Clinical Symposium 6 - Peripheral Vascular Disease Flashcards
Clinical case:
71 yr , BMI = 30 (classified as obese)
Train 7 hour trip, no drink,
to stay with friend for a week
2 days later sudden SOB
At hospital:
Swollen, tender leg
Tachycardia (120)
“Normal” Chest Examination
Well’s Criteria – PE likely
Diagnosis and management:
CTPA
Management including low molecular heparin and consideration for thrombolysis and anticoagulation
Patient recovers and has no further episodes of VTE
What is Virchow’s Triad?
Endothelial Injury
Hypercoagulability
Stasis
what factors are predisposing to thrombosis?
A family history of a blood clot in a vein deep in the body, called a deep vein thrombosis (DVT)
A history of DVT
Hormone therapy or birth control pills
Pregnancy
Injury to a vein, such as from surgery, a broken bone, or other trauma
Lack of movement, such as after surgery or on a long trip
Inherited blood clotting disorders
A central venous catheter
Older age
Smoking
Being overweight or obese
Some health conditions, such as cancer, heart disease, lung disease, or Crohn’s disease
Risk factors for arterial thrombosis may include:
What is peripheral vascular disease?
Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected. Peripheral vascular disease is also called peripheral arterial disease
Formation of atherosclerosis?
- Normal artery
- Endothelial dysfunction
- Fatty streak formation
- Stable fibrous plaque formation
- Unstable formation
Features of a stable plaque?
-Small lipid core
- Thick fibrous cap
- Low macrophage content
- No intraplaque haemorrhage
No cap rupture, no superimposed thrombus
Features of unstable, ruptured plaque?
- Large lipid core
- Thin fibrous cap
- High macrophage count
High micro vessel density
Presence of intraplaque haemorrhage
Cap rupture and superimposed thrombus
Difference between chronic and acute?
CHRONIC ACUTE
Gradual Plaque rupture
atherosclerosis or thrombus formation
Narrows lumen
↓
Reduced blood flow
↓
Ischaemia
↓
Tissue damage/ death
What happens to the chance of endothelial injury as you grow older?
Within increasing age, progressively higher chance of endothelial injury and dysfunction leading to more foci and greater degree of atherosclerotic damage
Also lower activity levels, higher chances of hypertension, diabetes and other comorbidities.
Symptoms of Critical limb ischemia?
Severe pain in lower limbs at restSkin pale, shiny, smooth and dryWounds and ulcers (open sores) – non-healingLoss of muscle mass in legsSkin on toes or lower limbs –cold, numb, turning red and then black, and/or beginning to swell and produce smelly pus, causing severe pain (gangrene)
