Cardiovascular - Lecture 3 Flashcards
Common presenting complaints of CDV - vascular
5 same as cdv general plus one more
chest discomfort breathlessness palpitations pre-syncope/syncope peripheral oedema limb pain
Limb pain is generally musculoskeletal in origin but vascular issues to consider are what two peripheral diseases?
MUST KNOW
Peripheral arterial disease -
acute ischemia, chronic ischemia, Raynauds
Peripheral Venous disease -
deep vein thrombosis, varicose veins, chronic venous insufficiency
Acute ischemia presents as……..5 things
(sudden severe limb pain)
MUST KNOW
generalised pain weak/absent pulse coolness pallor delayed capillary refill
What are the 6 P’s that constitute a medical emergency?
Painful Paraesthesia Paralysed Pale Pulseness Perishing cold
Sub acute limb pain could be inflammatory, cellulitis, DVT
How do each present?
Inflamm - redness/tenderness/swelling
cellulitis - patients with an infection look unwell
DVT - general circumferential swelling
Two possible reasons for intermittent limb pain
One is muscular
Other disease - signs?
peripheral arterial disease - intermittent claudication is sign
chronic skin changes, atrophy, hair loss, pale colour, ulceration
muscle cramp…
Hypertension.........? Normal Pre-hypertension Hypertension Stage 1 Hypertension Stage 2 Hypertensive crisis
N - less than 120/80 Pre HT - 120-139/80-89 HT 1 - 140-159/90-99 HT 2 - greater than 160/greater than 100 Hypertensive crisis - greater than 180/ greater than 120
What are the physiological implications of prolonged hypertension?
arteries harden, esp. arterioles
organs damaged - mainly heart, brain & kidneys
Note - early hypertension is generally asymptomatic
Risk factors for deep vein thrombosis
( a potential pulmonary embolism makes this life threatening)
MUST KNOW
immobility from recent surgery bed rest prolonged travel over 60 years acute medical illness pregnancy obesity obesity oral contraceptives family history
What is a TIA and stroke?
MUST KNOW
a cerebral artery is temporarily blocked (TIA) or completely blocked, decreasing blood flow to the brain - usually caused by an embolism from carotid or vertebral arteries
Difference is decreased function as opposed to perm. loss with a stroke
How to work out stroke risk?
ABCD2
Age - 60 years - 1 point
BP at presentation - greater than 140/90 - 1 point
Clinical features - unilat. weakness - 2 points, speech disturbance without weakness - 1 point
Duration of symptoms - more than 60 mins - 2 points, 10-59 mins - 1 point
Diabetes Mellitus - 1 point
Greater the points, higher risk of early stroke
TIA and stroke (both increase with age, 65plus)
FAST……..
How long does a TIA last?
Face - smile - is one side droopy
Arms - raise both arms - is one side weak?
Speech - can person speak/words jumbled/slurred?
Time - act fast, time lost is brain lost
A TIA is similar to a stroke except shorter, typically less than 5 mins but can last up to an hour - usually resolves
Discuss aortic aneurysms - size, type of pain…
(Male:3:1, 70 plus)
MUST KNOW
75% are abdominal & common cause is weakening of arterial wall from atherosclerosis
diameter greater than 3cm suggests an AAA
can be asymptomatic, pulsatile mass visible
steady, deep, boring pain (visceral) in lumbo-sacral area
Always consider AAAs in elderly patients with sudden onset of back/abdo pain
What is Raynauds? What are the 3 stages?
MUST KNOW
an exaggerated vasomotor response to cold or emotional stress
1 - arterial spasm turns fingers white
2 - blood becomes desaturated & fingers turn blue
3 - on rewarming reactive hyperaemia turns fingers red & can cause paraesthesia
80% idiopathic, 20% - RA, SLE, carpal tunnel, TOS, systemic sclerosis
Chronic venous insufficiency is caused by?
Advanced signs are:
history of DVT, valvular insufficiency or decreased muscle contraction leading to impaired venous return & venous hypertension
prolonged venous hypertension can lead to - tissue odema, inflamm & hypoxia
Advanced signs - stasis dermatitis & ulcers
