CVS Flashcards
Define aortic dissection
Where there is a break in the lumen of the aorta that causes blood to flow between the layers of the wall creating a false lumen.
Most commonly affects around the ascending aorta and aortic arch.
What is the presentation of aortic dissection?
- Tearing chest pain of sudden onset
- Radiating to back
- HTN
- Hypotension as the dissection becomes more severe
What is the management of aortic dissection?
Type A (ascending aorta): - surgical management but manage HTN to between 120-100 systolic
Type B (descending aorta):
Supportive
Manage HTN with IV labetalol
What are the possible end results of atherosclerosis?
- Angina
- Acute coronary syndrome
- TIA
- Strokes
- Peripheral arterial disease
- Chronic mesenteric ischaemia
Define peripheral arterial disease
PAD results from atherosclerosis and narrowing of the arteries supplying the limbs and periphery
Define critical limb ischaemia
is the end stage of peripheral arterial disease where there is an inadequate supply of blood to a limb to allow it to function normally at rest
Define intermittent claudication
is the symptom of having ischaemia in a limb during exertion that is relieved by rest. it is typically a crampy, achy pain in the calf muscles associated with muscle fatigue when walking beyond a certain intensity.
What is Leriche’s syndrome and what is the clinical presentation?
Associated with occlusion in the distal aorta or proximal common iliac artery
Clinical triad:
- thigh/buttock claudication
- Absent femoral pulses
- Male impotence
What are the examination findings in peripheral vascular disease?
Weak peripheral pulses Pallor Cold Skin changes Buerger's test
What are the investigations in peripheral vascular disease?
ABPI (>0.9 normal)
Arterial doppler
Angiography (CT or MRI)
What are the 6P’s in critical limb ischaemia
Pain Pallor Paraesthesia Pulselessness Paralysis Perishing cold
What is the management of intermittent claudication?
- Lifestyle changes to reduce risk factors
- Optimal medical tx for comorbidities
- Medical treatments: Atorvastating 80mg, Clopidogrel 75mg, naftidrofuryl oxalate (vasodilator).
- Surgical treatments: angioplasty and stenting, bypass surgery
What is the management for critical limb ischaemia?
Urgent referral to vascular Analgesia Urgent revascularisation by: - angioplassty and stending - bypass surgery
What are the causes of primary and secondary hypertension?
Primary has no particular cause
Secondary: ROPE - Renal diseease Obesity Pregnancy induced Endocrine
What are the complications of HTN?
Ischaemic heart disease Cerebrovascular accident Hypertensive retinopathy Hypertensive nephropathy Heart failure
What are the investigations done in order to assess for end organ damage in HTN?
Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage
Bloods for HbA1c, renal functiona nd lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities
What is the medical options of HTN?
ACE inhibitor Beta blocker Calcium channel blocker Diuretic (thiazide like) ARB
What is the medical management ladder in HTN?
Step 1:
- Aged less than 55 and non-black use ACE inhibitor
- Aged over 55 or black use Calcium channel blocker
Step 2: A+C or A+D or C+D (if black use ARB instead of A)
Step 3: A+C+D
Step 4: A+C+D+additional
Additonal: if K+ <4.5mmol then spironolactone. If >4.5 alpha or beta blocker
Give the pathophysiology of venous ulcers
Occurs due to pooling of blood and waste products in the skin secondary to venous deficiency (varicose veins, DVT, phlebitis etc)
What are the distinguishing features of venous ulcers?
- Odematous flushed skin
- Hyperpigmentation to skin
- Varicose eczema
- Tend to be larger
- Irregular boarder
- More likely to bleed
- Pain relieved by elevation and worse on hanging
What is the management of venous ulcers?
Treat underlying cause
Good wound care
Tissue viability nurse
Plastic surgery input
Define Patent ductus arteriosis
The ductus arterosus normally stops functioning within 1-3 days of birth but when it doesn’t it’s called patent ductus arterosus.
It can be due to maternal infections such as rubella or genetic. Prematurity is a key risk factor.
Small PDA can be asymptomatic throughout childhood and present with heart failure like symptoms later in life.
Describe the pathophysiology of patent ductus arteriosus
pressure in the aorta is higher than that in the pulmonary vessels, so blood flows from the aorta to the pulmonary artery.
This creates a left to right shunt where blood from the left side of the heart crosses to the right side increasing the pressure in the pulmonary vessels thus causing pulmonary hypertension leading to right sided heart strain.
Pulmonary hypertension and right sided heart strain lead to right ventricular hypertrophy.
The increased blood flowing through the pulmonary vessels and returning to the left side of the heart leads to left ventricular hypertrophy.
Describe the presentation of the patent ductus arteriosus
Can be picked up during newborn examination if a murmur is heard but may also present with:
- SOB
- difficulty feeding
- poor weight gain
- LRTI