Cardiovascular Conditions Flashcards
1
Q
A pattern of consistently elevated diastolic pressure, systolic pressure, or both
A
Hypertension
2
Q
Causes of arterial insufficiency
A
Atherosclerosis
Vasculitis
3
Q
Prevalence for peripheral vascular diseases
A
M > F
4
Q
Risk factors for PVD
A
DM
Hypertension
AbN platelet activation
Smoking
Hyperlipidemia
Old age
Metabolic dse
5
Q
Precipitation of Immunoglobulins when exposed to cold temperatures
A
Cryoglobulinemia
6
Q
An acute necrotizing vasculitis that affects primarily medium-sized and small arteries
A
Polyarteritis
7
Q
Thickening, hardening, and losing elasticity of the arterial walls
A
Arteriosclerosis
8
Q
Plaque formation
A
Atherosclerosis
9
Q
Common manifestations of pts c Atherosclerosis Obliterans
A
Intermittent claudication
Resting pain
Tropic changes
10
Q
Arteries affected by ASO
A
Medium to Large arteries
11
Q
Extremity affected by ASO
A
LE > UE
12
Q
inflammation leads to arterial occlusion and
tissue ischemia
A
Thromboangitis Obliterans
13
Q
Risk factors for TAO
A
Young male
Smoking
14
Q
Arteries affected by TAO
A
small to medium arteries
15
Q
Extremity affected by TAO
A
UE > LE
16
Q
a vasomotor disease of small arteries and arterioles
A
Raynaud’s disease
17
Q
Raynaud’s dse is commonly characterized by
A
Pallor of fingers
Cyanosis of fingers
18
Q
Triggers of Raynaud’s dse
A
Emotional upset
Cold
19
Q
a peripheral sign of a long-standing disease process
A
Ulceration
20
Q
Incidence of ulcers caused by arterial insufficiency
A
10% - 25%
21
Q
Common manifestations of PVDs
A
U/L or bilat LBP
Hip, Groin, or leg pain
Intermittent claudication
Trophic changes (ulcerations, rubor, gangrene)
21
Q
Skin temperature of pts c arterial insufficiency upon palpation
A
Cool
22
Q
Common site of ulcerations or wounds for pts c arterial insufficiency
A
Lateral malleoli
Toes
1/3 lower leg
Dorsum of feet
23
Q
Clinical s/sx of arterial insufficiency that is common in pts c diabetic atherosclerosis
A
Changes in vision
Fatigue upon exertion
24
1st sign of vascular occlusive dse
Loss of hair in toes
25
Skin characteristics of pts c arterial insufficiency
dry
scaly
shiny
26
2nd most important s/sx in pts c chronic arterial dse
intermittent claudication
ischemic resting pain
27
most common site of pain in pts c arterial occlusive dse
Superficial femoral a.
28
pulses on site of occlusion in pts c arterial occlusion
normal
28
where can abnormal or absent pulse be detected in pts c arterial occlusion?
Below the occluded a.
29
most common complications of arterial dse
Ulceration
Gangrene
30
Type I Cryoglobulin
generally IgM and IgG
31
Type II Cryoglobulins
Monoclonal IgM and Polyclonal IgG
32
Type III Cryoglobulins
Polyclonal IgM and IgG
33
an acute necrotizing vasculitis that affects primarily medium-sized and small arteries
Polyarteritis (Nodosa)
34
What are involved or affected in Polyarteritis?
Kidneys
Joints
Skin
Nerves
35
What blood vessels are spared by Polyarteritis?
Aorta and its major branches
Capillaries
Small arterioles
Venous system
36
Vasculitis of medium-sized arteries results in
Levido
Reticularis
Nodules
Ulcerations
Digital ischemia
37
Treatment for idiopathic PAN
Corticosteroids
Cytotoxic agents
38
What aggravates intermittent claudication?
Walking
39
What relieves intermittent claudication?
Rest
40
Common sites or intermittent claudication
Calf
Arch of foot
41
Less common site of intermittent claudication
Above the knee
42
Why is intermittent claudication not commonly found above the knee?
