Cardiovasc Flashcards
Two main pathophysiology of peripheral artery disease
atherosclerotic PAD and Buerger dz, describe both: pg 70
what is Buerger dz?
thromboangiitis obliterans, “caludication in young smoker”, more common in males/Middle East/Asian, pg 70
exam findings PAD
Muscle atrophy, shiny or scaly skin, evidence of poor wound healing, digital ulcerations, lots of hair follicles, diminished pulses, slowed capillary refill
vascular vs neurgenic claudication
GO!
Leriche Syndrome triad?
Bilateral hip claudication, erectile dysfunction, absent femoral pulses equals aortoiliac occlusive disease
What ABI is diagnostic of PAD? When does claudicatin start? When do rest symptoms start? Descrie ABI
< 0.9, < 0.6, <0.25, cuff and doppler “ankle to arm”
what is only effective therapy for beurger?
smoking cessation
3 layers or arteries
tunica: intima, media, adventitia
most common sites of arterieal aneusrysms
- abdo aorta (AAA)
- popliteal
pathophys of true and pseudo aneurysms, differentiate from a dissection
True aneurysm: constant shear stress weakens the tunica media leading to dilation/ ballooning of all three layers. This shear stress is generally caused by atheros sclerosis and its risk factors.
Pseudo aneurysm: trauma to the vessel wall results in disruption of the intima and the media and communicates with a pseudo aneurysm which is usually a thin wall of tunica adventitia or other surrounding tissue
this is different from a dissection where the tunica intima is disrupted and blood is in a false lumen between the media and the intima
where do AAA most commonly happen?
below renal arteries or inferior SMA
most common location of AAA rupture?
retroperitoneal
what size defines AAA, when is surgery indicated for non-ruptured AAA?
> 3 cm =AAA, if >5 cm in females, 5.5 cm in males
RF for AAA
1st degree relative with same, CAD, PAD, age greater than 65 , , smoking history
symptoms of rapidly expanding/ruptured AAA
Abdominal, back or flank pain. Nausea/vomiting. Syncope or hypertension
Rarely, can also rupture into GI tract leading to GIB or can rupture into IVC and cause AV fistula leading to CHF
** if pt has aortic graft and GIB, need to think AAA
exam finding AAA
pulsatile mass, abdo pain, peritonitis, hypotension/shock
if retroperitoneal rupture can tamponade which may have normal vitals. look for cullen/grey-turner sign
ddx of AAA
Renal colic, muscular back pain, pancreatitis, mesenteric ischaemia, diverticulitis, biliary disease, appendicitis . Rarely, GI bleed or congestive heart failure.
Can also present like a ACS due to hypo perfused coronary is especially impatient with predisposing CAD
what is endoleak?
complication of AAA graft repair. blood gets between graft and aneurysm and aneurysm can continue to grow +/- rupture
complications of AAA graft repair
Acute complications include vascular injury to renal, or mesenteric arteries.
Chronic complications include infection, thrombosis, migration, aortaenteric fistula, pseudo aneurysm at anastamosis site or endo leak
what defines thoracic aortic aneurysm
TAA > 4.5 cm, often an incidental finding
symptoms of thoracic aortic aneurysm
same as AAA, asymptomatic unless ruptures or rapidly expanding or mass effect
if ruptured: chest or back pain, can have hoarsness, cough, wheeze d/t RLN compression
Tx of thoracic aortic aneurysm
similar to dissection: aggressive BP/HR control, pain control, surgical consult STAT
Stanford Classification of Aortic Dissection
A: ascending (or both)
B: descending
RF for aortic dissection
Hypertension, advanced age, connective tissue disease, congenital heart disease, giant cell arteritis, family history, stimulant abuse, iatrogenic [ catheterization or surgery]