hyperthyroidism Mitral valve disease
What is the pathophysiology involved in atrial fibrillation?
The AV node is bombarded with depolarisation waves of varying strength and it only conducts in an “all or nothing” fashion
What is the epidemiology of atrial fibrillation?
It is the most common arrhythmia
What are the symptoms of atrial fibrillation?
Palpitations, anginal chest pain, dyspnoea, orthopnoea, dizziness, paroxysmal nocturnal dyspnoea, light headedness
What are the signs of atrial fibrillation?
An irregular pulse
What tests are used to diagnose atrial fibrillation?
ECG - absence of p waves with disorganised electrical activity in their place, irregular R-R intervals
Echo - identifies valvular heart disease, size and function of the chambers of the heart
What is the treatment for atrial fibrillation?
Rate control: beta-blockers, calcium channel blockers, digoxin
Restore sinus rhythm: electrical cardioversion, pharmacological cardioversion (amiodarone, flecainide)
Anticoagulation - Warfarin
What is a complication of atrial fibrillation?
A cerebro-vascular event
Which scoring system predicts the possibility of a cerebrovascular event?
CHAD-VASC score
What are some causes of atrial flutter?
Idiopathic
Ischaemic heart disease
Atrial depletion (septal defect, PE, mitral/tricuspid disease)
What is the pathophysiology involved in atrial flutter?
It is a type of supraventricular tachycardia caused by a re-entrant loop circuit within the right atrium
What are the symptoms of atrial flutter?
Palpitations, dyspnoea, chest pain, dizziness, nausea, nervousness
What are some signs of atrial flutter?
Oedema of the legs or abdomen
What tests are used to diagnose atrial flutter?
ECG - regular atrial rate of 20-400 bpm (depends on the size of the RA), sawtooth pattern best seen in II, III and VF, narrow complex QRS. The ventricular rate is determined by the AV conduction ratio (2:1 is the commonest)
What is the treatment of atrial flutter?
Rate control: beta-blockers, calcium channel blockers, digoxin
Restore sinus rhythm: electrical cardioversion, pharmacological cardioversion (amiodarone, flecainide)
Anticoagulation - Warfarin
What is a complication of atrial flutter?
A cerebrovascular event
What are some causes of an aortic aneurysm?
Atherosclerosis
Infection e.g. Syphilis
Trauma
Genetic diseases e.g. Marfan’s or Ehlers-Danlos
What is the pathophysiology involved in an aortic aneurysm?
A weakness in the arterial wall causes it to expand over time as the blood is under such high pressure within the aorta
What is the epidemiology of aortic aneurysms?
Men > women
Incidence increases with age
AAA is the most common
Infrarenal AAA is the most common AAA location
What are the symptoms of an aortic aneurysm?
Most are asymptomatic but rapid expansion or rupture can cause severe epigastric pain that radiates to the back
What are the signs of an aortic aneurysm?
A pulsatile, expansile mass (in the abdomen)
What tests are used to diagnose an aortic aneurysm?
USS abdomen/thorax
CT abdomen/thorax
Angiography - MRI or CT
Bloods - FBC, U&Es, CRP, group and save
What is the treatment for an aortic aneurysm?
Watch and wait with lipid and BP control
Surgical repair - EVAR, open repair with a Dacron or Gore-Tex graft
What are some causes of an aortic dissection?
Hypertension Connective tissue disorders Marfan's syndrome Cardiac surgery Chest trauma Infection e.g. syphilis
What is the pathophysiology involved in aortic dissection?
Blood penetrates the intima and enters the media layer, the high pressure rips the tissue of the media apart along the laminated plane
What is the epidemiology of aortic dissection?
Men > women
Mean age is 63
What are the symptoms of an aortic dissection?
Severe pain - location of the pain is the location of the dissection, radiating to the back
Syncope
Neurological symptoms (secondary to lack of blood supply to the spine
What are the signs of an aortic dissection?
Hypotension, shock, murmur - aortic insufficiency, MI, pleural effusion
What tests are used to diagnose an aortic dissection?
Bloods: FBC, U&E, cardiac enzymes, D-dimer, group and save
CT - tennis ball sign (visualisation of the intimal flap)
CXR - wide mediastinum in ascending aortic dissection
MRI
TOE
What is the treatment of an aortic dissection?
Medical management - strict BP control (beta-blockers, calcium channel blockers)
Surgery
What are some causes of critical limb ischaemia?
Smoking, DM, hypertension, hyperlipidaemia, physical inactivity
What is the pathophysiology involved in critical limb ischaemia?
The blood supply to the limb is barely adequate to allow basal metabolism so there is no reserve available for increased demand such as exercise
What is the epidemiology of critical limb ischaemia?
Men > women
Incidence increases with age
What are the symptoms of critical limb ischaemia?
Pain at rest, ulceration of the limb, gangrene of the limb, pain at night relieved by hanging the foot over the edge of the bed
What are the signs of critical limb ischaemia?
Cold limbs, dry skin on the limb, lack of hair, pulses diminished or absent
What tests are used to diagnose critical limb ischaemia?
Ankle/brachial pressure index (ABPI)
Doppler
CT angiography or MRI angiography
History and examination
What is the treatment for critical limb ischaemia?
Risk factor modification: smoking cessation; control of hypertension, hyperlipidaemia and diabetes; antiplatelet therapy, exercise and weight reduction
Revascularisation - stent, balloon angioplasty, carotid endarterectomy
Amputation if the tissue has died
What are some causes of intermittent claudication?
Smoking, DM, hypertension, hyperlipidaemia, physical inactivity
What is the pathophysiology involved in intermittent claudication?
Moderate ischaemia.
The cells undergo anaerobic metabolism when oxygen demand exceeds supply and lactic acid is formed, resulting in pain
What is the epidemiology of intermittent claudication?
Men > women
Incidence increases with age
What are the symptoms of intermittent claudication?
Pain on exertion (distal to the site of atheroma), resolves on resting
What are the signs of intermittent claudication?
Cyanosis, atrophic changes e.g. shiny skin, lack of hair, All the P's: Pallor increase Pulse decreased Perishing cold Pain Paraesthesia Paralysis
What tests are used to diagnose intermittent claudication?
History and examination
Bloods: FBC, U&Es, lipid profile, glucose
USS doppler of the limb
MR angiography
What is the treatment for intermittent claudication?
Risk factor modification: smoking cessation; control of hypertension, hyperlipidaemia and diabetes; antiplatelet therapy, exercise and weight reduction
Revascularisation - stent, balloon angioplasty