Because the thigh has a rich collateral circulation
43
Pathophysiology of vascular intermittent claudication
Increased O2 demand
Decreased blood supply
44
Pain description of vascular intermittent claudication
Burning, cramping, sharp pain
45
6 Ps of vascular intermittent claudication
Pain
Pallor
Paresthesia
Paralysis
Pulselessness
Poikilothermia (Polar)
46
PT goal for vascular intermittent claudication
amb in 6 wks
Increased training time without pain
47
Early warning sign of ASO
Intermittent claudication
48
Late sign of ASO
gangrene
49
Nonatherosclerotic segmental vasculitis that affects small and medium arteries and veins of the hands and feet
Thromboangitis Obliterans (TAO) / Buerger's dse
50
Pathophysio of TAO
Recurring progressive inflammation and thrombosis
51
1st possible manifestation of TAO
Superficial phlebitis
52
refers to intermittent episodes of arteriolar vasoconstriction during which small arteries or arterioles in extremities constrict
Raynaud's phenomenon
53
Cause of Raynaud's phenomenon episodes
cold temperature
strong emotion
54
Cause of primary Raynaud's dse
Idiopathic
55
associated with connective tissue or collagen vascular disease
Secondary Raynaud's dse
56
Diseases associated with Secondary Raynaud's
Scleroderma
Polymyositis/Dermatomyositis
SLE
RA
57
Unilateral Raynaud's phenomenon indication
Hidden neoplasm
58
primary vasospastic or vasomotor disorder
Raynaud's disease
59
Causes of Raynaud's dse
Hypersensitivity of digital arteries to cold
Release of serotonin
Congenital predisposition to vasospasm
Common in females 20-49 y/o
60
How is Raynaud's dse distinguished from secondary Raynaud's phenomenon?
At least 2 years with no progression of symptoms
No evidence of underlying cause
61
Clinical S/Sx of Raynaud's dse
Pallor
Cold or numbness
Cyanosis
Intense redness
62
How can the exacerbation of Raynaud's dse be relieved?
Place hands in axilla
Wiggle fingers
Move or walk
63
Laterality affected in Raynaud's dse
Symmetrical
64
Laterality of affectation in Raynaud's phenomenon
Mostly can be seen in one hand only or even in two fingers only
65
A specific name for Raynaud's phenomenon
Vibration syndrome
66
Caused by vibratory tools
Vibration syndrome
67
Occlusive disease in the hands can result from trauma to the hypothenar area caused by using the palm as a hammer in an activity that involves pushing, pounding, or twisting
Hypothenar Hammer Syndrome
68
The hypothenar hammer syndrome causes injury to what artery?
Ulnar a.
69
Test for Hypothenar Hammer Syndrome
Allen's test
70
Progressive, symptomatic ischemia leading to necrosis of the extremities
Critical Limb Ischemia
71
Indications for revascularization
Pain at rest
Gangrene
Non-healing ischemic ulcer
72
What pulse should be taken for the ABI in the UE?
Radial
73
What pulse should be taken for the ABI in the LE
Dorsalis pedis
74
Formula for ABI
LE SBP/UE SBP
75
> 1.2 ABI
Falsely elevated
Arterial dse
Diabetes
76
1.19 - 0.95 ABI
Normal
77
0.94 - 0.75 ABI
Mild arterial dse + Intermittent claudication
78
0.74 - 0.50 ABI
Moderate arterial dse + resting pain
79
< 0.50 ABI
Severe arterial dse
80
arterial closing and opening pressure at a
specific anatomic location
Segmental pressure measurement
81
Sites of measurement for segmental pressure measurement
Upper thigh
Lower thigh
Upper calf
Lower calf
82
Indication of 10-15 mmHg difference in segmental pressure measurement
Aortoiliac obstruction
83
Pressure gradient located between the upper and lower thigh cuffs indication
Superficial femoral artery obstruction
84
Gradient between the lower thigh and upper calf cuffs indication
Distal or superficial femoral or popliteal artery obstruction
85
Gradient between the upper and lower calf cuffs indication
Infrapopliteal dse
86
Use of ultrasound
Duplex scanning
87
Duplex scanning helps assess pts c
iliofemoral stenosis
88
traditional gold standard for LE evaluation
Contrast arteriography
89
