Chapter 4- Arterial Pathology Flashcards
What is the most common arterial pathology and what is it?
Atherosclerosis obliterans (ASO). It is the thickening, hardening of the arterial wall with plaque.
In atherosclerosis, in what layer is the plaque located?
The arterial wall beween intimal and media.
What is the most common symptom in Atherosclerosis?
leg pain
If you see atherosclerosis obliterans, where other locations in the body should you look ?
Carotid bulb, aortia/iliac, CFA, and femoral artery.
What are risk factors for atherosclerosis?
Smoking, obesity, diet, high blood pressure/ hyperlipidemia, diabetes.
How much of a dilation should be considered an aneurysm?
Dilated artery greater than 1 1/2 the diameter of adjacent artery.
What layers of an artery are involved in an aneurysm?
*intima, media, or adventeria (outer)
ALL OF THEM! Tricked ya ;)
What is the most common type of aneurysm?
Fusifom ** spindle shaped.
Fusiform aneurysms are longer and more spindle shaped where as saccular aneurysms have more of the appearance of a “bubble” involving shorter segment of vessel
True/False * Just know*
True
A patient with an aneurysm in their aorta has a 50% chance of having another aneurysm in their _____ artery
Popliteal artery
**I’ve seen this before. IT was crazy!!*
** IMPORTANT ***
What is a common complication of an AAA?
RUPTURE if it gets too large :(
*** IMPORTANT **
What is a common complication of a peripheral arterial aneurysm?
embolization
This type of arterial pathology creates a false lumen within the vessel
Aortic dissection
Explain what happens in an aortic dissection
Where is this often seen?
The intimal wall layer develops a tear and fills with blood dividing the vessel with a true and false lumen. It will often flap with each pulsation of the vessel.
Often seen in thoracic aorta so we usually wont see this.
What is an important cause arterial dissection?
Hypertension like everything else!! Don’t get high blood pressure people!
In some cases of arterial dissection, the vessel can dilate forming a _______,
Dissecting aneurysm in the thoracic aorta.
When a stricture of the thoracic aorta occur.
Coartaction.
Inflammation of the arterial wall
arteritis
What can arteritis often lead to?
Thrombosis
If temporal arteritis is not treated properly, _____ can occur.
*Think about where the temporal arteries are**
blindness
A 35 year old man comes reeking of smoke and says he has rest pain in his leg, and has ulcerations. What should we be concerned he has due to his age and life style?
Buerger’s Disease
**Think guys less than 40 years old love burgers and cigarettes and get burns on their legs from the cigs.
What is an example of a vasospastic disorder?
Raynaud’s.
What is the difference between Primary and Secondary Raynaud’s?
Primary is common in younger women and is hereditary versus secondary it happens with another condition, tissue necrosis, or ulcerations.
What are two types of entrapment syndromes?
Popliteal artery entrapment and thoracic outlet syndrome.
How does popliteal artery entrapment happen?
The pop artery is compressed by the medial head of the gastrocnemius muscle.
What types of people are at risk for popliteal artery entrapment?
Young athletes.
How does thoracic outlet syndrome occur?
The compression of the neurovascular bundle by the shoulders.
What symptoms occur with thoracic outlet syndrome?
Numbness, tingling of arm, pain, aching.
My sister is 30 years old. In the wintertime, she gets really cold easily. When she does, the tips of her hands get really white and painful. What should we wonder she has?
Raynauds
What are risk factors for having arterial disease?
Diabetes, hypertension, high blood pressure, high cholesterol, tobacco use, and age.
**Think about all the things you ask the patient before an carotid exam. These are all risk factors for stenosis and pathology.
Hypertension isn’t really the most significant risk factor for arterial disease.
True false?
FALSE
It has a significantly increased risk for atherosclerosis.
What is claudication and where is it most often found??
Pain with exercise, goes away with rest.
In calf
What does claudication pain usually indicate?
Disease is proximal to where the pain is.
What is an aortoiliac obstruction/occlusion called?
Leriche Syndrome
More common in males * Think it occurs in a guy named lee
What would a man with leriche syndrome come into the office complaining of?
Absent femoral pulses, hip, thigh, calve pain, and pallor/coldness
**Think if the aortic/iliac has obstruction, there is a decrease of low flow to the leg, therefore it gets cold and you wont have femoral pulses.
Pain at rest indicates what level of disease?
SEVERE.
Ischemic rest pain usually affects what body part?
Toes, forefoot, and heel.
What seems to alleviate ischemic rest pain?
Putting pressure or weight, it increases the hydrostatic pressure to increase perfusion
**Think about hydrostatic, the ankle increases by 100 mmhg when standing versus sitting.
If is a patient has a white foot, what is this called and what could it indicate?
Pallor-white, think **pale person/pallor*
*insufficient blood supply to tissue
If a patient has a reddish color to their foot, what is this called and what is it indicative of?
Rubor
Suggests dilated subcutaneous vessels. Seen with dependency of foot.
If a patient has a blueish colored foot, what is this called and what is it indicative of??
Cyanosis, high concentration of deoxygenated hemoglobin.
Pallor occurs with ____ of the foot and rubor occurs with ____ of the foot
Pallor- elevation
Rubor- with dependency.
What is Blue toe syndrome often called?
Trashfoot
What is Blue toe syndrome indicative of?
Distal Microemboli
Could be from pop or aortic aneurysm.
Squeezing the toe until it is white, release, note time of color return. The normal refill time is < ___ seconds?
4, 5, or 3
3 seconds
What ate the 6 P’s for acute arterial occlusion?
Pallor, pain, pulseness, paralysis, paresetheisa, and polar (cold).
What cn you do
Just do it.
What is the two most feared consequence or complication of atherosclerosis obliterans?
Limb amputation and life threatening ischemia
At what point does an acute arterial occlusion become a medical emergency?
When there is not sufficient collateralizarion to sustain tissue or organ function.
With arterial occlusion/thrombosis, is sudden occlusion or gradual occlusion have a more severe result?
When there is an ACUTE occlusion; there will be a sudden occlusion resulting in MINIMAL collaterlizarion therefore worse
When there is a gradual progression of a thrombosis, this is better tolerated bc there’s more collaterals former
A dissecting aneurysm is most commonly found in the _____ aorta
Thoracic, infrarenal, Supra renal
Thoracic
What are some causes of an arterial dissection?
Trauma or hypertension
Is coartaction of the aorta a congenital defect or an aquired defect?
Congenital
Coartaction of aorta often involves the abdominal aorta.
True or false
FALSE! Rarely in the abdominal aorta. Often in the thoracic aorta
Both coartaction of aorta and aortic dissection are seen in what portion of the aorta?
Thoracic
Why would someone with coartaction of the aorta be at risk for hypertension?
Decreased renal perfusion due to the narrowing of the aorta
Does coartaction of the aorta often affects the lower or upper portion of body?
Lower. Usually affects distal arteries
S/S - leg pain, ischemia and deceased absent pulses.
