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ESA 2: Cardiovascular > Cardiovascular: Session 11 > Flashcards

Cardiovascular: Session 11 Flashcards

1
Q

How do veins travel from superficial to deep?

A

Perforating veins

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2
Q

How are lower limb veins divided?

A
  • Superficial veins

- Deep veins

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3
Q

What does muscle enclosed within the deep fascia allow for?

A
  • Muscles contract within a compartment of fascia
  • This causes the pressure to rise that pushes the blood in vein back to the heart
  • Relevance to compartment syndrome
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4
Q

What are the important deep veins of the lower limb from the pelvis to the foot?

A
  • External iliac vein
  • Femoral vin
  • Popliteal vein
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5
Q

What are the superficial veins of the lower limb?

A
  • Long saphenous vein

- Short saphenous vein

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6
Q

What is the one constant vein?

A

-Long saphenous vein is always anterior to the medial malleolus

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7
Q

What are varicose veins?

A

Varicose veins are tortuous, twisted or lengthened veins.

more common in men than women

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8
Q

What is the pathophysiolgy of varicose veins?

A

The vein wall is inherently weak in varicose veins which leads to dilation and separation of valve cusps so that they become incompetent.

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9
Q

What are the symptoms of varicose veins that occur along the vein?

A
  • Heaviness
  • Tension
  • Aching
  • Itching (histamine mediated)
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10
Q

What are the complications of varicose veins as a result of the vein itself?

A
  • Haemorrhage

- Thrombophlebitis

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11
Q

What are the complications of varicose veins as a result of the venous hypertension?

A
  • Oedema
  • Skin pigmentation (haemosiderin staining)
  • Varicose eczema
  • Lipodermatosclerosis
  • Venous ulceration
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12
Q

What is the typical story of a patient with varicose vein?

A
  • Patient take a hot shower
  • Heat from the hot shower results in vasodilation
  • Pressure in the veins rises
  • Standing still so no calf muscle pump
  • This causes them to bleed
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13
Q

What causes thrombophlebitis?

A

Venous thrombosis produces an inflammatory response including pain.

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14
Q

What causes the haemosiderin stain?

A

Rust due to oxidising enzyme in macrophages producing ferric oxide from ferrous oxide

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15
Q

What does a lipodermatosclerosis feel like?

A

Very hard fat due to thickening.

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16
Q

What leads to venous ulceration?

A

Venous hypertension

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17
Q

What results in venous hypertension?

A

Calf muscle pump failure

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18
Q

What are the causes of calf muscle failure?

A
  • Failure of calf muscle contraction
  • Deep vein incompetence
  • Volume overload - superficial vein incompetence
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19
Q

What is the result of a superficial valve failure?

A
  • Every time blood is ejected, a proportion comes back to the calf muscle pump
  • Calf muscle pump dilates up
  • This means it can’t function properly as a pump so venous hypertension and venous ulceration
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20
Q

What is Virchow’s triad in the context of pathophysiology of a thrombosis ?

A
  • Changes in the lining of the vessel wall
  • Changes in the flow of blood
  • Changes int he constituents of blood
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21
Q

What is the most common pathophysiology of arterial thrombosis?

A

-Changes in the lining of the vessel wall

Atheroma

22
Q

What the most common pathophysiology of venous thrombosis?

A

-Changes in the flow of blood

Stasis leads to venous thrombosis

23
Q

Why does stasis lead to venous thrombosis?

A

-Usually stasis plus another provocateur such as surgery(trauma), oral contraceptive pill, dehydration, cancer.

24
Q

What is the venous thrombi rich in?

A

Venous thrombi are fibrin rich. Doest involve platelets in a major way

25
Q

What is the arterial thrombus rich in?

A

They are platelet rich. Arterial thrombosis in repose to bleeding involves platelets, extrinsic and then intrinsic pathways.

26
Q

What does a deep venous thrombosis produce?

A

Produces an inflammatory response.

  • Calor
  • Dolor
  • Functio lassie
  • Rubor
  • Tumor
27
Q

Where does a deep venous thrombosis begin?

A

Commonly being in the deep calf veins

28
Q

What are the clinical symptoms of a DVT?

A
  • Pain, cannot walk
  • Swelling
  • Blue-red skin discolouration
29
Q

What are the signs of a DVT?