A mainstay for preoperative imaging of abdominal aortic aneurysm
CT angiography
90
CT angio uses
X-ray
91
MR Angio uses
sound waves
92
Optimum imaging is an alternative for
pregnant pts
pts c iodinated contrast allergy
93
Contraindicated for pregnant pts
CT angio
94
Advantages of MR Angio
Not compromised by overlying bone, bowel gas, or calcification
95
Gadolinium plays a role in inducing
Nephrogenic Systemic Fibrosis
96
Survival rates of asymptomatic pts
50%
97
Survival rates of symptomatic pts
25-50%
98
Survival rates of severe symptomatic pts
15%
99
Statin therapy medications
Simvastatin
Rosuvastatin
Atorvastatin
100
LDL threshold maintained for the general population
< 100 mg/dL
101
LDL threshold maintained for pts c atherosclerotic dse
< 70 mg/dL
102
Things to watch out for during statin therapy
Elevation of liver enzymes
Myopathy and Rhabdomyolysis
103
Anti-hypertensives
Captopril
Enalapril
Fosinopril
Lisinopril
104
Agents for Intermittent Claudication
Cilostazol
Pentoxifylline
105
Parameters for Cilostazol
100 mg orally BID
106
Contraindications for Cilostazol
pts c heart failure
107
Rehab for pts c arterial disease
Wear protective footwear
Avoid extreme temperatures
Regular LE exercises
108
Endovascular interventions
Angioplasty/stenting
Peripheral Bypass Graft Surgery
Amputation
Optimal medication therapy - anti-coagulants
109
Distention or swollen superficial veins
Varicose veins
110
What structure is affected in varicose veins?
Valves
111
What happens to the layers of the blood vessels when a pt has Atherosclerosis Obliterans?
Fibrosis of tunica intima
Calcification of tunica media
112
Prevalence of Varicose veins
F > M
113
Pathogenesis of varicose veins
valves become incompetent
lack of pumping action of the LE muscles
114
S/Sx of varicose veins
aching, heavy leg with the appearance of varicose veins
115
Clinical manifestations of varicose veins
hemosiderin staining
fatigue brought on by periods of standing
cramps of the lower leg (m/c at night)
dilated elongated veins readily seen when standing
116
Another name for spider veins
Telangiectasia
117
What is involved in spider veins?
Broken capillaries
118
Special tests for varicose veins
Brodie's Trendelenburg test
Manual compression test
Percussion test
119
Treatment for varicose veins
rest periods with feet slightly elevated above the heart
elastic stocking
muscle contractions
120
Medical management for varicose veins
Compression sclerotherapy
Ligation and stripping
Radiofrequency ablation
Laser therapy
121
Swelling of a vein because of vein wall inflammation (phlebitis) occurring as a result of thrombus (blood clot) deposition in the vein
Superficial Vein Thrombosis
122
Veins affected by Superficial Vein Thrombosis
Great and small saphenous vein
123
Cause of SVT
Iatrogenic - caused by medical procedure
124
Clinical manifestations of SVT include
Dull, aching, tight feeling or pain the calf
Dilation of superficial veins
Pitting Edema
Warmth, redness
125
CM of pulmonary emoblism
Pleuritic chest pain
Diffuse chest discomfort
Tachypnea
Tachycardia
Dyspnea
126
What is used in identifying or diagnosing DVT?
Well's Clinical Decision Rule for DVT
127
How can SVT be diagnosed?
Well's risk assessment
Contrast venography
Doppler ultrasonography
Venous duple sonography
128
Clinical presentations with a score of 1 in Well's risk assessment
Active cancer (> 6 mos)
Paralysis or recent immobilization of LE
Bedridden for > 3 days
Major surgery in the past 4 wks
Localized tenderness in the LE
Entire LE swelling
U/L calf swelling
U/L pitting edema
Collateral superficial veins
129
Clinical presentation in Well's risk assessment with a score of -2
Alternative diagnosis
130
Management for SVT
prevent PE
Early mobilization
Anti-coagulants
Pneumatic pressure devices
Ankle pumps
ROM exercises
Early amputation
131
What should be avoided for SVT?
Putting pillows under the legs
132
How is pain from SVT relieved?
