Cardiovascular (peripheral vessels)

Question 1

Varicose Veins causes and risk factors

Answer 1

Causes: Trauma to saphenous veins-damage to one or more valves

Blood not being moved back up - gravity pulling it down

Risk factors:
Age, female, family hx, obesity, DVT, previous leg injury

Question 2

Chronic Venous Insufficiency

Answer 2

Caused by:
Valvular incompetence
Obesity
poor venous return longterm
Venous hypertension, circulatory stasis, tissue hypoxia

Untreated varicose veins lead to chronic venous insufficiency

Symptoms:
Edema to lower extremities
Hyperpigmentation of skin on feet and ankles

Tx: Elevate legs, compression stockings, physical exercise

Question 3

Thrombus

Answer 3

Occurs more in veins than arteries due to lower pressure

Thromboembolus: Venous more than arterial, DVT - deep vein thrombosis

Causes
Venous stasis - immobility, age, HF
Venous endothelial damage - trauma- IV meds
Hypercoagulable states - inherited disorders, pregnancy, oral contraceptives, HRT
Ortho surgery

Most thrombi dissolve without tx

Persistent obstruction: chronic venous insufficiency (causes blood to collect in vein)

Signs: Leg pain, red skin, warmth

Question 4

Thrombus vs thromboembolus

Answer 4

Thrombus: Blood clot attached to vessel wall

Thromboembolus: Detached thrombus

Question 5

Thrombus in veins causes

Answer 5

Venous stasis
Immobility
age
heart failure
venous endothelial damage
hypercoaguable states

Question 6

Primary hypertension

Answer 6

Most common
No underlying cause. Hypertension is the main issue

Question 7

Secondary Hypertension

Answer 7

Caused by Underlying disease (frequently involves kidneys)

Meds can cause hypertension

Fixing disease resolves BP

Question 8

Causes of acute hypotension

Answer 8

(lower than 90/60)

•Pregnancy (increased demand for blood from fetus)
•Blood loss
•Impaired circulation from heart attack
•Shock
•severe dehydration
•Anaphylaxis
•Sepsis

Question 9

Orthostatic hypotension

Answer 9

Decrease in Systolic by 20
Or
Decrease in diastolic by 10

After standing

Question 10

True aneurysm

Answer 10

Affects all 3 layers of arterial walll

Question 11

Dissecting aneurysm

Answer 11

Splits vessel wall along length of vessel

Question 12

False aneurysm

Answer 12

extra vascular hematoma

Question 13

Most common aneurysm areas

Answer 13

Thoracic or abdominal area

AAA or TAA
Ascending aorta vs descending aorta

Increased pressure in these vessels compared to other areas of body

Question 14

Thoracic aneurysm symptoms

Answer 14

Dysphagia
Dyspnea
Bulge affects surrounding tissue

Question 15

Embolism

Answer 15

Obstruction of vessels by embolus:

•Dislodged thrombus
•Bolus of aur
•Ambiotic fluid
•Fat
•Bacteria
•Cancer cells
•Foreign body

Pulmonary emboli originate from venous side

Arterial emboli originate in left ventricle (After MI, valvular disease, endocarditis, dysrhythmia)

Bolus of air: IV, chest trauma
Fat: Trauma of long bones

Question 16

Beurger’s Disease

Answer 16

Associated with smoking

Formation of thrombi in peripheral arteries. Overtime the thrombi become organized and fibrotic.

Permanent occlusion of vessels

Symptoms: Pain, tenderness, sluggish blood flow, rubor (redness) of skin due to dilated capillaries under skin, thin and shiny skin, nails thick and deformed.

Dx: <45 years, smoker, peripheral ischemia

Question 17

Raynaud phenomenon/disease

Answer 17

Is a primary disease. Vasospastic disorder with unknown origin

Attacks or vasospasm in small arteries and arterioles of fingers (less common in toes)

Secondary disease when associated with lupus.

Question 18

Arteriosclerosis

Answer 18

Thickening of artery walls

Question 19

Atherosclerosis

Answer 19

Build of up plaques of lipid material on artery walls.

Systemic issue. Never develops in just one area.

ATHEROsclerosis is a type of ARTERIOsclerosis

Leading cause of coronary artery disease and cerobrovascular disease

Question 20

Peripheral Artery Disease

Answer 20

Atherosclerotic disease of arteries in limbs.
Linked to diabetes and smoking.

Intermittent claudication: Normally pain free; but there is pain with ambulation. Will stop if ambulation stops. Due to vessels unable to handle increased blood flow that is required by body

Gradual: Pain with ambulation, can be gradual, walking more than 50 steps, climbing stairs. Pain stops when ambulation stops.

Acute: Thrombus development over atherosclerotic lesion causing complete blood flow obstruction, leading to severe pain, loss of pulses, skin change

Question 21

Venous vs Arterial Ulcer

Answer 21

Venous: On lower leg. typically between knee and ankle. Large, shallow wounds with inflamed base. Irregular and uneven borders. Moist or weepy. Surrounding skin shiny, tight, discoloured (deep pink to red), and warm to touch.

Arterial: Occur on angles, heels, toes, feet.
Are small, deep, round, look like hole punches. Have well-defined borders. Pale/very light pink

Question 22

BP for hypertension

Answer 22

Systolic >140
Diastolic >90

Question 23

Sympathetic Nervous System (SNS) - Primary Hypertension

Answer 23

Stress

Epinephrine/norepinephrine
•Beta 1: increased HR/contraction
•Alpha 1: Peripheral Vasoconstriction
•Increase ADH: Kidneys release less water, retain sodium/water

Question 24

Complicated Hypertension

Answer 24

Uncontrolled hypertension >180/120

Causes tissue damage to heart (left ventricular hypertrophy), angina, heart failure

Renal complications

Cerebrovascular: stroke, TIA, aneurysm, dementia

Question 25

Hypertensive crisis (malignant hypertension)

Answer 25

Rapid progression of hypertension

Increased arterial pressure = vascular fluid pushed into interstitial space which causes cerebral edema or encephalopathy

Causes:
•Exacerbation of hypertension usually managed by meds
•Pregnancy
•Adrenal tumours
•cocaine
•Alc use