A
  • Calf tenderness
  • Muscle induration
  • Skin warmth
  • Skin discolouration
  • Distended, warm superficial veins
  • Oedema
  • Pyrexia
30
Q

What is an important dreaded complication of a DVT?

A

Pulmonary embolism

31
Q

What is the association between surgery and DVT?(4)

A
  • Immobility prior to surgery
  • No calf muscle pump during surgery
  • Immobility after surgery
  • Surgery is trauma. The body’s response to trauma includes a prothrombotic state
32
Q

Where is the normal natural collateral circulation?

A

-Particularly across joints such as elbow and knee

33
Q

Why does a total occlusion of a vessel somethings have no real effect?

A
  • Occlusion gradual so time for collateral circulation to begin (takes weeks/months)
  • Collateral circulation established by the time the vessel is completely occluded so can supply the tissue
34
Q

What is acute limb ischaemia?

A
  • Limb goes from a normal blood supply to greatly impaired blood supply over a period of minutes. No chance for collateral vessel development
  • Commonest cause is an embolism and trauma
  • Sudden onset
  • If not reversed within 6 hours the limb cannot be recovered and if not amputated the patient will die. (hyperkalaemia due to dead tissue relating intracellular potassium)
35
Q

What are symptoms/signs of acute ischaemia?

A
  • Pain
  • Paralysis
  • Paraesthesia
  • Pallor (white)
  • Perishing cold
  • Pulseless
36
Q

What occurs in fixed mottling?

A

There is a thrombosis that results in a leg that doesn’t blanche when pressed. The thrombosed vessels and walls have been broken down.

37
Q

What occurs in chronic peripheral arterial disease?

A
  • Intermittent claudication

- Critical ischaemia (rest pain and ulceration/gangrene)

38
Q

What are the comparison of syndromes that occur in chronic peripheral arterial disease?

A
  • Intermittent claudication = equivalent to stable angina
  • Rest pain = equivalent to unstable angina
  • Ulceration/Gangrene = myocardial infarction
39
Q

What is the definition of claudication?

A

Pain in the muscles of the lower limb elected by walking/exercise

40
Q

What are the features of claudication?

A
  • Calf muscle are most frequently affected although more proximal muscles may be affected
  • Pain relieved rapidly by stopping exercise for a few minutes even whilst standing up
41
Q

What are the distribution of arteries in the lower limb?

A
  • Common iliac artery to the external and internal iliac artery
  • External iliac to the common femoral artery (felt at the mid-inguinal point)
  • Common femoral artery splits into the superficial femoral and profunda femoris artery.
  • Common femoral artery goes into the Popliteal artery which is difficult to feel
  • Popliteal artery goes into the anterior tibial artery, peroneal artery, posterior tibial artery
42
Q

Where can the femoral pulse be felt?

A

Mid inguinal point

43
Q

Why is the popliteal pulse difficult to feel?

A

It is deep in the popliteal fossa

44
Q

Where can the pedal pulses be felt?

A
  • Dorsalis pedis artery can be felt lateral to extensor hallucis longus
  • Posterior tibial artery can be felt behind the medial malleolus
45
Q

What is the effect of an aortoiliac occlusion?

A
  • Bilateral buttock, thigh and calf claudication
  • Absent lower limb pulses
  • Rare
46
Q

What is the effect of a common iliac occlusion?

A
  • Buttock, Thigh and calf claudication (on occluded side)
  • Absent Lower limb pulses (on occluded side)
  • Not very common
47
Q

What is the effect of a common femoral occlusion?

A
  • Thigh and calf claudication (on occluded side)
  • Absent lower limb pulses (on occluded side)
  • Not very common
48
Q

What is the effect of a superficial femoral artery occlusion?

A
  • Calf claudication
  • Femoral pulse present, absent in popliteal and pedal pulses
  • By far the commonest finding patient with claudication
49
Q

What is rest pain?

A
  • Pain in foot that comes on when the patient goes to bed and is relieved by hanging the foot out of bed
  • The ischaemia is so severe that at rest the foot skin, muscle, bones are ischaemic at rest. This means that there is not enough oxygen to provide for the cells basic metabolic requirement
50
Q

What does rest pain progress to when untreated?

A

-If left untreated will progress to gangrene

ESA 2: Cardiovascular (11 decks)

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