Bed rest + leg elevation
133
Another name for Chronic venous insufficiency
Postphlebitic syndrome
Venous stasis
134
Causes of chronic venous insufficiency
Leg trauma
Varicose veins
Neoplastic obstructions
135
Pathogenesis for chronic venous insufficiency
damaged valves resulting in poor venous return
136
Clinical manifestations of chronic venous insuficciency include
Progressive edema of the leg
Thickening of skin around the ankles
Venous ulcers
Hemosiderin staining around the ankles
137
What causes the hemosiderin staining?
pooling of blood
138
Advanced venous insufficiency occurs when
Perforator or deep vein valves are incompetent
139
Interventions for venous insufficiency include
Compression therapy
Exercise
Avoid whirlpool
140
Excessive fluid in the tissue
Lymphedema
141
Cause of lymphedema
Accumulation of fluid due to problems with the lymphatic system
142
Factors contributing to lymphedema include
Decreased lymphatic transport capacity
Increased lymphatic load
143
Pathogenesis of lymphedema
Lymph valvular insufficiency
144
Idiopathic lymphedema that appears at birth
Connatal/Milroy's dse
145
Lymphedema that appears at puberty caused by genetic disorder
Praecox
146
Lymphedema appearing in people past 35 y/o
Tarda
147
A type of lymphedema wherein lymphatic collectors are absent
Aplastic/Aplasia
148
Most common type of lymphedema wherein there are less than normal lymphatic collectors
Hypoplastic
149
A type of lymphedema wherein there is overdilation and enlargement of lymphatic vessels leading to varicose
Hyperplastic
150
A parasitic infection carried by mosquitoes
Filariasis
150
Acquired lymphedema
Secondary lymphedema
151
Most common cause of secondary lymphedema
filariasis
152
Where does filariasis commonly occur in?
Tropical regions
153
commonly associated with filariasis, a condition caused by filarial worms transmitted by mosquitoes in tropical regions.
Elephantiasis
154
A stage of lymphedema where lymph transport is reduced however, no clinical edema is present
Stage 0 - Latent Lymphedema
155
A stage of lymphedema where there is a presence of soft-pitting edema and is still reversible
Stage 1 - reversible
156
A stage of lymphedema where there is a presence of a non-pitting edema along with increase in connective and scar tissue
Stage 2 - Irreversible
157
A stage of lymphedema where there is atrophic changes and a sever non-pitting fibrotic edema
Stage 3 - Elephantiasis
158
Clinical presentation of pts c lymphedema
Swelling is not relieved by elevation
Fatigue, heaviness, and pressure
Discomfort varying from mild to intense
Loss of mobility and ROM
Impaired wound healing
159
Clinical S/Sx of lymphedema
Edema on the dorsum of hand or foot
Decreased ROM
U/L edema
160
Special test for primary lymphedema
Stemmer's sign
161
Management for lymphedema
Weight reduction
Compression
Exercises
Lymphatic mobilization
Dietary modification
Surgery
162
Types of compression used for patients c lymphedema
Elastic compression garments
Pneumatic compression
163
Two phases of complete decongestive therapy
Phase I - intensive
Phase II - self-management
164
Three phases of healing
Inflammation
Proliferation
Maturation/Remodeling
165
Time frame of phase I
onset up until day 10
166
time frame of phase II
day 3 up until day 20
167
time frame of phase III
day 9 up until 2 years
168
Moisture softens wound scab and eschar; under the right conditions, the body’s own enzymes will dissolve the eschar in a process.
Autolytic debridement
169
Healing by primary intention occurs when a healthcare provider closes a wound by bringing the edges
together.
Primary intention wound closure
170
Closure and subsequent healing by secondary intention occurs when a wound is left open to heal on its own.
Secondary intention wound closure
171
This type of closure occurs when a wound is allowed to heal by secondary intention and then is closed by
primary intention as the final treatment.
Tertiary intention wound closure
172
Another name for tertiary intention wound closure
delayed priamry
173
How are superficial wounds closed?
Re-epthilialization
174
How are partial-thickness wounds closed?
Re-epithelialization + minimal contraction
175
How are full thickness wounds closed?
Closed by contraction and scar formation
176
is identified if the presence of bacteria or microorganisms is greater than 105 per gram of
tissue determined by a quantitative culture.
True infection
177
Examples of intrinsic factors of wound healing
underlying diseases
178
